Preprint Article Version 1 This version is not peer-reviewed

Hemodynamic and Pulmonary Permeability Characterization of Hantavirus Cardiopulmonary Syndrome by Transpulmonary Thermodilution

Version 1 : Received: 1 August 2019 / Approved: 5 August 2019 / Online: 5 August 2019 (07:48:43 CEST)

A peer-reviewed article of this Preprint also exists.

López, R.; Pérez-Araos, R.; Salazar, Á.; Ulloa, A.L.; Vial, C.; Vial, P.A.; Graf, J. Hemodynamic and Pulmonary Permeability Characterization of Hantavirus Cardiopulmonary Syndrome by Transpulmonary Thermodilution. Viruses 2019, 11, 900. López, R.; Pérez-Araos, R.; Salazar, Á.; Ulloa, A.L.; Vial, C.; Vial, P.A.; Graf, J. Hemodynamic and Pulmonary Permeability Characterization of Hantavirus Cardiopulmonary Syndrome by Transpulmonary Thermodilution. Viruses 2019, 11, 900.

Journal reference: Viruses 2019, 11, 900
DOI: 10.3390/v11100900

Abstract

Hantavirus cardiopulmonary syndrome (HCPS) is characterized by capillary leak, pulmonary edema (PE) and shock that leads to death in up to 40% of patients. Treatment is supportive, including mechanical ventilation (MV) and extracorporeal membrane oxygenation (ECMO). Hemodynamic monitoring is critical to titrate therapy and to decide ECMO support. Transpulmonary thermodilution (TPTD) provides hemodynamic and PE data that has not been systematically used to understand HCPS pathophysiology. We identified 11 HCPS patients monitored with TPTD; 5 on MV, 3 on ECMO. We analyzed 133 measurements to describe the hemodynamic pattern and its association to PE. The main findings were reduced stroke volume, global ejection fraction (GEF) and preload parameters associated to increased extravascular lung water and pulmonary vascular permeability compatible with hypovolemia, myocardial dysfunction and increased permeability PE. Lung water correlated positively with heart rate (HR, r=0.20) and negatively with mean arterial pressure (r=-0.27) and GEF (r=-0.36), suggesting that PE is linked to hemodynamic impairment. Pulmonary vascular permeability correlated positively with HR (r=0.31) and negatively with cardiac index (r=-0.49), end-diastolic volume (r=-0.48) and GEF (r=-0.40), suggesting that capillary leak contributes to hypovolemia and systolic dysfunction. In conclusion, TPTD data suggests that in HCPS patients, increased permeability leads to PE, hypovolemia and circulatory impairment.

Subject Areas

Hantavirus cardiopulmonary syndrome; Hantavirus pulmonary syndrome; transpulmonary thermodilution; pulmonary edema; Andes virus

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