Cardiopulmonary interactions for severe respiratory and circulatory disorders

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Abstract
Distributive shock in combination with acute respiratory distress syndrome (ARDS) is an extremely serious condition in terms of the complexity of pathogenesis mechanisms, timely differential diagnosis, high-cost treatment, and is accompanied by high mortality. The simultaneous development of such disorders of vital functions leads to severe acute cardiovascular and acute hypoxemic respiratory failure, in which traditional, standard and documented treatment approaches often prove ineffective. The article will present current data on the features of cardiopulmonary interaction in normal and acute renal failure in combination with severe acute respiratory failure and ARDS, the significant role of right ventricular pulmonary-arterial conjugation and the mutual influence of pathological lung mechanics and impaired vascular regulation. Various cardiac hemodynamic disorders in pulmonary, extrapulmonary, and mixed ARDS phenotypes will be considered, as well as their effect on transpulmonary pressure, venous return, and right ventricular afterload. It will be shown that advanced monitoring methods such as esophageal manometry, echocardiography, and pulmonary artery catheterization are necessary tools for timely detection and phenotyping of respiratory circulatory disorders for personalized selection of respiratory support parameters, cardiohemodynamic correction methods, and adjuvant therapeutic technologies such as pronation and extracorporeal support. The integration of these theoretical data and clinical practice will improve the safety and clinical effectiveness of multicomponent treatment to reduce mortality in this cohort of high-risk patients.

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