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  1. Article ; Online: Discovering the Clinical Relevance of Heart-Lung Interactions.

    Pinsky, Michael R

    Anesthesiology

    2024  Volume 140, Issue 2, Page(s) 284–290

    Abstract: In 1978, Dr. Pinsky's scientific career became firmly directed toward understanding the deeper meaning of heart-lung interactions. This would define his focus for the next 45 yr. At the time, he and colleagues studied the effects of changes in ... ...

    Abstract In 1978, Dr. Pinsky's scientific career became firmly directed toward understanding the deeper meaning of heart-lung interactions. This would define his focus for the next 45 yr. At the time, he and colleagues studied the effects of changes in intrathoracic pressure on left ventricular performance in humans, documenting that the primary effect of large negative swings in intrathoracic pressure was to increase left ventricular transmural ejection pressure, and thus left ventricular afterload, selectively. They concluded that large intrathoracic pressure changes directly influence cardiac performance. This fundamental observation was followed by many additional observations in both highly invasive animal studies supported by less invasive clinical studies, which showed that intrathoracic pressure-induced changes in the gradients for venous return to the heart and left ventricular ejection from the heart disproportionately affected both right ventricular and left ventricular function. The direct clinical implications of these results form the rationale for use of continuous positive airway pressure as a primary treatment of acute cardiogenic pulmonary edema and immediate endotracheal intubation for acute upper airway obstruction. These findings subsequently led to the practical use of dynamic changes in left ventricular stroke volume and the associated arterial pulse pressure during positive-pressure ventilation to identify volume responsiveness and, thus, to personalize resuscitation efforts in the treatment of acute cardiovascular insufficiency.
    MeSH term(s) Animals ; Male ; Humans ; Clinical Relevance ; Heart ; Heart Ventricles ; Heart Diseases ; Continuous Positive Airway Pressure
    Language English
    Publishing date 2024-01-09
    Publishing country United States
    Document type Journal Article
    ZDB-ID 269-0
    ISSN 1528-1175 ; 0003-3022
    ISSN (online) 1528-1175
    ISSN 0003-3022
    DOI 10.1097/ALN.0000000000004789
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Ake Grenvik, MD, PhD, MCCM.

    Pinsky, Michael R

    Critical care medicine

    2022  Volume 50, Issue 2, Page(s) 171–172

    Language English
    Publishing date 2022-01-31
    Publishing country United States
    Document type Journal Article
    ZDB-ID 197890-1
    ISSN 1530-0293 ; 0090-3493
    ISSN (online) 1530-0293
    ISSN 0090-3493
    DOI 10.1097/CCM.0000000000005408
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Cardiovascular Effects of Prone Positioning in Acute Respiratory Distress Syndrome Patients: The Circulation Does Not Take It Lying Down.

    Pinsky, Michael R

    Critical care medicine

    2021  Volume 49, Issue 5, Page(s) 869–873

    MeSH term(s) Humans ; Patient Positioning ; Prone Position ; Respiratory Distress Syndrome/therapy
    Language English
    Publishing date 2021-03-24
    Publishing country United States
    Document type Editorial ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Comment
    ZDB-ID 197890-1
    ISSN 1530-0293 ; 0090-3493
    ISSN (online) 1530-0293
    ISSN 0090-3493
    DOI 10.1097/CCM.0000000000004858
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article: Pathophysiological implications of ventriculoarterial coupling in septic shock.

    Pinsky, Michael R / Guarracino, Fabio

    Intensive care medicine experimental

    2023  Volume 11, Issue 1, Page(s) 87

    Language English
    Publishing date 2023-12-07
    Publishing country Germany
    Document type Journal Article ; Review
    ZDB-ID 2740385-3
    ISSN 2197-425X
    ISSN 2197-425X
    DOI 10.1186/s40635-023-00573-9
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article: Cardiopulmonary interactions in left heart failure.

    Alvarado, Andrea C / Pinsky, Michael R

    Frontiers in physiology

    2023  Volume 14, Page(s) 1237741

    Abstract: The primary impact of ventilation and ventilatory efforts on left ventricular (LV) function in left ventricular dysfunction relate to how changes in intrathoracic pressure (ITP) alter the pressure gradients for venous return into the chest and LV ... ...

    Abstract The primary impact of ventilation and ventilatory efforts on left ventricular (LV) function in left ventricular dysfunction relate to how changes in intrathoracic pressure (ITP) alter the pressure gradients for venous return into the chest and LV ejection out of the chest. Spontaneous inspiratory efforts by decreasing ITP increase both of these pressure gradients increasing venous blood flow and impeding LV ejection resulting in increased intrathoracic blood volume. In severe heart failure states when lung compliance is reduced, or airway resistance is increased these negative swings in ITP can be exacerbated leading to LV failure and acute cardiogenic pulmonary edema. By merely reversing these negative swings in ITP by the use of non-invasive continuous positive airway pressure (CPAP), these profoundly detrimental forces can be immediately reversed, and cardiovascular stability can be restored in moments. This forms the clinical rationale for the immediate use of CPAP for the treatment of acute cardiogenic pulmonary edema. Increasing ITP during positive pressure ventilation decreases the pressure gradients for venous return and LV ejection decreasing intrathoracic blood volume. In a hypovolemic patient even with LV dysfunction this can result in hypotension due to inadequate LV preload. Minor increases in ITP as occur using pressure-limited positive-pressure ventilation primarily reverse the increased LV afterload of negative swings in ITP and if fluid overload was already present, minimally alter cardiac output. The effect of changes in lung volume on LV function are related primarily to its effects on right ventricular (RV) function through changes in pulmonary vascular resistance and overdistention (hyperinflation). In acute lung injury with alveolar collapse, positive pressure ventilation may reduce pulmonary vascular resistance if alveolar recruitment predominates. Hyperinflation, however, impedes diastolic filling while simultaneously increasing pulmonary vascular resistance. Thus, increasing lung volume can reduce RV afterload by reversing hypoxic pulmonary vasoconstriction or increase afterload by overdistention. Hyperinflation can also impede RV filling. All of these processes can be readily identified at the bedside using echocardiography.
    Language English
    Publishing date 2023-08-08
    Publishing country Switzerland
    Document type Journal Article ; Review
    ZDB-ID 2564217-0
    ISSN 1664-042X
    ISSN 1664-042X
    DOI 10.3389/fphys.2023.1237741
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Heart-Lung Interactions.

    Hamahata, Natsumi / Pinsky, Michael R

    Seminars in respiratory and critical care medicine

    2023  Volume 44, Issue 5, Page(s) 650–660

    Abstract: The pulmonary and cardiovascular systems have profound effects on each other. Overall cardiac function is determined by heart rate, preload, contractility, and afterload. Changes in lung volume, intrathoracic pressure (ITP), and hypoxemia can ... ...

    Abstract The pulmonary and cardiovascular systems have profound effects on each other. Overall cardiac function is determined by heart rate, preload, contractility, and afterload. Changes in lung volume, intrathoracic pressure (ITP), and hypoxemia can simultaneously change all of these four hemodynamic determinants for both ventricles and can even lead to cardiovascular collapse. Intubation using sedation depresses vasomotor tone. Also, the interdependence between right and left ventricles can be affected by lung volume-induced changes in pulmonary vascular resistance and the rise in ITP. An increase in venous return due to negative ITP during spontaneous inspiration can shift the septum to the left and cause a decrease in left ventricle compliance. During positive pressure ventilation, the increase in ITP causes a decrease in venous return (preload), minimizing ventricular interdependence and will decrease left ventricle afterload augmenting cardiac output. Thus, positive pressure ventilation is beneficial in acute heart failure patients and detrimental in hypovolemic patients where it can cause a significant decrease in venous return and cardiac output. Recently, this phenomenon has been used to assess patient's volume responsiveness to fluid by measuring pulse pressure variation and stroke volume variation. Heart-lung interaction is very dynamic and changes in lung volume, ITP, and oxygen level can have various effects on the cardiovascular system depending on preexisting cardiovascular function and volume status. Heart failure and either hypo or hypervolemia predispose to greater effects of ventilation of cardiovascular function and gas exchange. This review is an overview of the basics of heart-lung interaction.
    MeSH term(s) Humans ; Heart ; Hemodynamics/physiology ; Lung ; Blood Pressure ; Heart Failure/therapy ; Cardiac Output ; Heart Ventricles
    Language English
    Publishing date 2023-08-04
    Publishing country United States
    Document type Review ; Journal Article
    ZDB-ID 1183617-9
    ISSN 1098-9048 ; 1069-3424
    ISSN (online) 1098-9048
    ISSN 1069-3424
    DOI 10.1055/s-0043-1770062
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Significance of critical closing pressures (starling resistors) in arterial circulation.

    Pinsky, Michael R / García, M Ignacio Monge / Dubin, Arnaldo

    Critical care (London, England)

    2024  Volume 28, Issue 1, Page(s) 127

    MeSH term(s) Humans ; Arteries ; Pressure ; Blood Pressure
    Language English
    Publishing date 2024-04-18
    Publishing country England
    Document type Letter
    ZDB-ID 2041406-7
    ISSN 1466-609X ; 1364-8535
    ISSN (online) 1466-609X
    ISSN 1364-8535
    DOI 10.1186/s13054-024-04912-4
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  8. Article ; Online: Dynamic right and left ventricular interactions in the pig.

    Pinsky, Michael R

    Experimental physiology

    2020  Volume 105, Issue 8, Page(s) 1293–1315

    Abstract: New findings: What is the central question of this study? Are the mechanisms that cause ventricular interdependence different when due to primary right to left ventricular pressure loading? What is the main finding and its importance? An instantaneous ... ...

    Abstract New findings: What is the central question of this study? Are the mechanisms that cause ventricular interdependence different when due to primary right to left ventricular pressure loading? What is the main finding and its importance? An instantaneous selective increase in aortic pressure causes an immediate increase in right ventricular end-systolic pressure independent of the pericardium, whereas a selective increase in pulmonary artery pressure decreases left ventricular diastolic compliance owing to a subsequent increasing right ventricular end-diastolic volume as a function of an intact pericardium limiting biventricular volume. Changes in contraction synchrony of either ventricle do not appear to be causing these effects.
    Abstract: I characterized the dynamic factors determining ventricular interdependence with and without the pericardium. I measured right (RV) and left ventricular (LV) pressures and volumes simultaneously using conductance catheters in seven pentobarbitone-anaesthetized open-chested 5- to 7-week-old piglets. I studied these effects during apnoea, inferior vena caval occlusion and rapid partial aortic and pulmonary arterial occlusions. Conductance catheter-defined long-axis regional volumes were assessed to define regional contractile synchrony. Closed-pericardium measures were made from an initial (baseline) volume, then after two 20 ml kg
    MeSH term(s) Animals ; Arterial Pressure ; Diastole ; Heart Ventricles ; Pericardium/physiology ; Swine ; Systole ; Ventricular Function
    Language English
    Publishing date 2020-07-06
    Publishing country England
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 1016295-1
    ISSN 1469-445X ; 0958-0670
    ISSN (online) 1469-445X
    ISSN 0958-0670
    DOI 10.1113/EP088550
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Book ; Conference proceedings: Cerebral blood flow

    Pinsky, Michael R.

    mechanisms of ischemia, diagnosis and therapy ; with 17 tables ; [part of the 5th International Symposium on Applied Physiology of the Peripheral Circulation held in Pittsburgh, Pennsylvania in June 2000]

    (Update in intensive care and emergency medicine ; 37)

    2002  

    Event/congress International Symposium on Applied Physiology of the Peripheral Circulation (5, 2000, PittsburghPa.)
    Author's details M. R. Pinsky (ed.)
    Series title Update in intensive care and emergency medicine ; 37
    Collection
    Keywords Cerebrovascular Circulation ; Brain / blood supply ; Ischemia ; Lebensbedrohende Krankheit ; Immunreaktion
    Subject Abwehrreaktion ; Immunantwort ; Immunoreaktivität ; Immunabwehr ; Lebensgefahr ; Lebensgefährliche Krankheit ; Lebensbedrohliche Krankheit ; Schwere Krankheit ; Schwersterkrankung ; Tödliche Krankheit
    Language English
    Publisher Springer
    Publishing place Berlin u.a.
    Publishing country Germany
    Document type Book ; Conference proceedings
    HBZ-ID HT013224340
    ISBN 3-540-42037-1 ; 978-3-540-42037-8
    Database Catalogue ZB MED Medicine, Health

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    Shelf markLoan statusLocation
    2001 A 6358 order for loan Magazin

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  10. Article ; Online: Expanding the usefulness of hemodynamic waveform analysis in the critically Ill.

    Pinsky, Michael R

    Journal of clinical monitoring and computing

    2019  Volume 33, Issue 4, Page(s) 563–564

    MeSH term(s) Arrhythmias, Cardiac/diagnostic imaging ; Blood Pressure ; Cardiac Output ; Cardiovascular System ; Critical Care ; Critical Illness ; Databases, Factual ; Hemodynamics ; Homeostasis ; Humans ; Monitoring, Physiologic/methods ; Pulmonary Artery/physiopathology ; Reproducibility of Results ; Sensitivity and Specificity ; Signal Processing, Computer-Assisted ; Ventilation ; Ventricular Function, Right
    Language English
    Publishing date 2019-01-02
    Publishing country Netherlands
    Document type Editorial
    ZDB-ID 1418733-4
    ISSN 1573-2614 ; 1387-1307 ; 0748-1977
    ISSN (online) 1573-2614
    ISSN 1387-1307 ; 0748-1977
    DOI 10.1007/s10877-018-00239-y
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