Cyanosis medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Zand, M.D.[2] Mohammed Abdelwahed M.D[3]
Overview
In every neonate presented with cyanosis and shock, congenital heart disease dependent on patency ductus arteriosus should be considered. The physiologic constriction of ductus arteriosus after birth in a neonate whose pulmonary blood flow or aortic blood flow is dependent on PDA leads to shock and collapse in the neonate. Infusion of prostaglan in such a neonate is life-saving and keeps patency ductus arteriosus. Treatment of underlying causes of peripheral cyanosis such as tamponade or cardiogenic shock due to low cardiac output state and peripheral vasoconstriction lead to disappearing of cyanosis.
Medical therapy
- The mainstay of therapy for cyanosis is the treatment of underlying causes of cyanosis.
- In cyanotic congenital heart disease whether the flow is dependent on patency ductus arteriosus, infusion of prostaglandin E1 is recommended.
- In the setting of pulmonary disease such as pneumonia, pleural effusion, treatment of underlying disease and oxygen therapy are advised.
- In the setting of low cardiac output state such as pulmonary thromboembolism and cardiogenic shock, management of thrombotic events and oxygen supplement therapy is recommended.
- In methemoglobinemia discontinuing the medications related disorder and administration of methylene blue is recommended.
Medical therapy of Cyanosis
The mainstay of therapy is treatment of underlying causes of cyanosis.[1] [2][3][4][5][6]
Abbreviations:
d-TGA: dextro-Transposition of great arteries;
PDA: Patent ductus arteriosus ;
ASD: Atrial septal defect;
VSD: Ventricular septal defect;
TOF: Tetralogy of fallot;
CHD: Congenital heart disease;
PS: Pulmonary stenosis;
PTE: Pulmonary thromboembolism;
AS: Aortic stenosis;
ARDS: Acute respiratory distress syndrome;
PFO: Patent foramen ovale;
PVR: Pulmonary vascular resistance;
SpO2: Peripheral capillary oxygen saturation.;
FiO2: Fraction of inspired oxygen;
PEEP: Positive end-expiratory pressure;
| Causes of cyanosis | CHD with severe restriction of pulmonary blood flow | CHD with severe restriction of systemic blood flow | CHD due to bidirectional shunt | Methemoglobinemia | PTE | Cardiogenic shock | ARDS | Acute mountain sickness |
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| Note | Complication of exposue to some drugs such as nitrites and aniline leading to dizziness , coma, chocolate-brown discoloration of blood samples, respiratory distress seizures and myocardial ischemia | Hypoxia due to V/Q mismatch, low cardiac out-put state, acute right ventricular dilation and increased pulmonary vascular resistance | Cyanosis, olyguria, altered mental status |
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Leakage of large molecules into alveolar space leading rich protein pulmonary edema | |||
| Mechanism of cyanosis | Hypoxia and cyanosis due to constriction of the ductus arteriosus after birth and dependency of the Pulmonary circulation on the patency of the ductus arteriosus | Cyanosis,systemic hypoperfusion, circulatory collapse, metabolic acidosis, shock due to constriction ductus arteriosus and dependency systemic circulation on PDA after birth | Constriction of PDA after birth leading decreased systemic circulation due to mixing of pulmonary and systemic blood flow via PDA |
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Low cardiac output state due to myocardial infarction and pump failure leading to vasoconstriction and peripheral cyanosis |
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Central cyanosis due to alveolar hypoxia , pulmonary vasoconstriction, pulmonary hypertension |
| Treatment | Prostaglandin E1 | Prostaglandin E1 | Prostaglandin E1 |
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Coronary revascularization |
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References
- ↑ Cucerea, Manuela; Simon, Marta; Moldovan, Elena; Ungureanu, Marcela; Marian, Raluca; Suciu, Laura (2016). "Congenital Heart Disease Requiring Maintenance of Ductus Arteriosus in Critically Ill Newborns Admitted at A Tertiary Neonatal Intensive Care Unit". The Journal of Critical Care Medicine. 2 (4): 185–191. doi:10.1515/jccm-2016-0031. ISSN 2393-1817.
- ↑ Henretig, Fred M.; Gribetz, Bruce; Kearney, Thomas; Lacouture, Peter; Loveiov, Frederick H. (2011). "Interpretation of Color Change in Blood with Varying Degree of Methemoglobinemia". Journal of Toxicology: Clinical Toxicology. 26 (5–6): 293–301. doi:10.1080/15563658809167094. ISSN 0731-3810.
- ↑ Tisi, G M; Wolfe, W G; Fallat, R J; Nadel, J A (1970). "Effects of O2 and CO2 on airway smooth muscle following pulmonary vascular occlusion". Journal of Applied Physiology. 28 (5): 570–573. doi:10.1152/jappl.1970.28.5.570. ISSN 8750-7587.
- ↑ Austin, John H. M. (1973). "Intrapulmonary Airway Narrowing after Pulmonary Thromboembolism in Dogs". Investigative Radiology. 8 (5): 315–321. doi:10.1097/00004424-197309000-00003. ISSN 0020-9996.
- ↑ . doi:10.1164/rccm.201503-0584OC. Check
|doi=value (help). Missing or empty|title=(help) - ↑ Smedley, Tom; Grocott, Michael PW (2013). "Acute high-altitude illness: a clinically orientated review". British Journal of Pain. 7 (2): 85–94. doi:10.1177/2049463713489539. ISSN 2049-4637.