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Table 2 Local factors increasing pulmonary vascular tone

From: Pulmonary vascular and right ventricular dysfunction in adult critical care: current and emerging options for management: a systematic literature review

Factors increasing pulmonary vascular tone Additional contributors to elevated PVR in ARDS
High pulmonary arterial pCO2/low pH Vasoconstrictor: vasodilator imbalance
Low mixed venous pO2    Excess ET-1 [361], TXA-1, PDE, 5HT [2]
High sympathetic tone; α-adrenoceptor agonism    Reduced NO, prostanoids [20]
Mechanical effects:    Effects of endotoxin [22, 362]
   High airway Pplat; gravity; increased flow (for example, one-lung ventilation) Endothelial injury [363]
Relating to CPB: Hypoxic vasoconstriction (80% arteriolar) [22, 364]
   Preexisting PH; endothelial injury [17]; protamine [18] Microthrombosis, macrothrombosis [62, 365]
  Pulmonary vascular remodeling [1]
  1. 5-HT, serotonin; ARDS, acute respiratory distress syndrome; CPB, cardiopulmonary bypass; ET-1, endothelin-1; NO, nitric oxide; pCO2, partial pressure of carbon dioxide; PDE, phosphodiesterase; pO2, partial pressure of oxygen; Pplat, plateau pressure; PVR, pulmonary vascular resistance; TXA-1, thromboxane A1.