Estimating cardiac filling pressure in mechanically ventilated patients with hyperinflation
| Autor: | Jean-Louis Teboul, Gilles Bernardin, Alain Mercat, Jean-Michel Achard, Thierry Boulain, Michael R. Pinsky, Nadia Anguel, Christian Richard |
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| Rok vydání: | 2000 |
| Předmět: |
Male
Critical Care medicine.medical_treatment Positive pressure Blood Pressure Pulmonary Edema Critical Care and Intensive Care Medicine Ventricular Function Left Positive-Pressure Respiration Plateau pressure Diastole Intensive care Humans Medicine Prospective Studies Pulmonary Wedge Pressure Pulmonary wedge pressure Lung Aged Mechanical ventilation Respiratory Distress Syndrome Pulmonary gas pressures business.industry Middle Aged Pulmonary Alveoli Preload Blood pressure Anesthesia Female Respiratory Insufficiency business |
| Zdroj: | Critical Care Medicine. 28:3631-3636 |
| ISSN: | 0090-3493 |
| Popis: | Objective: When positive end-expiratory pressure (PEEP) is applied, the intracavitary left ventricular end-diastolic pressure (LVEDP) exceeds the LV filling pressure because pericardial pressure exceeds 0 at end-expiration. Under those conditions, the LV filling pressure is itself better reflected by the transmural LVEDP (tLVEDP) (LVEDP minus pericardial pressure). By extension, end-expiratory pulmonary artery occlusion pressure (eePAOP), as an estimate of end-expiratory LVEDP, overestimates LV filling pressure when pericardial pressure is >0, because it occurs when PEEP is present. We hypothesized that LV filling pressure could be measured from eePAOP by also knowing the proportional transmission of alveolar pressure to pulmonary vessels calculated as index of transmission = (end-inspiratory PAOP - eePAOP)/ (plateau pressure - total PEEP). We calculated transmural pulmonary artery occlusion pressure (tPAOP) with this equation: tPAOP = eePAOP - (index of transmission x total PEEP). We compared tPAOP with airway disconnection nadir PAOP measured during rapid airway disconnection in subjects undergoing PEEP with and without evidence of dynamic pulmonary hyperinflation. Design: Prospective study. Setting: Medical intensive care unit of a university hospital. Patients: We studied 107 patients mechanically ventilated with PEEP for acute respiratory failure. Patients without dynamic pulmonary hyperinflation (group A; n = 58) were analyzed separately from patients with dynamic pulmonary hyperinflation (group B; n = 49). Intervention: Transient airway disconnection. Measurements and Main Results: In group A, tPAOP (8.5 ± 6.0 mm Hg) and nadir PAOP (8.6 ± 6.0 mm Hg) did not differ from each other but were lower than eePAOP (12.4 ± 5.6 mm Hg; p < .05). The agreement between tPAOP and nadir PAOP was good (bias, 0.15 mm Hg; limits of agreement, -1.5-1.8 mm Hg). In group B, tPAOP (9.7 ± 5.4 mm Hg) was lower than both nadir PAOP and eePAOP (12.1 ± 5.4 and 13.9 ± 5.2 mm Hg, respectively; p |
| Databáze: | OpenAIRE |
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