Phase-related changes in right ventricular cardiac output under volume-controlled mechanical ventilation with positive end-expiratory pressure
| Autor: | Michael Laule, Johannes Hundertmark, Jana Binkau, Gert Baumann, Karl Stangl, Manfred Blobner, W. Erhardt, Roland Heinze, Heinz Theres |
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| Rok vydání: | 1999 |
| Předmět: |
Male
Artificial ventilation Cardiac output Time Factors Swine medicine.medical_treatment Hemodynamics Pilot Projects Vena Cava Inferior Pulmonary Artery Mean airway pressure Critical Care and Intensive Care Medicine Inferior vena cava Positive-Pressure Respiration medicine Animals Prospective Studies Cardiac Output Positive end-expiratory pressure Mechanical ventilation business.industry Airway Resistance Disease Models Animal medicine.vein Catheterization Swan-Ganz Anesthesia Circulatory system Respiratory Mechanics Ventricular Function Right cardiovascular system Female business |
| Zdroj: | ResearcherID |
| ISSN: | 0090-3493 |
| DOI: | 10.1097/00003246-199905000-00033 |
| Popis: | Objective: To examine determinants of right ventricular function throughout the ventilatory cycle under volume-controlled mechanical ventilation with various positive end-expiratory pressure (PEEP) stages. Design: Prospective observational animal pilot study. Setting: Animal research laboratory at a university hospital. Subjects: Eight healthy swine under volume- controlled mechanical ventilation. Interventions: Flow probes were implanted in eight swine in order to continuously measure blood flow in the pulmonary artery and inferior vena cava. After a recovery phase of 14 days, the swine were subjected to various PEEP stages (0, 5, 10 cm H 2 O) during volume-controlled positive pressure ventilation. Measurements and Main Results: Continuous flow measurement took place in the pulmonary artery and inferior vena cava. Data on standard hemodynamic parameters were additionally acquired. Respiration-phase-specific analysis of right ventricular cardiac output and of additional hemodynamic function parameters followed, after calculation of mean values throughout five respiration cycles. PEEP at 5 cm H 2 O led to significant decreases in inferior vena cava flow (4.1%), and in right ventricular cardiac output (5.2%); the respective decreases at PEEP 10 cm H 2 O were 13.9% and 18.3%. In the inspiration phase at PEEP 10 cm H 2 O, results revealed an overproportlonally pronounced decrease In comparison with the expiration phase in inferior vena cava flow (-24.6% vs. -10%) and right ventricular cardiac output (-35% vs. -13.5%). This phenomenon is presumably caused by a PEEP-related increase in mean airway pressure by the amount of 10.7 cm H 2 O In inspiration. Conclusions: Increases in PEEP during volume-controlled mechanical ventilation leads to respiration-phase-specific reduction of right ventricular cardiac output, with a significantly pronounced decrease during the Inspiration phase. This decrease in cardiac output should be taken Into particular consideration for patients with already critically reduced cardiac output. |
| Databáze: | OpenAIRE |
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