| Control of breathing during acute change in cardiac preload in a patient with partial cardiopulmonary bypass. | |
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MedLine Citation:
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PMID: 19837189 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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We recently had the opportunity to investigate the ventilatory effects of changing the rate of venous return to the heart (and thus pulmonary gas exchange) in a patient equipped with a venous-arterial oxygenated shunt (extracorporeal membrane oxygenation (ECMO) support). The presence of the ECMO support provided a condition wherein venous return to the right heart could be increased or decreased while maintaining total aortic blood flow and arterial blood pressure (ABP) constant. The patient, who had received a heart transplant 12 years ago, was admitted for acute cardiac failure related to graft rejection. The clinical symptomatology was that of right heart failure. We studied the patient on the 4th day of ECMO support, while she was breathing spontaneously. The blood flow diverted through the ECMO system represented 2/3 of the total aortic flow (4 l min(-1)). With these ECMO settings, the baseline level of ventilation was low (3.89+/-0.99 l min(-1)), but PET(CO2) was not elevated (37+/-2 mmHg). When Pa(CO2) in the blood coming from the ECMO was increased, no stimulatory effect on ventilation was observed. However, when the diversion of the venous return to the ECMO was stopped then restored, minute ventilation respectively increased then decreased by more than twofold with opposite changes in PET(CO2). These maneuvers were associated with large changes in the size of the right atrium and ventricle and of the left atrium. This observation suggests that the change in venous return affects breathing by encoding some of the consequences of the changes in cardiac preload. The possible sites of mediation are discussed. |
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Authors:
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Edgar Bekteshi; Harold J Bell; Annick Haouzi; Aly El-Banayosy; Philippe Haouzi |
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Publication Detail:
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Type: Case Reports; Journal Article; Research Support, Non-U.S. Gov't Date: 2009-10-27 |
Journal Detail:
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Title: Respiratory physiology & neurobiology Volume: 170 ISSN: 1878-1519 ISO Abbreviation: Respir Physiol Neurobiol Publication Date: 2010 Jan |
Date Detail:
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Created Date: 2010-02-04 Completed Date: 2010-04-16 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101140022 Medline TA: Respir Physiol Neurobiol Country: Netherlands |
Other Details:
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Languages: eng Pagination: 37-43 Citation Subset: IM |
Copyright Information:
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Copyright 2009 Elsevier B.V. All rights reserved. |
Affiliation:
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Division of Pulmonary Critical Care Medicine, Penn State University, College of Medicine, Hershey, PA 17033-0850, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Blood Flow Velocity
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physiology Blood Pressure / physiology Carbon Dioxide / metabolism Cardiac Output / physiology* Cardiopulmonary Bypass / methods* Echocardiography / methods Extracorporeal Membrane Oxygenation / methods* Female Heart Failure / physiopathology, surgery* Hemodynamics / physiology Humans Myocardial Contraction / physiology Pulmonary Gas Exchange / physiology Pulmonary Ventilation / physiology* Tomography, X-Ray Computed / methods Young Adult |
| Chemical | |
Reg. No./Substance:
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124-38-9/Carbon Dioxide |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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