Document Detail

Effect of the mechanical ventilatory cycle on thermodilution right ventricular volumes and cardiac output.
MedLine Citation:
PMID:  10904039     Owner:  NLM     Status:  MEDLINE    
The purpose of this study was to evaluate right ventricular (RV) loading and cardiac output changes, by using the thermodilution technique, during the mechanical ventilatory cycle. Fifteen critically ill patients on mechanical ventilation, with 5 cmH(2)O of positive end-expiratory pressure, mean respiratory frequency of 18 breaths/min, and mean tidal volume of 708 ml, were studied with help of a rapid-response thermistor RV ejection fraction pulmonary artery catheter, allowing 5-ml room-temperature 5% isotonic dextrose thermodilution measurements of cardiac index (CI), stroke volume (SV) index, RV ejection fraction (RVEF), RV end-diastolic volume (RVEDV), and RV end-systolic volume (RVESV) indexes at 10% intervals of the mechanical ventilatory cycle. The ventilatory modulation of CI and RV volumes varied from patient to patient, and the interindividual variability was greater for the latter variables. Within patients also, RV volumes were modulated more by the ventilatory cycle than CI and SV index. Around a mean value of 3.95 +/- 1.18 l. min(-1). m(-2) (= 100%), CI varied from 87.3 +/- 5.2 (minimum) to 114.3 +/- 5.1% (maximum), and RVESV index varied between 61.5 +/- 17.8 and 149.3 +/- 34.1% of mean 55.1 +/- 17.9 ml/m(2) during the ventilatory cycle. The variations in the cycle exceeded the measurement error even though the latter was greater for RVEF and volumes than for CI and SV index. For mean values, there was an inspiratory decrease in RVEF and increase in RVESV, whereas a rise in RVEDV largely prevented a fall in SV index. We conclude that cyclic RV afterloading necessitates multiple thermodilution measurements equally spaced in the ventilatory cycle for reliable assessment of RV performance during mechanical ventilation of patients.
A B Groeneveld; R R Berendsen; A J Schneider; I A Pneumatikos; L A Stokkel; L G Thijs
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of applied physiology (Bethesda, Md. : 1985)     Volume:  89     ISSN:  8750-7587     ISO Abbreviation:  J. Appl. Physiol.     Publication Date:  2000 Jul 
Date Detail:
Created Date:  2000-08-21     Completed Date:  2000-08-21     Revised Date:  2013-09-26    
Medline Journal Info:
Nlm Unique ID:  8502536     Medline TA:  J Appl Physiol (1985)     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  89-96     Citation Subset:  IM; S    
Medical Intensive Care Unit, Institute for Cardiovascular Research, Free University Hospital, 1081 HV Amsterdam, The Netherlands.
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MeSH Terms
Blood Pressure / physiology
Cardiac Output / physiology*
Catheterization, Swan-Ganz / standards
Critical Care
Heart Rate / physiology
Middle Aged
Reproducibility of Results
Respiration, Artificial*
Respiratory Function Tests
Thermodilution / standards
Ventricular Function, Right / physiology*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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