Document Detail

Phase-related changes in right ventricular cardiac output under volume-controlled mechanical ventilation with positive end-expiratory pressure.
MedLine Citation:
PMID:  10362419     Owner:  NLM     Status:  MEDLINE    
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 H2O) 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 H2O 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 H2O were 13.9% and 18.3%. In the inspiration phase at PEEP 10 cm H2O, results revealed an overproportionally 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 H2O 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.
H Theres; J Binkau; M Laule; R Heinze; J Hundertmark; M Blobner; W Erhardt; G Baumann; K Stangl
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Critical care medicine     Volume:  27     ISSN:  0090-3493     ISO Abbreviation:  Crit. Care Med.     Publication Date:  1999 May 
Date Detail:
Created Date:  1999-06-23     Completed Date:  1999-06-23     Revised Date:  2003-11-14    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  953-8     Citation Subset:  AIM; IM    
Charité, Med. Klinik I, Berlin, Germany.
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MeSH Terms
Airway Resistance / physiology
Cardiac Output* / physiology*
Catheterization, Swan-Ganz
Disease Models, Animal
Pilot Projects
Positive-Pressure Respiration / methods*
Prospective Studies
Pulmonary Artery / physiology
Respiratory Mechanics / physiology*
Time Factors
Vena Cava, Inferior / physiology
Ventricular Function, Right* / physiology*
Comment In:
Crit Care Med. 1999 May;27(5):864-5   [PMID:  10362399 ]

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

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