Abstract:
PURPOSE:We evaluated the impact of increasing tidal volume (V (t)), decreased chest wall compliance, and left ventricular (LV) contractility during intermittent positive-pressure ventilation (IPPV) on the relation between pulse pressure (PP) and LV stroke volume (SV(LV)) variation (PPV and SVV, respectively), and intrathoracic blood volume (ITBV) changes. METHODS:Sixteen pentobarbital-anesthetized thoracotomized mongrel dogs were studied both before and after propranolol-induced acute ventricular failure (AVF) (n = 4), with and without chest and abdominal pneumatic binders to decrease chest wall compliance (n = 6), and during V (t) of 5, 10, 15, and 25 ml/kg (n = 6). SV(LV) and right ventricular stroke volume (SV(RV)) were derived from electromagnetic flow probes around aortic and pulmonary artery roots. Arterial pressure was measured in the aorta using a fluid-filled catheter. Arterial PPV and SVV were calculated over three breaths as (max - min)/[(max + min)/2]. ITBV changes during ventilation were inferred from the beat-to-beat volume differences between SV(RV) and SV(LV). RESULTS:Arterial PP and SV(LV) were tightly correlated during IPPV under all conditions (r (2) = 0.85). Both PPV and SVV increased progressively as V (t) increased and with thoraco-abdominal binding, and tended to decrease during AVF. SV(RV) phasically decreased during inspiration, whereas SV(LV) phasically decreased 2-3 beats later, such that ITBV decreased during inspiration and returned to apneic values during expiration. ITBV decrements increased with increasing V (t) or with thoraco-abdominal binding, and decreased during AVF owing to variations in SV(RV), such that both PPV and SVV tightly correlated with inspiration-associated changes in SV(RV) and ITBV. CONCLUSION:Arterial PP and SV(LV) are tightly correlated during IPPV and their relation is not altered by selective changes in LV contractility, intrathoracic pressure, or V (t). However, contractility, intrathoracic pressure, and V (t) directly alter the magnitude of PPV and SVV primarily by altering the inspiration-associated decreases in SV(RV) and ITBV.
journal_name
Intensive Care Medjournal_title
Intensive care medicineauthors
Mesquida J,Kim HK,Pinsky MRdoi
10.1007/s00134-011-2304-3subject
Has Abstractpub_date
2011-10-01 00:00:00pages
1672-9issue
10eissn
0342-4642issn
1432-1238journal_volume
37pub_type
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journal_title:Intensive care medicine
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更新日期:2003-10-01 00:00:00
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更新日期:1980-05-01 00:00:00
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journal_title:Intensive care medicine
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doi:10.1007/s00134-012-2760-4
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更新日期:1987-01-01 00:00:00
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doi:10.1007/s00134-004-2496-x
更新日期:2005-01-01 00:00:00
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pub_type: 临床试验,杂志文章
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更新日期:2000-06-01 00:00:00
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更新日期:2012-06-01 00:00:00
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journal_title:Intensive care medicine
pub_type: 杂志文章
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更新日期:2001-01-01 00:00:00
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journal_title:Intensive care medicine
pub_type: 杂志文章,多中心研究
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更新日期:2017-07-01 00:00:00
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journal_title:Intensive care medicine
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更新日期:1998-10-01 00:00:00
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更新日期:2003-09-01 00:00:00
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更新日期:2006-04-01 00:00:00
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更新日期:2018-12-01 00:00:00
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更新日期:2001-11-01 00:00:00
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pub_type: 杂志文章,评审
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更新日期:2018-10-01 00:00:00
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更新日期:1995-04-01 00:00:00
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pub_type: 杂志文章
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更新日期:1988-01-01 00:00:00
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pub_type: 杂志文章,评审
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更新日期:1995-09-01 00:00:00