Cardiopulmonary interactions during mechanical ventilation in critically ill patients

Cherpanath, Thomas G. V.; Lagrand, Wim K.; Schultz, MJ; Groeneveld, A. B. J.

doi:10.1007/s12471-013-0383-1

Cited by 39 publications

(29 citation statements)

References 48 publications

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“…PAT/PET measured using echocardiography has been shown to correlate closely with invasively measured right ventricle systolic pressure [ 12 ]. This increase in PAT/PET may be explained by the lower transpulmonary pressure, regarded as the main determinant of pulmonary vascular resistance, by increased blood flow into the lung capillaries, which in turn reduces pulmonary vascular resistance secondary to vascular distension and recruitment [ 33 ], and by decreased right ventricular impedance as a result of reduced lung hyperinflation [ 34 ]. EF may appear not to differ between PSV and PCV because more time would be required for any changes to show; furthermore, visual detection of alterations in right ventricular area may be limited due to the lower sensitivity of EF compared to PAT/PET [ 35 ].…”

Section: Discussionmentioning

confidence: 99%

Comparison between effects of pressure support and pressure-controlled ventilation on lung and diaphragmatic damage in experimental emphysema

Padilha

Horta

Moraes

et al. 2016

ICMx

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BackgroundIn patients with emphysema, invasive mechanical ventilation settings should be adjusted to minimize hyperinflation while reducing respiratory effort and providing adequate gas exchange. We evaluated the impact of pressure-controlled ventilation (PCV) and pressure support ventilation (PSV) on pulmonary and diaphragmatic damage, as well as cardiac function, in experimental emphysema.MethodsEmphysema was induced by intratracheal instillation of porcine pancreatic elastase in Wistar rats, once weekly for 4 weeks. Control animals received saline under the same protocol. Eight weeks after first instillation, control and emphysema rats were randomly assigned to PCV (n = 6/each) or PSV (n = 6/each) under protective tidal volume (6 ml/kg) for 4 h. Non-ventilated control and emphysema animals (n = 6/group) were used to characterize the model and for molecular biology analysis. Cardiorespiratory function, lung histology, diaphragm ultrastructure alterations, extracellular matrix organization, diaphragmatic proteolysis, and biological markers associated with pulmonary inflammation, alveolar stretch, and epithelial and endothelial cell damage were assessed.ResultsEmphysema animals exhibited cardiorespiratory changes that resemble human emphysema, such as increased areas of lung hyperinflation, pulmonary amphiregulin expression, and diaphragmatic injury. In emphysema animals, PSV compared to PCV yielded: no changes in gas exchange; decreased mean transpulmonary pressure (Pmean,L), ratio between inspiratory and total time (Ti/Ttot), lung hyperinflation, and amphiregulin expression in lung; increased ratio of pulmonary artery acceleration time to pulmonary artery ejection time, suggesting reduced right ventricular afterload; and increased ultrastructural damage to the diaphragm. Amphiregulin correlated with Pmean,L (r = 0.99, p < 0.0001) and hyperinflation (r = 0.70, p = 0.043), whereas Ti/Ttot correlated with hyperinflation (r = 0.81, p = 0.002) and Pmean,L (r = 0.60, p = 0.04).ConclusionsIn the model of elastase-induced emphysema used herein, PSV reduced lung damage and improved cardiac function when compared to PCV, but worsened diaphragmatic injury.Electronic supplementary materialThe online version of this article (doi:10.1186/s40635-016-0107-0) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Comparison between effects of pressure support and pressure-controlled ventilation on lung and diaphragmatic damage in experimental emphysema

Padilha

Horta

Moraes

et al. 2016

ICMx

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“…Furthermore, impaired baseline cardiac function or fluid status can aggravate the haemodynamic effects of mechanical ventilation. This can all lead to a vicious circle of hypotension and hypoxia with a decrease in coronary perfusion pressure and subsequent myocardial ischaemia, resulting in a further reduction in cardiac output [24].…”

Section: Cardiovascular Stress and Morbidity In Elderly Cap Patientsmentioning

confidence: 99%

Macrolides: Are They Safe Bet in Management of Community Acquired Pneumonia (CAP) in Elderly Patients Admitted to an Intensive Care Unit (ICU)

Inzirillo¹,

Giorgetta²,

Ravalli³

et al. 2017

Insights Chest Dis

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“…Many reasons described why static parameters are of poor value in the prediction of FR. First, cardiac filling pressures represent intramural pressure; however, preload is determined by transmural pressure, which is affected by both intramural and extramural pressures [ 14 ]. Second, preload alone cannot predict FR because the response of a patient to fluids depends on both preload and cardiac contractility that varies between patients.…”

Section: Reviewmentioning

confidence: 99%

Fluid responsiveness in acute circulatory failure

Hasanin

2015

j intensive care

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Although fluid resuscitation of patients having acute circulatory failure is essential, avoiding unnecessary administration of fluids in these patients is also important. Fluid responsiveness (FR) is defined as the ability of the left ventricle to increase its stroke volume (SV) in response to fluid administration. The objective of this review is to provide the recent advances in the detection of FR and simplify the physiological basis, advantages, disadvantages, and cut-off values for each method. This review also highlights the present gaps in literature and provides future thoughts in the field of FR.Static methods are generally not recommended for the assessment of FR. Dynamic methods for the assessment of FR depend on heart-lung interactions. Pulse pressure variation (PPV) and stroke volume variation (SVV) are the most famous dynamic measures. Less-invasive dynamic parameters include plethysmographic-derived parameters, variation in blood flow in large arteries, and variation in the diameters of central veins. Dynamic methods for the assessment of FR have many limitations; the most important limitation is spontaneous breathing activity.Fluid challenge techniques were able to overcome most of the limitations of the dynamic methods. Passive leg raising is the most popular fluid challenge method. More simple techniques have been recently introduced such as the mini-fluid challenge and 10-s fluid challenge. The main limitation of fluid challenge techniques is the need to trace the effect of the fluid challenges on SV (or any of its derivatives) using a real-time monitor. More research is needed in the field of FR taking into consideration not only the accuracy of the method but also the ease of implementation, the applicability on a wider range of patients, the time needed to apply each method, and the feasibility of its application by acute care physicians with moderate and low experience.

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Cardiopulmonary interactions during mechanical ventilation in critically ill patients

Cited by 39 publications

References 48 publications

Comparison between effects of pressure support and pressure-controlled ventilation on lung and diaphragmatic damage in experimental emphysema

Comparison between effects of pressure support and pressure-controlled ventilation on lung and diaphragmatic damage in experimental emphysema

Macrolides: Are They Safe Bet in Management of Community Acquired Pneumonia (CAP) in Elderly Patients Admitted to an Intensive Care Unit (ICU)

Fluid responsiveness in acute circulatory failure

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