Central haemodynamic changes during lower body positive pressure in patients with congestive cardiac failure

Abstract

Fifteen patients with moderately severe and severe chronic congestive heart failure were studied to determine the central haemodynamic results of short term increases in lower body positive pressure. Central haemodynamic variables were determined by Swan-Ganz thermodilution catheterisation and arterial cannulation. Graded increases in lower body positive pressure were applied to supine patients using Medical Anti-Shock Trousers (MAST). Increasing lower body positive pressure by 25 mm Hg and 55 mm Hg caused increases in mean right atrial pressure (6.0 to 13.2 to 17.9 mm Hg; p less than 0.001 and p less than 0.0001 respectively) and mean pulmonary artery pressure (26.8 to 35.5 to 41.3 mm Hg; p less than 0.05 and p less than 0.01 respectively). No significant changes were seen in left heart filling pressures or in pulmonary vascular resistance. Furthermore, there were no significant increases in indices of cardiac work (cardiac index, left ventricular stroke work index, right ventricular stroke work index or cardiac power output) despite the increased right heart filling pressures. These results show that in patients with longstanding severe congestive heart failure, short term increases in cardiac return may increase right heart pressures but do not appear to cause either beneficial or detrimental changes in left heart haemodynamic indices.

Alterations in upper airway cross-sectional area in response to lower body positive pressure in healthy subjects

“…LBPP displaces fluid into the upper body 9 and increases central venous pressure, 10 but without increasing left ventricular filling pressure. 11 In a recent study we applied LBPP to healthy euvolaemic subjects to mimic the effects of fluid redistribution from the lower to the upper body upon assuming the recumbent position in patients with fluid overload. We showed in 11 healthy subjects that LBPP caused significant increases in neck circumference and pharyngeal resistance to airflow measured by pressure transducers in the hypopharynx and nasopharynx.…”

Inflatable External Upper and Lower Leg Compression Improves Stroke Volume and Peripheral Perfusion During Central Hypovolemia in Healthy Volunteers

“…One may argue that blood volume shift by the ELC, as described, could cause problems in patients with cardiac failure by additional increase in intracardiac pressure produced by the volume shift. However, previous studies have demonstrated that this does not appear to cause any detrimental changes in patient with heart failure [25,26]. In addition, ELC increases central blood volume transiently, an effect that is immediately reversed by ELC deflation, indicating that it is safe to use in critically ill patients.…”

Ödementstauung und Herzinsuffizienz – wann sind Kompression und Manuelle Lymphdrainage gegenangezeigt?

“…In the case of structural heart disease, however, altered myocardial function and changes in the regulatory processes are to be expected: these changes have been demonstrated in various studies (Dereppe et al [11], Bain et al [12]). An increased volume in the right atrium increases the local pressure, and stress in the walls resulting from overstretching triggers an increase in natriuretic peptide expression (13).…”