Effects of acute intrathoracic pressure changes on left ventricular geometry and filling

Iliceto, Sabino; Dambrosio, Michele; Sorino, Margherita; D’Ambrosio, G; Amico, Antonio; Fiore, Tommaso; Rizzon, Paolo

doi:10.1016/0002-8703(88)90618-7

Cited by 16 publications

(12 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The early phase of inspiration in the presence of PEEPi should be, to some extent, equivalent to a Müller manoeuvre (decrease in pleural pressure with no change in lung volume) [40] or to acute asthma [41,42]. Under these conditions, the following sequence of phenomena should occur: increase in venous return; increase in RV septumfree wall dimension and leftward displacement of the septum; and decrease in LV dimension and filling [43,44]. These effects should decrease SV through the leftward shift of the interventricular septum (ventricular interdependence).…”

Section: Inspiratory Threshold Loadmentioning

confidence: 99%

See 1 more Smart Citation

Intrinsic PEEP and cardiopulmonary interaction in patients with COPD and acute ventilatory failure

Dambrosio¹,

Brienza²

1996

Eur Respir J

View full text Add to dashboard Cite

Intrinsic PEEP and cardiopulmonary interaction in patients with COPD and acute ventilatory failure. V.M. Ranieri, M. Dambrosio, N. Brienza. ERS Journals Ltd 1996. ABSTRACT: Deviation of end-expiratory lung volume from the elastic equilibrium volume of the respiratory system is recognized as a cardinal feature in mechanically-ventilated patients with severe chronic obstructive pulmonary disease (COPD) and acute ventilatory failure (AVF). The presence of dynamic hyperinflation implies that alveolar pressure remains positive throughout expiration. At the end of the expiration, this positive pressure is named intrinsic positive end-expiratory pressure (PEEPi).Recent studies have suggested that, in COPD patients with expiratory flow limitation, the application of external PEEP during assisted mechanical ventilation, or the use of continuous positive airway pressure (CPAP) in spontaneously breathing patients, can counterbalance and reduce the inspiratory threshold load imposed by PEEPi, without causing further increase in lung volume and alveolar and intrathoracic pressures until a critical value of PEEP (Pcrit) is reached. Above this critical limit further hyperinflation is observed.A specific and characteristic role of PEEPi in compromising the heart function in COPD patients during AVF may be identified based on: 1) an increase in right ventricular impedance due to lung hyperinflation; 2) an increase in the venous return to the right ventricle and, consequently, a leftward shift of the septum caused by the large negative deflections in intrathoracic pressure due to the inspiratory threshold load; 3) a further increase in venous return to the right ventricle, with the eventual collapse of the vena cava caused by the expiratory recruitment of abdominal muscles; and 4) hypoxia and hypercapnia consequent to acute ventilatory failure, which may further increase right ventricular impedance and venous return to the right ventricle.All these phenomenon are directly correlated to the large negative intrathoracic pressure developed by the respiratory muscles to overcome the inspiratory threshold caused by intrinsic positive end-expiratory pressure (preload effect), and to the increase in lung volume (afterload effect). Application of positive end-expiratory pressure/continuous positive airway pressure in chronic obstructive pulmonary disease patients during acute ventilatory failure may, hence, unload the respiratory muscles as well as the heart. Eur Respir J., 1996Respir J., , 9, 1283Respir J., -1292

show abstract

Section: Inspiratory Threshold Loadmentioning

confidence: 99%

“…If venous return is reduced, the right ventricle will not dilate and the leftward shift of the interventricular septum will not occur [43,44]. In figure 5, four-chamber views of the heart obtained by transthoracic echocardiography and oesophageal pressure traces are shown.…”

Section: Inspiratory Threshold Loadmentioning

confidence: 99%

Intrinsic PEEP and cardiopulmonary interaction in patients with COPD and acute ventilatory failure

Dambrosio¹,

Brienza²

1996

Eur Respir J

View full text Add to dashboard Cite

show abstract

“…Acute pharmacological modification is not equivalent to LV dilatation and dysfunction, a hallmark of chronic heart failure. Moreover, acute intrathoracic pressure changes during positive airway ventilation may have altered LV geometry . The current analysis program was dependent on 2‐dimensional tracking in one selected plane of LV.…”

Section: Limitationsmentioning

confidence: 99%

Determinants of Left Ventricular Vortex Flow Parameters Assessed by Contrast Echocardiography in an In Vivo Animal Model

et al. 2012

View full text Add to dashboard Cite

show abstract

“…andin human experimental subjects~Bardoczky et al, 1994;Becker et al, 1995;Iliceto et al, 1988;Innes, De Cort, & Guz, 1992;Innes, De Cort, Kox, & Guz, 1993;Pinsky, Mataschak, Birnardi, Rogers, & Klain, 1984;Robotham & Takata, 1995;Scharf, 1995;Sharp, Goldberg, Druz, & Danon, 1975!. Nevertheless, in none of these studies was the spontaneous variations in respiratory pressures during normal or experimental respiration considered. Even when subjects are instructed to keep their tidal volume sinusoidal with the aid of a monitor~Hirsch & Bishop, 1981! or when they are given feedback to manipulate their own heart rate~Stoney, Langler, Sutterer, & Gelling, 1987!, little attention is paid to the way they achieve control.…”

Section: Literature On Strained Breathingmentioning

confidence: 99%

The psychobiology of strained breathing and its cardiovascular implications: A functional system review

Fokkema

1999

Psychophysiology

View full text Add to dashboard Cite

Strained breathing is a natural respiratory pattern, with cardiovascular implications. It is associated with social factors, attention, expectation, and anxiety and with defense behavior in animals. An inhibition of active behavior is characteristic. Strained breathing is based on the functional heterogeneity of the medullary postinspiratory neurons. In stressful circumstances, muscle tension and laryngeal reflexes induce a strong reduction of airflow in the glottis, resulting in a prolonged Stage I of expiration and an elevated intrathoracic pressure. The resulting elevations of blood pressure and CO2 level further stimulate the strained breathing pattern. The straining factor intrathoracic pressure is an important psychophysiological parameter. Functional aspects of strained breathing may be an elevated brain perfusion and the prevention of hyperventilation. It induces blood pressure oscillations and respiratory sinus arrhythmia. Frequent strained breathing may contribute to cardiovascular pathology and sleep apnea, creating a link between functional behavior and disease.

show abstract

Effects of acute intrathoracic pressure changes on left ventricular geometry and filling

Cited by 16 publications

References 33 publications

Intrinsic PEEP and cardiopulmonary interaction in patients with COPD and acute ventilatory failure

Intrinsic PEEP and cardiopulmonary interaction in patients with COPD and acute ventilatory failure

Determinants of Left Ventricular Vortex Flow Parameters Assessed by Contrast Echocardiography in an In Vivo Animal Model

The psychobiology of strained breathing and its cardiovascular implications: A functional system review

Contact Info

Product

Resources

About