Mechanisms of Decreased Left Ventricular Preload during Continuous Positive Pressure Ventilation in ARDS

Continuous positive pressure ventilation is associated with a reduction in left ventricular preload and cardiac output, but the mechanisms responsible are controversial. The decrease in left ventricular preload may result exclusively from a decreased systemic venous return due to increased pleural p...

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Veröffentlicht in:Chest 1986-07, Vol.90 (1), p.74-80
Hauptverfasser: Dhainaut, Jean F., Devaux, Jean Y., Monsallier, Julien F., Brunet, Fabrice, Villemant, Didier, Huyghebaert, Marie-F.
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container_issue 1
container_start_page 74
container_title Chest
container_volume 90
creator Dhainaut, Jean F.
Devaux, Jean Y.
Monsallier, Julien F.
Brunet, Fabrice
Villemant, Didier
Huyghebaert, Marie-F.
description Continuous positive pressure ventilation is associated with a reduction in left ventricular preload and cardiac output, but the mechanisms responsible are controversial. The decrease in left ventricular preload may result exclusively from a decreased systemic venous return due to increased pleural pressure, or from an additional effect such as decreased left ventricular compliance. To determine the mechanisms responsible, we studied the changes in cardiac output induced by continuous positive pressure ventilation in eight patients with the adult respiratory distress syndrome. We measured cardiac output by thermodilution, and biventricular ejection fraction by equilibrium gated blood pool scintigraphy. Biventricular end-diastolic volumes were then calculated by dividing stroke volume by ejection fraction. As positive end-expiratory pressure increased from 0 to 20 cm H2O, stroke volume and biventricular end-diastolic volumes fell about 25 percent, and biventricular ejection fraction remained unchanged. At 20 cm H2O positive end-expiratory pressure, volume expansion for normalizing cardiac output restored biventricular end-diastolic volumes without markedly changing biventricular end-diastolic transmural pressures. The primary cause of the reduction in left ventricular preload with continuous positive pressure ventilation appears to be a fall in venous return and hence in right ventricular stroke volume, without evidence of change in left ventricular diastolic compliance.
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At 20 cm H2O positive end-expiratory pressure, volume expansion for normalizing cardiac output restored biventricular end-diastolic volumes without markedly changing biventricular end-diastolic transmural pressures. The primary cause of the reduction in left ventricular preload with continuous positive pressure ventilation appears to be a fall in venous return and hence in right ventricular stroke volume, without evidence of change in left ventricular diastolic compliance.</abstract><cop>Northbrook, IL</cop><pub>Elsevier Inc</pub><pmid>3522122</pmid><doi>10.1378/chest.90.1.74</doi><tpages>7</tpages></addata></record>
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identifier ISSN: 0012-3692
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subjects 550601 - Medicine- Unsealed Radionuclides in Diagnostics
Adult
Aged
BETA DECAY RADIOISOTOPES
BETA-MINUS DECAY RADIOISOTOPES
Biological and medical sciences
BLOOD FLOW
BODY
Cardiac Catheterization
Cardiac Output
CARDIOVASCULAR SYSTEM
COUNTING TECHNIQUES
DIAGNOSTIC TECHNIQUES
DISEASES
Female
HEART
Heart - diagnostic imaging
Heart - physiopathology
Heart Ventricles - diagnostic imaging
Heart Ventricles - physiopathology
HOURS LIVING RADIOISOTOPES
Humans
INTERMEDIATE MASS NUCLEI
ISOMERIC TRANSITION ISOTOPES
ISOTOPES
Male
Medical sciences
Middle Aged
NUCLEI
ODD-EVEN NUCLEI
ORGANS
PATHOGENESIS
PATIENTS
Pneumology
Positive-Pressure Respiration
PRESSURE EFFECTS
RADIOISOTOPE SCANNING
RADIOISOTOPES
RADIOLOGY AND NUCLEAR MEDICINE
Radionuclide Imaging
RESPIRATION
Respiratory Distress Syndrome, Adult - diagnostic imaging
Respiratory Distress Syndrome, Adult - physiopathology
Respiratory Distress Syndrome, Adult - therapy
Respiratory system : syndromes and miscellaneous diseases
RESPIRATORY SYSTEM DISEASES
SCINTISCANNING
Stroke Volume
Technetium
TECHNETIUM 99
TECHNETIUM ISOTOPES
YEARS LIVING RADIOISOTOPES
title Mechanisms of Decreased Left Ventricular Preload during Continuous Positive Pressure Ventilation in ARDS
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