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Blood circulation changes associated with switching to non-invasive ventilation in COVID-19 patients. ACTA BIOMEDICA SCIENTIFICA 2021. [DOI: 10.29413/abs.2021-6.6-2.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background. Various methods of respiratory support in combination with prone positioning have been used during the COVID-19 pandemic. The effects of combination of these two factors on hemodynamics are of interest for clinical practitioners.The aim: to evaluate the effect of prone positioning on hemodynamics in COVID-19 patients depending on the method of respiratory support.Materials and methods. The study included 17 patients of both sexes diagnosed with COVID-19-associated community-acquired polysegmental viral and bacterial pneumonia with progressive respiratory failure. The study consisted of two stages. During the first stage, the patients were receiving respiratory support with humidified oxygen (3–7 liters per minute). The second stage was initiated after switching to noninvasive ventilation (NIV). The measurements were performed using a technique of volumetric compression oscillometry on a non-invasive hemodynamic monitoring system KAP CGosm-Globus (Russia).Results. The study showed that prone positioning in patients with severe COVID-19 when switching from oxygen therapy to NIV resulted in a change in the diastolic blood pressure difference module from 2.5 (1.0; 8.2) to 8.0 (5.7; 14.0) (p = 0.016). Escalation of respiratory support led to the changes in the left ventricular outflow tract velocity difference module from 11.5 (9.5; 34.2) to 31.0 (15.7; 42.0) (p = 0.049).Conclusions. Patients with community-acquired polysegmental viral and bacterial pneumonia associated with COVID-19 demonstrated changes in diastolic blood pressure and left ventricular outflow tract velocity as a result of prone positioning following switching from oxygen therapy to NIV.
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Becker A, Seiler F, Muellenbach RM, Danziger G, Kamphorst M, Lotz C, Bals R, Lepper PM. Pulmonary Hemodynamics and Ventilation in Patients With COVID-19-Related Respiratory Failure and ARDS. J Intensive Care Med 2021; 36:655-663. [PMID: 33678052 DOI: 10.1177/0885066621995386] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND It has been suggested that COVID-19-associated severe respiratory failure (CARDS) might differ from usual acute respiratory distress syndrome (ARDS) due to failing autoregulation of pulmonary vessels and higher shunt. We sought to investigate pulmonary hemodynamics and ventilation properties in patients with CARDS compared to patients with ARDS of pulmonary origin. METHODS This was a retrospective analysis of prospectively collected data from consecutive adults with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 patients treated in our ICU in 04/2020 and a comparison of the data to matched controls with ARDS due to respiratory infections treated in our ICU from 01/2014 to 08/2019 for whom pulmonary artery catheter data were available. RESULTS CARDS patients (n = 10) had ventilation characteristics similar to those of ARDS (n = 10) patients. Nevertheless, mechanical power applied by ventilation was significantly higher in CARDS patients (23.4 ± 8.9 J/min) than in ARDS (15.9 ± 4.3 J/min; P < 0.05). COVID-19 patients had similar pulmonary artery pressure but significantly lower pulmonary vascular resistance, as cardiac output was higher in CARDS vs. ARDS patients (P < 0.05). Shunt fraction and dead space were similar in CARDS compared to ARDS (P > 0.05) and were correlated with hypoxemia in both groups. The arteriovenous pCO2 difference (▵pCO2) was elevated (CARDS 5.5 ± 2.8 mmHg vs. ARDS 4.7 ± 1.1 mmHg; P > 0.05), as was the P(v-a)CO2/C(a-v)O2 ratio (CARDS mean 2.2 ± 1.5 vs. ARDS 1.7 ± 0.8; P > 0.05). CONCLUSIONS Respiratory failure in COVID-19 patients seems to differ only slightly from ARDS regarding ventilation characteristics and pulmonary hemodynamics. Our data indicate microcirculatory dysfunction. More data need to be collected to assure these findings and gain more pathophysiological insights into COVID-19 and respiratory failure.
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Affiliation(s)
- André Becker
- Department of Internal Medicine V-Pneumology, Allergology and Critical Care Medicine, 39072University Hospital of Saarland and Saarland University, Homburg/Saar, Germany.,Interdisciplinary COVID-19-Center, 39072University Hospital of Saarland, Saarland University, Homburg/Saar, Germany
| | - Frederik Seiler
- Department of Internal Medicine V-Pneumology, Allergology and Critical Care Medicine, 39072University Hospital of Saarland and Saarland University, Homburg/Saar, Germany.,Interdisciplinary COVID-19-Center, 39072University Hospital of Saarland, Saarland University, Homburg/Saar, Germany
| | - Ralf M Muellenbach
- Department of Anaesthesiology and Critical Care, Campus Kassel of the University of Southampton, Kassel, Germany
| | - Guy Danziger
- Department of Internal Medicine V-Pneumology, Allergology and Critical Care Medicine, 39072University Hospital of Saarland and Saarland University, Homburg/Saar, Germany.,Interdisciplinary COVID-19-Center, 39072University Hospital of Saarland, Saarland University, Homburg/Saar, Germany
| | - Maren Kamphorst
- Department of Internal Medicine V-Pneumology, Allergology and Critical Care Medicine, 39072University Hospital of Saarland and Saarland University, Homburg/Saar, Germany.,Interdisciplinary COVID-19-Center, 39072University Hospital of Saarland, Saarland University, Homburg/Saar, Germany
| | - Christopher Lotz
- Department of Anaesthesiology and Critical Care Medicine, 9190University of Würzburg, Würzburg, Germany
| | | | - Robert Bals
- Department of Internal Medicine V-Pneumology, Allergology and Critical Care Medicine, 39072University Hospital of Saarland and Saarland University, Homburg/Saar, Germany.,Interdisciplinary COVID-19-Center, 39072University Hospital of Saarland, Saarland University, Homburg/Saar, Germany
| | - Philipp M Lepper
- Department of Internal Medicine V-Pneumology, Allergology and Critical Care Medicine, 39072University Hospital of Saarland and Saarland University, Homburg/Saar, Germany.,Interdisciplinary COVID-19-Center, 39072University Hospital of Saarland, Saarland University, Homburg/Saar, Germany
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Skoric J, D'Mello Y, Lortie M, Gagnon S, Plant DV. Effect of Static Respiratory Volume on the Waveform of Cardiac-induced Sternal Vibrations. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:4917-4921. [PMID: 31946963 DOI: 10.1109/embc.2019.8857505] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cardio-respiratory activity originating in the chest creates vibrations that diffuse through the organs to the thoracic wall. The vibrational waves were detected in all six degrees of freedom by an inertial motion sensor at the xiphoid process of the sternum. Vibrational cardiography (VCG) combines the detection of vibrations via acceleration, termed as seismocardiography, and gyration, termed as gyrocardiography. The objective of this study was to determine the effect of static respiration volume on the morphology of cardiac-induced waveforms in the VCG signal. In this study, 24 subjects were tested while holding breath at peak inhalation, and at peak exhalation. Ensemble averages of the waveforms showed larger variations in the signal when the lungs were inhaled for both the primary and secondary heart sounds. Inter-subject variability was accounted for by averaging all waveforms and calculating the root mean squared value over a sliding window of 60 milliseconds. The peak amplitudes of both heart sounds were consistently larger for high lung volumes. However, the ratio of primary to the secondary heart sound was found to be inversely proportional to lung volume. These opposing effects offer a strong analysis tool for the determination of relative inhalation volume using VCG morphology alone.
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Stohl S, Klein MJ, Ross PA, vonBusse S, Menteer J. Impact of Anesthetic and Ventilation Strategies on Invasive Hemodynamic Measurements in Pediatric Heart Transplant Recipients. Pediatr Cardiol 2020; 41:962-971. [PMID: 32556487 DOI: 10.1007/s00246-020-02344-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 04/08/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Care of pediatric heart transplant recipients relies upon serial invasive hemodynamic evaluation, generally performed under the artificial conditions created by anesthesia and supportive ventilation. OBJECTIVES This study aimed to evaluate the hemodynamic impacts of different anesthetic and ventilatory strategies. METHODS We compared retrospectively the cardiac index, right- and left-sided filling pressures, and pulmonary and systemic vascular resistances of all clinically well and rejection-free heart transplant recipients catheterized from 2005 through 2017. Effects of spontaneous versus positive pressure ventilation and of sedation versus general anesthesia were tested with generalized linear mixed models for repeated measures using robust sandwich estimators of the covariance matrices. Least squared means showed adjusted mean outcome values, controlled for appropriate confounders. RESULTS 720 catheterizations from 101 recipients met inclusion criteria. Adjusted cardiac index was 3.14 L/min/m2 (95% CI 3.01-3.67) among spontaneously breathing and 2.71 L/min/m2 (95% CI 2.56-2.86) among ventilated recipients (p < 0.0001). With spontaneous breathing, left filling pressures were lower (9.9 vs 11.0 mmHg, p = 0.030) and systemic vascular resistances were higher (24.0 vs 20.5 Woods units, p < 0.0001). After isolating sedated from anesthetized spontaneously breathing patients, the observed differences in filling pressures and resistances emerged as a function of sedation versus general anesthesia rather than of spontaneous versus positive pressure ventilation. CONCLUSION In pediatric heart transplant recipients, positive pressure ventilation reduces cardiac output but does not alter filling pressures or vascular resistances. Moderate sedation yields lower left filling pressures and higher systemic vascular resistances than does general anesthesia. Differences are quantitatively small.
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Affiliation(s)
- Sheldon Stohl
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Los Angeles, 4650 Sunset Blvd, Los Angeles, CA, 90027, USA. .,Department of Anesthesiology and Critical Care Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Margaret J Klein
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Los Angeles, 4650 Sunset Blvd, Los Angeles, CA, 90027, USA
| | - Patrick A Ross
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Los Angeles, 4650 Sunset Blvd, Los Angeles, CA, 90027, USA.,Department of Pediatrics, University of Southern California, Los Angeles, CA, USA
| | - Sabine vonBusse
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Los Angeles, 4650 Sunset Blvd, Los Angeles, CA, 90027, USA.,Department of Anesthesiology and Critical Care Medicine, University of Southern California, Los Angeles, CA, USA
| | - JonDavid Menteer
- Department of Pediatrics, University of Southern California, Los Angeles, CA, USA.,Division of Pediatric Cardiology, Children's Hospital of Los Angeles, Los Angeles, CA, USA
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El Hadidy S, Saad M, El Hossany R, El Gohary T, El Ghobashy M. Coinciding Changes in B Lines Patterns, Haemoglobin and Hematocrit Values Can Predict Outcomes of Weaning from Mechanical Ventilation. Open Access Maced J Med Sci 2019; 7:4010-4014. [PMID: 32165943 PMCID: PMC7061374 DOI: 10.3889/oamjms.2019.615] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 10/18/2019] [Accepted: 10/19/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Weaning from invasive mechanical ventilation (MV) is considered as a daily challenging practice in the management of critically ill patients. The use of lung ultrasound and change in haemoglobin and hematocrit during weaning may help to predict weaning outcomes. AIM We aim to study the impact of weaning induced pulmonary edema on outcomes of weaning from mechanical ventilation. PATIENTS AND METHODS Sixty patients who fulfilled readiness criteria for weaning from MV. Spontaneous breathing trial (SBT) on T-piece for 120 minutes was performed under close hemodynamic monitoring. Lung ultrasound was performed using eight lung zones protocol to detect both the presence and the trend of change in B lines before and after SBT. For all the studied patients, haemoglobin and hematocrit values were checked just before and at the end of SBT. RESULTS Patient who failed to pass SBT showed significant increase in lung segments showing B pattern, haemoglobin and hematocrit levels (p-value < 0.001 for all) also those patients had significantly higher duration of ICU stay (p-value < 0.001) Despite mortality rate was higher among patients who failed SBT yet it was statistically insignificant (p-value 0.104). CONCLUSION lung ultrasound and both haemoglobin and hematocrit levels correlate with weaning outcomes.
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Affiliation(s)
- Samir El Hadidy
- Critical Care Medicine Department, Cairo University Hospitals, Cairo, Egypt
| | - Mohamed Saad
- Critical Care Medicine Department, Cairo University Hospitals, Cairo, Egypt
| | - Rania El Hossany
- Critical Care Medicine Department, Cairo University Hospitals, Cairo, Egypt
| | - Tarek El Gohary
- Critical Care Medicine Department, Cairo University Hospitals, Cairo, Egypt
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Abstract
The hemodynamic effects of ventilation can be grouped into three concepts: 1) Spontaneous ventilation is exercise; 2) changes in lung volume alter autonomic tone and pulmonary vascular resistance and can compress the heart in the cardiac fossa; and 3) spontaneous inspiratory efforts decrease intrathoracic pressure, increasing venous return and impeding left ventricular ejection, whereas positive-pressure ventilation decreases venous return and unloads left ventricular ejection. Spontaneous inspiratory efforts may induce acute left ventricular failure and cardiogenic pulmonary edema. Reversing the associated negative intrathoracic pressure swings by using noninvasive continuous positive airway pressure rapidly reverses acute cardiogenic pulmonary edema and improves survival. Additionally, in congestive heart failure, states increasing intrathoracic pressure may augment left ventricular ejection and improve cardiac output. Using the obligatory changes in venous return induced by positive pressure breathing, one can quantify the magnitude of associated decreases in venous flow and left ventricular ejection using various parameters, including vena caval diameter changes, left ventricular stroke volume variation, and arterial pulse pressure variation. These parameters vary in proportion to the level of cardiac preload reserve present, thus accurately predicting which critically ill patients will increase their cardiac output in response to fluid infusions and which will not. Common parameters include arterial pulse pressure variation and left ventricular stroke volume variation. This functional hemodynamic monitoring approach reflects a practical clinical application of heart-lung interactions.
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Lamia B. [Heart-lung interactions]. Rev Mal Respir 2018; 35:1002-1004. [PMID: 30551744 DOI: 10.1016/j.rmr.2018.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- B Lamia
- Normandie Université UNIROUEN, EA 3830, CHU de Rouen, Service de pneumologie, 76000 Rouen, France; Normandie Université UNIROUEN, EA 3830, GH Le Havre, Département de pneumologie, 76600 Le Havre, France.
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Abstract
BACKGROUND Following stage 1 palliation, delayed sternal closure may be used as a technique to enhance thoracic compliance but may also prolong the length of stay and increase the risk of infection. METHODS We reviewed all neonates undergoing stage 1 palliation at our institution between 2010 and 2017 to describe the effects of delayed sternal closure. RESULTS During the study period, 193 patients underwent stage 1 palliation, of whom 12 died before an attempt at sternal closure. Among the 25 patients who underwent primary sternal closure, 4 (16%) had sternal reopening within 24 hours. Among the 156 infants who underwent delayed sternal closure at 4 [3,6] days post-operatively, 11 (7.1%) had one or more failed attempts at sternal closure. Patients undergoing primary sternal closure had a shorter duration of mechanical ventilation and intensive care unit length of stay. Patients who failed delayed sternal closure had a longer aortic cross-clamp time (123±42 versus 99±35 minutes, p=0.029) and circulatory arrest time (39±28 versus 19±17 minutes, p=0.0009) than those who did not fail. Failure of delayed sternal closure was also closely associated with Technical Performance Score: 1.3% of patients with a score of 1 failed sternal closure compared with 18.9% of patients with a score of 3 (p=0.0028). Among the haemodynamic and ventilatory parameters studied, only superior caval vein saturation following sternal closure was different between patients who did and did not fail sternal closure (30±7 versus 42±10%, p=0.002). All patients who failed sternal closure did so within 24 hours owing to hypoxaemia, hypercarbia, or haemodynamic impairment. CONCLUSION When performed according to our current clinical practice, sternal closure causes transient and mild changes in haemodynamic and ventilatory parameters. Monitoring of SvO2 following sternal closure may permit early identification of patients at risk for failure.
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Vieillard-Baron A, Naeije R, Haddad F, Bogaard HJ, Bull TM, Fletcher N, Lahm T, Magder S, Orde S, Schmidt G, Pinsky MR. Diagnostic workup, etiologies and management of acute right ventricle failure : A state-of-the-art paper. Intensive Care Med 2018; 44:774-790. [PMID: 29744563 DOI: 10.1007/s00134-018-5172-2] [Citation(s) in RCA: 125] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 04/07/2018] [Indexed: 02/07/2023]
Abstract
INTRODUCTION This is a state-of-the-art article of the diagnostic process, etiologies and management of acute right ventricular (RV) failure in critically ill patients. It is based on a large review of previously published articles in the field, as well as the expertise of the authors. RESULTS The authors propose the ten key points and directions for future research in the field. RV failure (RVF) is frequent in the ICU, magnified by the frequent need for positive pressure ventilation. While no universal definition of RVF is accepted, we propose that RVF may be defined as a state in which the right ventricle is unable to meet the demands for blood flow without excessive use of the Frank-Starling mechanism (i.e. increase in stroke volume associated with increased preload). Both echocardiography and hemodynamic monitoring play a central role in the evaluation of RVF in the ICU. Management of RVF includes treatment of the causes, respiratory optimization and hemodynamic support. The administration of fluids is potentially deleterious and unlikely to lead to improvement in cardiac output in the majority of cases. Vasopressors are needed in the setting of shock to restore the systemic pressure and avoid RV ischemia; inotropic drug or inodilator therapies may also be needed. In the most severe cases, recent mechanical circulatory support devices are proposed to unload the RV and improve organ perfusion CONCLUSION: RV function evaluation is key in the critically-ill patients for hemodynamic management, as fluid optimization, vasopressor strategy and respiratory support. RV failure may be diagnosed by the association of different devices and parameters, while echocardiography is crucial.
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Affiliation(s)
- Antoine Vieillard-Baron
- Service de Réanimation, Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, 92100, Boulogne-Billancourt, France.
- INSERM U-1018, CESP, Team 5, University of Versailles Saint-Quentin en Yvelines, Villejuif, France.
| | - R Naeije
- Professor Emeritus at the Université Libre de Bruxelles, Brussels, Belgium
| | - F Haddad
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford, USA
| | - H J Bogaard
- Department of Pulmonary Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - T M Bull
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - N Fletcher
- Department of Cardiothoracic Critical Care, St Georges University Hospital NHS Trust, London, SW17 0QT, UK
| | - T Lahm
- Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Department of Medicine, Indiana University School of Medicine and Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA
| | - S Magder
- Department of Critical Care, McGill University Health Centre, 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada
| | - S Orde
- Intensive Care Unit, Nepean Hospital, Kingswood, Sydney, NSW, Australia
| | - G Schmidt
- Department of Internal Medicine and Critical Care, University of Iowa, Iowa City, USA
| | - M R Pinsky
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, USA
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10
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Association between decreased respiratory function and increased blood pressure variability. Blood Press Monit 2017; 23:79-84. [PMID: 29266017 DOI: 10.1097/mbp.0000000000000310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The respiratory system is an important component in the control of the autonomic nervous system, and is a possible factor of blood pressure variability (BPV). We examined whether decreased respiratory function is associated with exaggerated BPV in hypertensives. PATIENTS AND METHODS This is a substudy of the Japan Morning Surge-Home Blood Pressure Study and patients who underwent both spirometry and ambulatory blood pressure monitoring (ABPM) in the Japan Morning Surge-Home Blood Pressure study were analyzed. In 95 hypertensives without known clinical respiratory diseases, we performed ABPM and the respiratory function test. RESULTS Percent vital capacity (%VC), but not forced expiratory volume in 1 s as a percentage of forced vital capacity, was associated with the SD (r=-0.23, P<0.05) and coefficient of variation (r=-0.25, P<0.05) of daytime systolic blood pressure (SBP). Lower %VC was associated with higher SD of daytime SBP (P=0.049 for trend). After adjusting for covariates, %VC tended to be associated with SD of daytime SBP (β=-0.22, P=0.08) and was associated with coefficient of variation of daytime SBP (β=-0.26, P=0.04). CONCLUSION Decreased respiratory function was associated with exaggerated ambulatory BPV, especially in the daytime in hypertensives without respiratory diseases. This is the first study to show an association between respiratory function and increased BPV as assessed by ABPM. The results of our study indicate that low respiratory function could exaggerate BPV, and thus may be one of the mechanisms underlying the elevated cardiovascular risk in patients with decreased respiratory function.
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Lamia B, Molano LC, Muir JF, Cuvelier A. [Cardiopulmonary interactions in the course of mechanical ventilation]. Rev Mal Respir 2016; 33:865-876. [PMID: 26857198 DOI: 10.1016/j.rmr.2015.11.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 11/15/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The haemodynamic consequences of ventilation are multiple and complex and may affect all the determinants of cardiac performance such as heart rate, preload, contractility and afterload. These consequences affect both right and left ventricle and are also related to the biventricular interdependence. STATE-OF-THE-ART Ventilation modifies the lung volume and also the intrathoracic pressure. Variations in lung volume have consequences on the pulmonary vascular resistance, hypoxic pulmonary vasoconstriction and ventricular interdependence. Variations in intrathoracic pressure have a major impact and affect systemic venous return, right ventricular preload, left ventricular preload, right ventricular afterload, left ventricular afterload and myocardial contracility. The haemodynamic consequences of positive pressure ventilation depend on the underlying chronic cardiopulmonary pathologies leading to the acute respiratory failure that was the indication for ventilation. CONCLUSION In this review, we will focus on severe COPD exacerbation, acute left heart failure and weaning from ventilation.
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Affiliation(s)
- B Lamia
- UPRES EA 3830, service de pneumologie et soins intensifs respiratoires, institut hospitalo-universitaire de recherche biomédicale et d'innovation, CHU de Rouen, université de Rouen, 76031 Rouen cedex, France.
| | - L-C Molano
- UPRES EA 3830, service de pneumologie et soins intensifs respiratoires, institut hospitalo-universitaire de recherche biomédicale et d'innovation, CHU de Rouen, université de Rouen, 76031 Rouen cedex, France
| | - J-F Muir
- UPRES EA 3830, service de pneumologie et soins intensifs respiratoires, institut hospitalo-universitaire de recherche biomédicale et d'innovation, CHU de Rouen, université de Rouen, 76031 Rouen cedex, France
| | - A Cuvelier
- UPRES EA 3830, service de pneumologie et soins intensifs respiratoires, institut hospitalo-universitaire de recherche biomédicale et d'innovation, CHU de Rouen, université de Rouen, 76031 Rouen cedex, France
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Wrobel JP, Thompson BR, Stuart-Andrews CR, Kee K, Snell GI, Buckland M, Williams TJ. Intermittent positive pressure ventilation increases diastolic pulmonary arterial pressure in advanced COPD. Heart Lung 2014; 44:50-6. [PMID: 25453391 DOI: 10.1016/j.hrtlng.2014.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Revised: 10/08/2014] [Accepted: 10/15/2014] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To measure the impact of intermittent positive pressure ventilation (IPPV) on diastolic pulmonary arterial pressure (dPAP) and pulmonary pulse pressure in patients with advanced COPD. BACKGROUND The physiological effects of raised intrathoracic pressures upon the pulmonary circulation have not been fully established. METHODS 22 subjects with severe COPD receiving IPPV were prospectively assessed with pulmonary and radial arterial catheterization. Changes in dPAP were assessed from end-expiration to early inspiration during low and high tidal volume ventilation. RESULTS Inspiration during low tidal volume IPPV increased the median [IQR] dPAP by 3.9 [2.5-4.8] mm Hg (P < 0.001). During high tidal volume, similar changes were observed. The IPPV-associated change in dPAP was correlated with baseline measures of PaO2 (rho = 0.65, P = 0.005), pH (rho = 0.64, P = 0.006) and right atrial pressure (rho = -0.53, P = 0.011). CONCLUSIONS In severe COPD, IPPV increases dPAP and reduces pulmonary pulse pressure during inspiration.
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Affiliation(s)
- Jeremy P Wrobel
- Department of Medicine, Monash University, Melbourne, Australia; Allergy, Immunology & Respiratory Medicine, The Alfred, Melbourne, Australia; Advanced Lung Disease Unit, Royal Perth Hospital, Perth, Australia.
| | - Bruce R Thompson
- Department of Medicine, Monash University, Melbourne, Australia; Allergy, Immunology & Respiratory Medicine, The Alfred, Melbourne, Australia
| | | | - Kirk Kee
- Department of Medicine, Monash University, Melbourne, Australia; Allergy, Immunology & Respiratory Medicine, The Alfred, Melbourne, Australia
| | - Gregory I Snell
- Department of Medicine, Monash University, Melbourne, Australia; Allergy, Immunology & Respiratory Medicine, The Alfred, Melbourne, Australia
| | - Mark Buckland
- Department of Anaesthesia, The Alfred, Melbourne, Australia
| | - Trevor J Williams
- Department of Medicine, Monash University, Melbourne, Australia; Allergy, Immunology & Respiratory Medicine, The Alfred, Melbourne, Australia
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O'Donnell DE, Laveneziana P, Webb K, Neder JA. Chronic obstructive pulmonary disease: clinical integrative physiology. Clin Chest Med 2013; 35:51-69. [PMID: 24507837 DOI: 10.1016/j.ccm.2013.09.008] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Peripheral airway dysfunction, inhomogeneous ventilation distribution, gas trapping, and impaired pulmonary gas exchange are variably present in all stages of chronic obstructive pulmonary disease (COPD). This article provides a cogent physiologic explanation for the relentless progression of activity-related dyspnea and exercise intolerance that all too commonly characterizes COPD. The spectrum of physiologic derangements that exist in smokers with mild airway obstruction and a history compatible with COPD is examined. Also explored are the perceptual and physiologic consequences of progressive erosion of the resting inspiratory capacity. Finally, emerging information on the role of cardiocirculatory impairment in contributing to exercise intolerance in patients with varying degrees of airway obstruction is reviewed.
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Affiliation(s)
- Denis E O'Donnell
- Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University, 102 Stuart Street, Kingston, Ontario K7L 2V6, Canada.
| | - Pierantonio Laveneziana
- Service d'Explorations Fonctionnelles de la Respiration, de l'Exercice et de la Dyspnée Hôpital Universitaire Pitié-Salpêtrière (AP-HP), Laboratoire de Physio-Pathologie Respiratoire, Faculty of Medicine, Pierre et Marie Curie University (Paris VI), 47-83 Boulevard de l'Hôpital,75013 Paris, France
| | - Katherine Webb
- Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University, 102 Stuart Street, Kingston, Ontario K7L 2V6, Canada
| | - J Alberto Neder
- Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University, 102 Stuart Street, Kingston, Ontario K7L 2V6, Canada
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Costalat G, Coquart J, Castres I, Tourny C, Lemaitre F. Hemodynamic adjustments during breath-holding in trained divers. Eur J Appl Physiol 2013; 113:2523-9. [PMID: 23821240 DOI: 10.1007/s00421-013-2690-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 06/25/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE Voluntary breath-holding (BH) elicits several hemodynamic changes, but little is known about maximal static immersed-body BH. We hypothesized that the diving reflex would be strengthened with body immersion and would spare more oxygen than maximal dry static BH, resulting in a longer BH duration. METHODS Eleven trained breath-hold divers (BHDs) performed a maximal dry-body BH and a maximal immersed-body BH. Cardiac output (CO), stroke volume (SV), heart rate (HR), left ventricular end-diastolic volume (LVEDV), contractility index (CTI), and ventricular ejection time (VET) were continuously recorded by bio-impedancemetry (PhysioFlow PF-05). Arterial oxygen saturation (SaO2) was assessed with a finger probe oximeter. RESULTS In both conditions, BHDs presented a bi-phasic kinetic for CO and a tri-phasic kinetic for SV and HR. In the first phase of immersed-body BH and dry-body BH, results (mean ± SD) expressed as percentage changes from starting values showed decreased CO (55.9 ± 10.4 vs. 39.3 ± 16.8 %, respectively; p < 0.01 between conditions), due to drops in both SV (24.9 ± 16.2 vs. 9.0 ± 8.5 %, respectively; p < 0.05 between conditions) and HR (39.7 ± 16.7 vs. 33.6 ± 17.0 %, respectively; p < 0.01 between conditions). The second phase was marked by an overall stabilization of hemodynamic variables. In the third one, CO kept stabilizing due to increased SV (17.0 ± 20.2 vs. 10.9 ± 13.8 %, respectively; p < 0.05 between conditions) associated with a second HR drop (14.0 ± 10.0 vs. 12.7 ± 8.9 %, respectively; p < 0.01 between conditions). CONCLUSION This study highlights similar time-course patterns for cardiodynamic variables during dry-body and immersed-body BH, although the phenomenon was more pronounced in the latter condition.
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Affiliation(s)
- Guillaume Costalat
- CETAPS, EA No. 3832, Faculté des Sciences du Sport, Boulevard Siegfried, Université de Rouen, 76130, Mont-Saint-Aignan, France,
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Henao-Guerrero N, Ricco C, Jones JC, Buechner-Maxwell V, Daniel GB. Comparison of four ventilatory protocols for computed tomography of the thorax in healthy cats. Am J Vet Res 2012; 73:646-53. [DOI: 10.2460/ajvr.73.5.646] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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16
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Butt M, Dwivedi G, Khair O, Lip GYH. Obstructive sleep apnea and cardiovascular disease. Int J Cardiol 2009; 139:7-16. [PMID: 19505734 DOI: 10.1016/j.ijcard.2009.05.021] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2009] [Revised: 05/07/2009] [Accepted: 05/11/2009] [Indexed: 01/25/2023]
Abstract
Obstructive sleep apnea (OSA) is a common yet an under-diagnosed sleep related breathing disorder affecting predominantly middle-aged men. OSA is associated with many adverse health outcomes, including cardiovascular disease. Common OSA associated/induced cardiovascular disorders include coronary artery disease, heart failure, hypertension, cardiac arrhythmias and stroke, which further increase morbidity and mortality in the OSA population. Endothelial dysfunction, coagulopathy, impaired sympathetic drive, oxidative and inflammatory stress are the pathophysiological pathways suggested for the development of cardiovascular disease in OSA. The evidence would suggest that OSA should be considered as a cardiovascular risk factor, and is a treatable condition. Multiple studies using Continuous Positive Airway Pressure (CPAP) have shown improvements in the clinical state as well as retardation of disease progression. Therefore, patients with cardiovascular disease should be proactively screened for OSA and vice versa.
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Affiliation(s)
- Mehmood Butt
- University Department of Medicine, City Hospital, Birmingham B18 7QH, UK
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Marumo CK, Otsuki DA, Fantoni DT, Margarido CB, Ambrósio AM, Pelosi P, Auler JOC. Hemodynamic effects of PEEP in a porcine model of HCl-induced mild acute lung injury. Acta Anaesthesiol Scand 2009; 53:190-202. [PMID: 19094174 DOI: 10.1111/j.1399-6576.2008.01842.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Positive end-expiratory pressure (PEEP) and sustained inspiratory insufflations (SI) during acute lung injury (ALI) are suggested to improve oxygenation and respiratory mechanics. We aimed to investigate the hemodynamic effects of PEEP with and without alveolar recruiting maneuver in a mild ALI model induced by inhalation of hydrochloric acid. METHODS Thirty-two pigs were randomly allocated into four groups (Control-PEEP, Control-SI, ALI-PEEP and ALI-SI). ALI was induced by intratracheal instillation of hydrochloric acid. PEEP values were progressively increased and decreased from 5, 10, 15 and 20 cmH2O in all groups. Three SIs maneuvers of 30 cmH2O for 20 s were applied to the assignable groups between each PEEP level. Transesophageal echocardiography (TEE), global hemodynamics, oxygenation indexes and gastric tonometry were measured 5 min after the maneuvers had been concluded and at each established value of PEEP (5, 10, 15 and 20 cmH2O). RESULTS The cardiac index, ejection fraction and end-diastolic volume of right ventricle were significantly (P < 0.001) decreased with PEEP in both Control and ALI groups. Left ventricle echocardiography showed a significant decrease in end-diastolic volume at 20 cmH2O of PEEP (P < 0.001). SIs did not exert any significant hemodynamic effects either early (after 5 min) or late (after 3 h). CONCLUSIONS In a mild ALI model induced by inhalation of hydrochloric acid, significant hemodynamic impairment characterized by cardiac function deterioration occurred during PEEP increment, but SI, probably due to low applied values (30 cmH2O), did not exert further negative hemodynamic effects. PEEP should be used cautiously in ALI caused by acid gastric content inhalation.
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Affiliation(s)
- C K Marumo
- Laboratory of Medical Investigation LIM08, Faculdade de Medicina, Universidade de São Paulo, Brazil
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ARTERIAL PULSE PRESSURE VARIATION PREDICTING FLUID RESPONSIVENESS IN CRITICALLY ILL PATIENTS: Retracted. Shock 2008; 30 Suppl 1:18-22. [DOI: 10.1097/shk.0b013e3181818708] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Jörgensen K, Müller MF, Nel J, Upton RN, Houltz E, Ricksten SE. Reduced intrathoracic blood volume and left and right ventricular dimensions in patients with severe emphysema: an MRI study. Chest 2007; 131:1050-7. [PMID: 17426209 DOI: 10.1378/chest.06-2245] [Citation(s) in RCA: 105] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Left ventricular (LV) filling is impaired in patients with severe emphysema manifesting in small end-diastolic dimensions. We hypothesized that the hyperinflated lungs of these patients with high intrinsic positive end-expiratory pressure will decrease intrathoracic blood volume (ITBV) and ventricular preload. We therefore measured ITBV, and LV and right ventricular (RV) dimensions and function using MRI techniques in patients with severe emphysema. METHODS Patients with severe emphysema (n = 13) and matched healthy volunteers (n = 11) were included. The magnetic resonance (MR) examination consisted of three parts: (1) evaluation of RV and LV dimensions and function and interventricular septum curvature using cine MRI; (2) quantification of aortic flow using MR phase velocity mapping; and (3) calculation of the cardiopulmonary peak transit time (PTT) from the pulmonary artery to the ascending aorta using contrast-enhanced, time-resolved, two-dimensional MR angiography. RESULTS There were no differences between the groups regarding age, height, or weight. In the emphysema patients, ITBV index (- 35%), LV end-diastolic volume index (LVEDVI) [- 21%], RV end-diastolic volume index (- 20%), cardiac index (- 22%), and stroke volume index (SVI) [- 40%] were lower compared to control subjects. LV and RV end-systolic volumes, LV wall mass, septal curvature, and PTT did not differ between the groups. LVEDVI (r = 0.83) as well as SVI (r = 0.82) correlated closely to ITBV index. SVI correlated closely to LVEDVI (r = 0.84). CONCLUSIONS LV and RV performance is impaired in patients with severe emphysema because of small end-diastolic dimensions. One possible explanation for the decreased biventricular preload in these patients is intrathoracic hypovolemia caused by hyperinflated lungs.
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Affiliation(s)
- Kirsten Jörgensen
- Department of Cardiothoracic Anesthesia and Intensive Care, Sahlgrenska University Hospital, S-413 45 Gothenburg, Sweden
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van den Hout RJ, Lamb HJ, van den Aardweg JG, Schot R, Steendijk P, van der Wall EE, Bax JJ, de Roos A. Real-time MR imaging of aortic flow: influence of breathing on left ventricular stroke volume in chronic obstructive pulmonary disease. Radiology 2003; 229:513-9. [PMID: 14526092 DOI: 10.1148/radiol.2292020559] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To assess real-time changes of left ventricular stroke volume (SV) in relation to the breathing pattern in healthy subjects and in patients with chronic obstructive pulmonary disease (COPD). MATERIALS AND METHODS Real-time magnetic resonance (MR) imaging flow measurements were performed in the ascending aorta of 10 healthy volunteers and nine patients with severe COPD. Breathing maneuvers were registered with an abdominal pressure belt, which was synchronized to the electrocardiographic signal and the flow measurement. Healthy subjects performed normal breathing, deep breathing, and the Valsalva maneuver. Patients with COPD performed spontaneous breathing. Paired two-tailed Student t tests were used in healthy volunteers to assess significant SV differences between normal breathing and deep breathing or the Valsalva maneuver. The results of measurements in the patients with COPD were compared with the results during normal breathing in healthy subjects with the unpaired two-tailed Student t test. RESULTS In healthy subjects, SV decreased during inspiration and increased during expiration (r2 = 0.78, P <.05). When compared with the SV during normal breathing, mean SV did not change during deep breathing but declined during the Valsalva maneuver (P <.05). The difference between minimal and maximal SVs (ie, SV range) increased because of deep breathing or the Valsalva maneuver (P <.05). In normal and deep breathing, velocity of SV elevation and velocity of SV decrease were equal (which resulted in a ratio of 1), whereas during the Valsalva maneuver, this value increased (P <.05). Spontaneous breathing in COPD resulted in SV changes (P <.05) similar to those observed in healthy subjects who performed the Valsalva maneuver. CONCLUSION Real-time MR imaging of aortic flow reveals physiologic flow alterations, which are dependent on variations in the breathing pattern.
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Affiliation(s)
- Rik J van den Hout
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
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Haney MF, Johansson G, Häggmark S, Biber B. Analysis of left ventricular systolic function during elevated external cardiac pressures: an examination of measured transmural left ventricular pressure during pressure-volume analysis. Acta Anaesthesiol Scand 2001; 45:868-74. [PMID: 11472290 DOI: 10.1034/j.1399-6576.2001.045007868.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Variations or disturbances in intrathoracic and extracardiac pressures (ECP) occur in critically ill and anaesthetised patients. There are uncertainties concerning the analysis of left ventricular pressure-volume relationship (LVPVR) and the calculation of systolic function parameters when conducted without reference to transmural left ventricular pressure (LVPtm) in the setting of elevated ECP. METHODS In 7 anaesthetised adult pigs, we measured LVPVR using conductance volumetry and tip manometry along with measurement of pericardial and other intrathoracic pressures. Experimental pericardial infusion and pleural insufflation were performed. Transient controlled preload reductions were accomplished using balloon occlusion of the inferior vena cava. Preload recruitable stroke work (PRSW) was calculated using both intracavitary left ventricular pressure (LVPic) and LVPtm, and differences were tested for using a paired t-test. RESULTS The pericardial and pleural interventions produced significant elevations in ECP. No difference in PRSW calculated using LVPic and LVPtm was detected. CONCLUSION These results suggest that LVPtm need not be measured and included in LVPVR analysis of systolic function when there is significant external cardiac pressure. To be able to employ LVPVR analysis of systolic function without reference to LVPtm is important for simplified application in the clinical setting, particularly when elevated extracardiac pressures are suspected, or have been therapeutically induced, as with continuous positive pressure ventilation.
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Affiliation(s)
- M F Haney
- Surgical and Perioperative Sciences, Section for Anaesthesiology and Intensive Care Medicine, Umeå University, Umeå, Sweden.
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Haney MF, Johansson G, Häggmark S, Biber B. Heart-lung interactions during positive pressure ventilation: left ventricular pressure-volume momentary response to airway pressure elevation. Acta Anaesthesiol Scand 2001; 45:702-9. [PMID: 11421828 DOI: 10.1034/j.1399-6576.2001.045006702.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Left ventricular (LV) pressure and volume changes are known to occur in response to positive airway pressure (PAP). We aimed to further describe the immediate LV response to increased PAP as demonstrated in successive heart cycles with LV pressure and volume alterations. We postulated that these acute systematic LV events during institution of PAP can follow a distinct pattern that would allow calculation of parameters of systolic function, including end-systolic elastance (Ees) and preload recruitable stroke work (PRSW). We also aimed to examine the relationship of PAP-derived Ees and PRSW to the same parameters derived from vascular occlusion. METHODS Eight anesthetized adult pigs were studied with invasive circulatory measurements including LV pressure and volume (conductance). The PAP intervention was an airway pressure plateau of 15 cm H2O for 6 s (APP). Venous occlusion was performed by transient balloon inflation in the inferior vena cava (IVCO). Ees and PRSW were derived for each APP and IVCO intervention. RESULTS Central circulatory variables during APP and IVCO are reported. LV systolic function parameters could be derived from each of the heart-lung interactions during APP sequences. Ees and PRSW derived from APP showed a significant positive bias in relation to those derived from the IVCO sequence. CONCLUSIONS We conclude that the heart-lung interactions during APP of the magnitude and duration shown here can allow derivation of Ees and PRSW. These parameters are not interchangeable with Ees and PRSW derived from IVCO.
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Affiliation(s)
- M F Haney
- Surgical and Perioperative Sciences, Anaesthesiology and Intensive Care Medicine, Umeå University, Umeå, Sweden.
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