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Decreased paradoxic pulse from increased venous return in severe asthma
P Squara1, J F Dhainaut, B Schremmer
1Medical ICU, Victor Dupouy Hospital, Argenteuil, France.
Chest
|February 1, 1990
Summary
Severe asthma can cause paradoxic pulse. Reversible blood volume expansion using MAST therapy reduced this pulse, indicating decreased pulmonary venous return is a key factor.
Area of Science:
- Cardiology
- Pulmonology
- Critical Care Medicine
Background:
- Paradoxic pulse during severe asthma is linked to left ventricular dysfunction.
- Potential causes include increased impedance, ventricular interdependence, and reduced pulmonary venous return.
Purpose of the Study:
- To investigate the impact of reversible blood volume expansion on paradoxic pulse in severe asthma.
- To differentiate the roles of ventricular interdependence and pulmonary venous return in its etiology.
Main Methods:
- Studied ten severe asthma patients with significant paradoxic pulse (>20 mm Hg).
- Administered standard asthma therapy and reversible blood volume expansion via MAST (Military Anti-Shock Trousers) inflation.
- Monitored respiratory rate, heart rate, and paradoxic pulse changes during MAST inflation and deflation.
Main Results:
- No significant changes in respiratory or heart rates were observed during MAST inflation.
- Paradoxic pulse consistently decreased during MAST inflation and returned to baseline after deflation.
- The reduction in paradoxic pulse correlated with increased inspiratory systolic arterial pressure.
Conclusions:
- Reduced pulmonary venous return plays a more significant role than ventricular interdependence in causing paradoxic pulse during severe asthma.
- Reversible blood volume expansion can effectively mitigate paradoxic pulse in severe asthma attacks.