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Related Experiment Videos

Ventilatory pattern, intrapleural pressure, and cardiac output.

J B Downs, M E Douglas, P M Sanfelippo

    Anesthesia and Analgesia
    |January 1, 1977
    PubMed
    Summary

    Mechanical ventilation, especially intermittent positive-pressure ventilation (IPPV), can decrease cardiac output. However, allowing spontaneous breathing during mechanical ventilation, even with positive end-expiratory pressure (PEEP), preserves cardiopulmonary function and oxygen delivery.

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    Area of Science:

    • Critical Care Medicine
    • Cardiopulmonary Physiology
    • Respiratory Therapy

    Background:

    • Continuous positive-pressure ventilation is known to potentially reduce cardiac output.
    • Distinguishing the effects of positive end-expiratory pressure (PEEP) from overall mechanical ventilation is crucial.

    Purpose of the Study:

    • To investigate the separate effects of PEEP and intermittent positive-pressure ventilation (IPPV) on cardiopulmonary function.
    • To evaluate the impact of spontaneous ventilatory activity during mechanical ventilation.

    Main Methods:

    • Ten surgical patients undergoing mechanical ventilatory support were studied.
    • Hemodynamic parameters including cardiac output, right atrial pressure (RAP), and pulmonary artery occlusion pressure (PAOP) were measured.
    • Measurements were taken during varying levels of PEEP and during IPPV, with and without spontaneous breathing via intermittent mandatory ventilation (IMV).

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    Main Results:

    • PEEP (0, 5, 10 cm H2O) did not significantly affect atrial filling pressures or cardiac output.
    • Intermittent positive-pressure ventilation (IPPV) significantly increased airway pressure, intrapleural pressure, RAP, and PAOP, while decreasing atrial filling pressures and cardiac output.
    • Patients on IMV maintained cardiac output and oxygen delivery, irrespective of PEEP levels, by generating negative intrapleural pressure.

    Conclusions:

    • Mechanical ventilation, particularly IPPV, can impair cardiac function.
    • Patients requiring mechanical respiratory support may benefit from preserved cardiopulmonary function when allowed spontaneous ventilatory activity, even with PEEP.
    • IMV appears to mitigate the negative cardiovascular effects of mechanical ventilation.