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Respirator paradox.

J J Rick, S S Burke

    Southern Medical Journal
    |November 1, 1978
    PubMed
    Summary
    This summary is machine-generated.

    Reverse pulsus paradoxus, or respirator paradox, occurs when blood pressure unexpectedly increases with inspiration during mechanical ventilation. This phenomenon, observed in intensive care patients, may complicate diagnoses like cardiac tamponade.

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    Area of Science:

    • Critical Care Medicine
    • Cardiology
    • Respiratory Physiology

    Background:

    • Massumi described reverse pulsus paradoxus in 1973, noting reversed blood pressure variations during respiration.
    • This phenomenon was observed in patients receiving intermittent positive pressure ventilation (IPPV), with or without positive end-expiratory pressure (PEEP).
    • The condition has been documented in various intensive care unit (ICU) patient populations.

    Purpose of the Study:

    • To describe the occurrence of respirator paradox in ICU patients on IPPV.
    • To propose a theoretical mechanism for respirator paradox.
    • To highlight the diagnostic challenges posed by respirator paradox, particularly after cardiac surgery.

    Main Methods:

    • Observational study of intensive care patients receiving IPPV.

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  • Review of clinical cases exhibiting reversed pulsus paradoxus.
  • Theoretical analysis of potential mechanisms, focusing on afterload changes.

    • Main Results:

    • Respirator paradox was observed in ICU patients on IPPV, irrespective of PEEP.
    • A theoretical mechanism involving afterload alterations is proposed.
    • The occurrence of respirator paradox can complicate the early diagnosis of cardiac tamponade post-open heart surgery.

    Conclusions:

    • Respirator paradox is a recognized phenomenon in mechanically ventilated patients.
    • Changes in afterload may explain the mechanism of respirator paradox.
    • This finding has implications for diagnosing cardiac tamponade in post-operative cardiac surgery patients.