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Pneumothorax during positive-pressure mechanical ventilation.

T Bitto, J D Mannion, L W Stephenson

    The Journal of Thoracic and Cardiovascular Surgery
    |April 1, 1985
    PubMed
    Summary
    This summary is machine-generated.

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    Positive-pressure mechanical ventilation can decrease cardiac output with increasing pneumothorax. Arterial oxygen tension may not predict this serious complication.

    Area of Science:

    • Cardiovascular Physiology
    • Respiratory Physiology
    • Critical Care Medicine

    Background:

    • Unilateral pneumothorax is a potential complication during mechanical ventilation.
    • The hemodynamic and respiratory consequences of pneumothorax under positive-pressure ventilation require further elucidation.

    Purpose of the Study:

    • To investigate the effects of induced unilateral pneumothorax on hemodynamic and respiratory parameters.
    • To assess the relationship between pneumothorax size and cardiac output during mechanical ventilation.

    Main Methods:

    • Five sheep were mechanically ventilated with positive end-expiratory pressure.
    • Unilateral pneumothorax was induced by injecting air into the pleural cavity (500, 1000, 1500 ml).
    • Hemodynamic (cardiac output, stroke volume, heart rate) and respiratory (airway pressure, intrapleural pressure) parameters were measured.

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    Main Results:

    • Cardiac output significantly decreased with increasing pneumothorax size (1000 and 1500 ml).
    • A linear correlation was observed between pneumothorax size and cardiac output reduction (r=0.991).
    • Intrapleural pressure increased, with a greater rise on the right side; arterial oxygen tension remained stable.

    Conclusions:

    • Increasing pneumothorax size during mechanical ventilation leads to significant decreases in cardiac output.
    • Chest roentgenograms may underestimate the severity of pneumothorax's impact on cardiac function.
    • Arterial oxygen tension is an unreliable indicator for detecting pneumothorax during mechanical ventilation.