Stein, KL and Kramer, DJ and Killian, A and Pinsky, MR
(1990)
Hemodynamic effects of synchronous high-frequency jet ventilation in mitral regurgitation.
Journal of Applied Physiology, 69 (6).
2120 - 2125.
ISSN 0161-7567
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Abstract
We tested the hypothesis that increases in intrathoracic pressure (ITP), by decreasing the pressure gradient for anterograde left ventricular (LV) ejection, should augment cardiac output in acute mitral regurgitation (MR). In a pentobarbital-anesthetized closed-chest canine model, LV stroke volume (SL(LV)) was measured by integration from an aortic flow probe signal. MR was induced by a regurgitant ring. ITP was elevated over apnea by means of intermittent positive-pressure ventilation (IPPV), asynchronous (asynch) high-frequency jet ventilation (HFJV), and cardiac cycle-specific (synch) HFJV. IPPV resulted in the greatest increase in ITP. MR caused a fall in SV(LV) and a rise in LV filling pressure that were not altered by IPPV. Compared with IPPV or apnea, both asynch and synch HFJV increased SV(LV) and reduced LV filling pressures (P < 0.05). Systolic synch HFJV induced a greater increase in SV(LV) (32%) than diastolic synch HFJV (26%) despite similar ventilatory settings. Our data suggest that when LV contractility is normal but MR impairs forward flow, cardiac cycle-specific increases in ITP will augment forward flow.
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