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Mechanical ventilation and the cardiovascular system

Pinsky, MR (1996) Mechanical ventilation and the cardiovascular system. Current Opinion in Critical Care, 2 (5). 391 - 395. ISSN 1070-5295

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Abstract

Ventilation has profound effects on the cardiovascular system through almost every aspect of its control. Four concepts determine most acute aspects of mechanical ventilation and its withdrawal. First, ventilation is exercise. A cardiovascular system unable to meet the increased metabolic demand of breathing will prevent successful weaning. Second, hyperinflation and increasing lung volume per se, and not the increase in airway pressure, determine the hemodynamic effect of ventilation. However, in a given patient, if ventilatory modes are matched for similar tidal volumes and mean airway pressures, then the hemodynamic effects of these modes of ventilation will also be similar. Third, although decreases in intrathoracic pressure increase left ventricular afterload, of more clinical relevance is the transition from spontaneous ventilatory efforts to positive pressure ventilation because the fall in venous return is much less, whereas the decrease in left ventricular afterload is identical for the same relative increase in intrathoracic pressure. Fourth, the decrease in venous return seen during positive pressure ventilation probably reflects an impairment in left ventricular filling rather than a reduction in the pressure gradient for venous return because of the associated increase in intra-abdominal pressure during inspiration.


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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Pinsky, MRpinsky@pitt.eduPINSKY
Date: 1 January 1996
Date Type: Publication
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Journal or Publication Title: Current Opinion in Critical Care
Volume: 2
Number: 5
Page Range: 391 - 395
DOI or Unique Handle: 10.1097/00075198-199610000-00010
Institution: University of Pittsburgh
Schools and Programs: School of Medicine > Critical Care Medicine
Refereed: Yes
ISSN: 1070-5295
Date Deposited: 05 Mar 2012 17:16
Last Modified: 04 Feb 2019 15:56
URI: http://d-scholarship.pitt.edu/id/eprint/11243

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