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Estimating left ventricular contractility using inspiratory-hold maneuvers

Kim, HK and Alhammouri, MT and Mokhtar, YM and Pinsky, MR (2007) Estimating left ventricular contractility using inspiratory-hold maneuvers. Intensive Care Medicine, 33 (1). 181 - 189. ISSN 0342-4642

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Abstract

Objective: To compare estimates of left ventricular (LV) end-systolic elastance created by inferior vena caval (IVC) occlusion with those by apneic continuous positive airway pressure (CPAP). Design and setting: Prospective interventional study in a university large animal research laboratory. Subjects: Sixteen intact, pentobarbital-anesthetized mongrel male dogs. Interventions: Insertion of LV conductance and pressure catheters, then during apnea sequentially performed IVC occlusion and CPAP of 5, 10, and 15 mmHg for 10 s, each interspersed by positive-pressure breathing. In the final 11 dogs runs were repeated during both esmolol (2 mg min-1) and dobutamine (5 μg kg-1 min-1) infusions. Measurements: LV pressure-volume relationships during apneic baseline and then as LV end-diastolic volume decreased by each maneuver to calculate LV end-systolic elastance and preload-recruitable stroke work as measures of contractility. Results: End-systolic elastance estimated at 5 mmHg CPAP levels and IVC occlusions were similar while 10 and 15 mmHg CPAP gave different values. However, end-systolic elastance was lower during esmolol infusion and higher during dobutamine for all CPAP and IVC occlusion maneuvers. Preload-recruitable stroke work measures were similar across maneuvers. With increasing CPAP the LV filling and end-systolic elastance were progressively shifted upward and to the left, with volume on the x-axis, consistent with an unaccounted for increase in intrathoracic pressure. Conclusions: The use of 5 mmHg CPAP-induced preload-reduction allows estimation of LV end-systolic elastance and preload-recruitable stroke work in intact dogs. Increasing CPAP to more than 10 mmHg creates estimates of LV contractility that are different but covary with IVC occlusion-derived values. © 2006 Springer-Verlag.


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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Kim, HKhyk11@pitt.eduHYK11
Alhammouri, MT
Mokhtar, YM
Pinsky, MRpinsky@pitt.eduPINSKY
Date: 1 January 2007
Date Type: Publication
Journal or Publication Title: Intensive Care Medicine
Volume: 33
Number: 1
Page Range: 181 - 189
DOI or Unique Handle: 10.1007/s00134-006-0443-8
Schools and Programs: School of Medicine > Critical Care Medicine
Refereed: Yes
ISSN: 0342-4642
PubMed ID: 17103142
Date Deposited: 05 Apr 2012 21:12
Last Modified: 18 Feb 2019 14:55
URI: http://d-scholarship.pitt.edu/id/eprint/11598

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