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Heart-lung interactions

Pinsky, MR (2007) Heart-lung interactions. Current Opinion in Critical Care, 13 (5). 528 - 531. ISSN 1070-5295

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PURPOSE OF REVIEW: Assessment of cardiovascular stability using ventilation-induced changes in measured physiological variables, referred to as functional hemodynamic monitoring, usually requires measurement of ventilation-induced changes in venous return. Thus, it is important to understand the determinants of these complex heart-lung interactions. RECENT FINDINGS: Several animal and human studies have recently documented that ventricular interdependence plays an important role during positive-pressure breathing, causing acute cor pulmonale. With the use of lower tidal volume ventilation in patients with acute respiratory failure, the incidence of acute cor pulmonale is decreasing proportionally. When present, however, it induces a stroke volume variation that is 180° out of phase with that seen in hypovolemic states, such that left ventricular stroke volume increases during inspiration rather than decreasing as seen in hypovolemia. Further, when either tidal volume or positive end-expiratory pressure levels are varied, both stroke volume variation and pulse pressure variation are affected in a predictable manner. The greater the swing in intrathoracic pressure, the greater the change in venous return. SUMMARY: Functional hemodynamic monitoring is becoming more prevalent. For it to be used effectively, the operator needs to have a solid understanding of how ventilation induces both pulse pressure variation and stroke volume variation in that specific patient. © 2007 Lippincott Williams & Wilkins, Inc.


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Item Type: Article
Status: Published
CreatorsEmailPitt UsernameORCID
Pinsky, MRpinsky@pitt.eduPINSKY0000-0001-6166-700X
Date: 1 October 2007
Date Type: Publication
Journal or Publication Title: Current Opinion in Critical Care
Volume: 13
Number: 5
Page Range: 528 - 531
DOI or Unique Handle: 10.1097/mcc.0b013e3282efad97
Schools and Programs: School of Medicine > Critical Care Medicine
Refereed: Yes
ISSN: 1070-5295
Article Type: Review
PubMed ID: 17762231
Date Deposited: 22 Jun 2012 15:41
Last Modified: 30 Jan 2020 16:55


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