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Cardiac augmentation by phasic high intrathoracic pressure support in man

Pinsky, MR and Summer, WR (1983) Cardiac augmentation by phasic high intrathoracic pressure support in man. Chest, 84 (4). 370 - 375. ISSN 0012-3692

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Abstract

Left ventricular performance can be significantly influenced by changes in intrathoracic pressure. In man, sustained increases in intrathoracic pressure unload the left ventricle, but since venous return decreases, increased intrathoracic pressure is associated with a decreased cardiac output. In a canine model of acute ventricular failure, it has been shown that phasic increases in intrathoracic pressure, which do not decrease venous return, improve steady-state cardiac output. We thus studied the cardiovascular effects of phasic high intrathoracic pressure support (PHIPS) in seven patients with shock in our intensive care unit whose condition was not responsive to conventional types of therapy. The PHIPS was generated by abdominal and chest wall binding during positive-pressure ventilation. As compared to the state before PHIPS, the PHIPS was associated with an increase in esophageal pressure (6.6 ± 1.1 mm Hg; p<0.01) and in mean arterial pressure (43.0 ± 6.1 to 51.0± 7.7 mm Hg; p<0.01) while not changing arterial pressure relative to esophageal pressure. Cardiac output also increased from 3.6±0.5 to 4.2±0.6 L/min (p<0.05), while left ventricular filling pressures remained constant. In one subject a gated cardiac blood pool scan demonstrated a PHIPS-associated increase in ejection fraction and decreased end-diastolic volume. These results are consistent with the hypothesis that PHIPS, by increasing intrathoracic pressure, augments left ventricular performance by reducing left ventricular afterload. This appears to be a promising area for future research.

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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Pinsky, MRpinsky@pitt.eduPINSKY0000-0001-6166-700X
Summer, WR
Date: 1 January 1983
Date Type: Publication
Journal or Publication Title: Chest
Volume: 84
Number: 4
Page Range: 370 - 375
DOI or Unique Handle: 10.1378/chest.84.4.370
Schools and Programs: School of Medicine > Critical Care Medicine
Refereed: Yes
ISSN: 0012-3692
MeSH Headings: Bandages; Cardiac Output; Heart Ventricles--physiopathology; Humans; Intensive Care Units; Pulmonary Wedge Pressure; Respiration, Artificial; Shock, Cardiogenic--therapy
PubMed ID: 6617271
Date Deposited: 25 Aug 2012 17:26
Last Modified: 30 Jan 2020 16:56
URI: http://d-scholarship.pitt.edu/id/eprint/13642

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