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Heart lung interactions during mechanical ventilation

Pinsky, MR (2012) Heart lung interactions during mechanical ventilation. Current Opinion in Critical Care, 18 (3). 256 - 260. ISSN 1070-5295

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Purpose of review: To survey the recent medical literature examining studies of the hemodynamic effects of mechanical ventilation. Recent findings: Ventilation-induced dynamic changes in arterial pulse pressure and stroke volume variation (PPV and SVV, respectively) identify volume responsiveness. The cause of PPV and SVV are due to intrathoracic pressure-induced variations in right atrial pressure changing intrathoracic blood volume over the ventilatory cycle. This explains why PPV and SVV are inaccurate with smaller tidal volumes used in acute lung injury, but remain useful in one-lung ventilation and prone positioning. Noninvasive measures of PPV and SVV using finger plethysmography and aortic root ultrasound or estimates of intrathoracic blood volume by thoracic impedance also predict volume responsiveness. Finally, the PPV-to-SVV ratio varies with vasomotor tone and can be used to identify vasopressor need in hypotensive patients. The clinical implications of these findings are starting to be realized in recommended management principles. Summary: PPV and SVV predict volume responsiveness, but like all monitoring approaches, need to be understood within the framework of their physiologic determinations. © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.


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Item Type: Article
Status: Published
CreatorsEmailPitt UsernameORCID
Pinsky, MRpinsky@pitt.eduPINSKY0000-0001-6166-700X
Centers: Other Centers, Institutes, Offices, or Units > McGowan Institute for Regenerative Medicine
Date: 1 June 2012
Date Type: Publication
Journal or Publication Title: Current Opinion in Critical Care
Volume: 18
Number: 3
Page Range: 256 - 260
DOI or Unique Handle: 10.1097/mcc.0b013e3283532b73
Schools and Programs: School of Medicine > Critical Care Medicine
Refereed: Yes
ISSN: 1070-5295
Article Type: Review
PubMed ID: 22473256
Date Deposited: 30 Oct 2012 16:57
Last Modified: 30 Jan 2020 16:55


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