Effect of Intermittent Positive Pressure Ventilation on Cardiac Systolic Time Intervals

Brundin, T.; Hedenstierna, Göran; McCarthy, Graham

doi:10.1111/j.1399-6576.1976.tb05040.x

Cited by 16 publications

(9 citation statements)

References 23 publications

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“…Several human studies have also found that decreased PEP after fluid challenge is associated with increase in stroke volume (10,13,18). Interestingly, Brundin et al (9) demonstrated that intermittent positive pressure ventilation increased PEP by the reduction of venous return and thus stroke volume. In the present study, ⌬PEP was used as an index of preload responsiveness, with the hypothesis that, as Values are means Ϯ SD.…”

Section: Discussionmentioning

confidence: 99%

The respiratory change in preejection period: a new method to predict fluid responsiveness

Bendjelid

Suter

Romand

2004

Journal of Applied Physiology

105

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The accuracy and clinical utility of preload indexes as bedside indicators of fluid responsiveness in patients after cardiac surgery is controversial. This study evaluates whether respiratory changes (Delta) in the preejection period (PEP; DeltaPEP) predict fluid responsiveness in mechanically ventilated patients. Sixteen postcoronary artery bypass surgery patients, deeply sedated under mechanical ventilation, were enrolled. PEP was defined as the time interval between the beginning of the Q wave on the electrocardiogram and the upstroke of the radial arterial pressure. DeltaPEP (%) was defined as the difference between expiratory and inspiratory PEP measured over one respiratory cycle. We also measured cardiac output, stroke volume index, right atrial pressure, pulmonary arterial occlusion pressure, respiratory change in pulse pressure, systolic pressure variation, and the Deltadown component of SPV. Data were measured without positive end-expiratory pressure (PEEP) and after application of a PEEP of 10 cmH2O (PEEP10). When PEEP10 induced a decrease of >15% in mean arterial pressure value, then measurements were re-performed before and after volume expansion. Volume loading was done in eight patients. Right atrial pressure and pulmonary arterial occlusion pressure before volume expansion did not correlate with the change in stroke volume index after the fluid challenge. Systolic pressure variation, DeltaPEP, Deltadown, and change in pulse pressure before volume expansion correlated with stroke volume index change after fluid challenge (r2 = 0.52, 0.57, 0.68, and 0.83, respectively). In deeply sedated, mechanically ventilated patients after cardiac surgery, DeltaPEP, a new method, can be used to predict fluid responsiveness and hemodynamic response to PEEP10.

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Section: Discussionmentioning

confidence: 99%

The respiratory change in preejection period: a new method to predict fluid responsiveness

Bendjelid

Suter

Romand

2004

Journal of Applied Physiology

105

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“…We also need to consider other causes for the shortening of PTT unrelated to a direct effect of sympathetic tone on PTT. The increased abdominal pressure may have affected PTT either via changes in preload (causing a shortening of PEP) or due to the requirement for higher intrathoracic pressures for a given tidal volume [13][14][15]. A higher intrathoracic pressure will affect PTT by changing PEP as well as by changing the compliance of the arterial blood vessels [13][14][15].…”

Section: Discussionmentioning

confidence: 99%

Pulse Transit Time (PTT) Measurements During Laparoscopic and Open Abdominal Surgery: A Pilot Study in ASA I-II Female Patients

Sigtermans¹,

Looijestijn²,

Olofsen³

et al. 2008

TOATJ

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Abstract:Background: The pulse transit time (PTT) is the time interval between the R-wave of the ECG and the appearance of the pulse wave in the periphery during the same cardiac cycle. PTT is influenced by various factors including sympathetic tone and vascular compliance. The authors assessed the effect of anesthesia, intubation and laparoscopic (LPS) versus laparotomic (LPT) surgery on PTT.Methods: PTT, mean arterial blood pressure (MAP) and heart rate (HR) were measured during induction of anesthesia and during the first 45-min of LPS (n = 17) and LPT (n = 13) surgery in a group of female patients.Results: Anesthesia increased PTT values, while painful stimuli caused an immediate reduction. During surgery, we observed group effects on PTT and MAP with 10-25% lower PTT values (P < 0.001) and 15-30% greater MAP values (P < 0.01) in the LPS group. HR did not differ between groups. Conclusions:The pulse transit time was used successfully to track the effect of anesthesia and stressful nociceptive stimuli during induction of anesthesia. The shorter PTT values during laparoscopic abdominal surgery compared to open abdominal surgery suggest a higher sympathetic tone in patients undergoing laparoscopic surgery and/or an effect of the increased abdominal pressure on PTT.

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“…Several human studies have also found that decreased PEP after fluid challenge is associated with increase in stroke volume. [12][13][14] Interestingly, Brundin et al 15 demonstrated that intermittent-positive pressure ventilation increased PEP by the reduction of venous return and thus stroke volume. As already stated, ⌬PEP was used as a gauge of volume status hypothesizing that as PPV; ⌬PEP is a relative and not absolute index related to positive pressure breath that induces change in ventricular stroke volume related to change in ventricular preload.…”

Section: Discussionmentioning

confidence: 98%

Pre-Ejection Period to Estimate Cardiac Preload Dependency in Mechanically Ventilated Pigs Submitted to Severe Hemorrhagic Shock

Giraud

Siegenthaler

Morel

et al. 2011

Journal of Trauma: Injury, Infection &Amp; Critical Care

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Effect of Intermittent Positive Pressure Ventilation on Cardiac Systolic Time Intervals

Cited by 16 publications

References 23 publications

The respiratory change in preejection period: a new method to predict fluid responsiveness

The respiratory change in preejection period: a new method to predict fluid responsiveness

Pulse Transit Time (PTT) Measurements During Laparoscopic and Open Abdominal Surgery: A Pilot Study in ASA I-II Female Patients

Pre-Ejection Period to Estimate Cardiac Preload Dependency in Mechanically Ventilated Pigs Submitted to Severe Hemorrhagic Shock

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