Interactions between respiration and systemic hemodynamics. Part II: practical implications in critical care

Feihl, François; Broccard, Alain F.

doi:10.1007/s00134-008-1298-y

Cited by 67 publications

(12 citation statements)

References 74 publications

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“…reduced CI and DO 2 I. The greater decrease in macro-circulatory variables seen in the protectively ventilated animals is probably explained by the higher PEEP, leading to higher intrathoracic pressure and subsequent lower venous return [22]. …”

Section: Discussionmentioning

confidence: 99%

Lung Protective Ventilation Induces Immunotolerance and Nitric Oxide Metabolites in Porcine Experimental Postoperative Sepsis

et al. 2013

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Low tidal volume ventilation is beneficial in patients with severe pulmonary dysfunction and would, in theory, reduce postoperative complications if implemented during routine surgery. The study aimed to investigate whether low tidal volume ventilation and high positive end-expiratory pressure (PEEP) in a large animal model of postoperative sepsis would attenuate the systemic inflammatory response and organ dysfunction. Thirty healthy pigs were randomized to three groups: Group Prot-7h, i.e. protective ventilation for 7 h, was ventilated with a tidal volume of 6 mL x kg-1 for 7 h; group Prot-5h, i.e. protective ventilation for 5 h, was ventilated with a tidal volume of 10 mL x kg-1 for 2 h, after which the group was ventilated with a tidal volume of 6 mL x kg-1; and a control group that was ventilated with a tidal volume of 10 mL x kg-1 for 7 h. In groups Prot-7h and Prot-5h PEEP was 5 cmH2O for 2 h and 10 cmH2O for 5 h. In the control group PEEP was 5 cmH2O for the entire experiment. After surgery for 2 h, postoperative sepsis was simulated with an endotoxin infusion for 5 h. Low tidal volume ventilation combined with higher PEEP led to lower levels of interleukin 6 and 10 in plasma, higher PaO2/FiO2, better preserved functional residual capacity and lower plasma troponin I as compared with animals ventilated with a medium high tidal volume and lower PEEP. The beneficial effects of protective ventilation were seen despite greater reductions in cardiac index and oxygen delivery index. In the immediate postoperative phase low VT ventilation with higher PEEP was associated with reduced ex vivo plasma capacity to produce TNF-α upon endotoxin stimulation and higher nitrite levels in urine. These findings might represent mechanistic explanations for the attenuation of systemic inflammation and inflammatory-induced organ dysfunction.

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Section: Discussionmentioning

confidence: 99%

Lung Protective Ventilation Induces Immunotolerance and Nitric Oxide Metabolites in Porcine Experimental Postoperative Sepsis

et al. 2013

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“…Feihl and Broccard [32, 33] provide a Guytonian analysis of the effects of PEEP on cardiac output, and terminate the review with some remarks on the potential of positive pressure breathing to induce acute cor pulmonale, and on the cardiovascular mechanisms that underlie failure to wean a patient from the ventilator. These two articles must be mandatory to read and understand for every in-training intensivist and also for board-certified specialists in this field, providing in-depth, state-of-the-art description of cardiorespiratory interactions.…”

Section: Mechanical Ventilation Ards and Alimentioning

confidence: 99%

Year in review in Intensive Care Medicine 2009. Part III: Mechanical ventilation, acute lung injury and respiratory distress syndrome, pediatrics, ethics, and miscellanea

et al. 2010

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“…Understanding cardio-respiratory interactions is extremely important to the practicing intensivist as reviewed elsewhere [1,2]. The heart and the lungs are anatomically and physiologically coupled.…”

Section: Introductionmentioning

confidence: 99%

Cardiopulmonary interactions and volume status assessment

Broccard

2012

J Clin Monit Comput

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Assessment of the hemodynamics and volume status is an important daily task for physicians caring for critically ill patients. There is growing consensus in the critical care community that the "traditional" methods-e.g., central venous pressure or pulmonary artery occlusion pressure-used to assess volume status and fluid responsiveness are not well supported by evidence and can be misleading. Our purpose is to provide here an overview of the knowledge needed by ICU physicians to take advantage of mechanical cardiopulmonary interactions to assess volume responsiveness. Although not perfect, such dynamic assessment of fluid responsiveness can be helpful particularly in the passively ventilated patients. We discuss the impact of phasic changes in lung volume and intrathoracic pressure on the pulmonary and systemic circulation and on the heart function. We review how respirophasic changes on the venous side (great veins geometry) and arterial side (e.g., stroke volume/systolic blood pressure and surrogate signals) can be used to detect fluid responsiveness or hemodynamic alterations commonly encountered in the ICU. We review the physiological limitations of this approach.

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Interactions between respiration and systemic hemodynamics. Part II: practical implications in critical care

Cited by 67 publications

References 74 publications

Lung Protective Ventilation Induces Immunotolerance and Nitric Oxide Metabolites in Porcine Experimental Postoperative Sepsis

Lung Protective Ventilation Induces Immunotolerance and Nitric Oxide Metabolites in Porcine Experimental Postoperative Sepsis

Year in review in Intensive Care Medicine 2009. Part III: Mechanical ventilation, acute lung injury and respiratory distress syndrome, pediatrics, ethics, and miscellanea

Cardiopulmonary interactions and volume status assessment

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