Negative Pressure Ventilation as a Therapy for Post-operative Complications in a Patient with Single Ventricle Physiology

Deshpande, Shriprasad; Kirshbom, Paul M.; Maher, Kevin

doi:10.1016/j.hlc.2011.03.010

Cited by 10 publications

(5 citation statements)

References 7 publications

(5 reference statements)

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“…With the increase in intrathoracic pressure during an Ex+IL, we did not see any significant change in Qc or SV, in contrast to a previous study in post-operative mechanically ventilated patients (26). We did find a dramatic change in the Fontan patients during the Ex+EL condition, with a reduction in SVI to back to baseline, resting values despite ongoing exercise.…”

Section: Discussioncontrasting

confidence: 99%

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The Importance of the Muscle and Ventilatory Blood Pumps During Exercise in Patients Without a Subpulmonary Ventricle (Fontan Operation)

Shafer

García

Babb

et al. 2012

Journal of the American College of Cardiology

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Objectives The aim of this study was to determine the relative contribution of the muscle and ventilatory pumps to stroke volume in patients without a subpulmonic ventricle. Background In patients with Fontan circulation, it is unclear how venous return is augmented to increase stroke volume and cardiac output during exercise. Methods Cardiac output (acetylene rebreathing), heart rate (electrocardiography), oxygen uptake (Douglas bag technique), and ventilation were measured in 9 patients age 15.8 ± 6 years at 6.1 ± 1.8 years after Fontan operation and 8 matched controls. Data were obtained at rest, after 3 min of steady-state exercise (Ex) on a cycle ergometer at 50% of individual working capacity, during unloaded cycling at 0 W (muscle pump alone), during unloaded cycling with isocapnic hyperpnea (muscle and ventilatory pump), during Ex plus an inspiratory load of 12.8 ± 1.5 cm water, and during Ex plus an expiratory load of 12.8 ± 1.6 cm water. Results In Fontan patients, the largest increases in stroke volume and stroke volume index were during zero-resistance cycling. An additional increase with submaximal exercise occurred in controls only. During Ex plus expiratory load, stroke volume indexes were reduced to baseline, non-exercise levels in Fontan patients, without significant changes in controls. Conclusions With Fontan circulation increases in cardiac output and stroke volume during Ex were due to the muscle pump, with a small additional contribution by the ventilatory pump. An increase in intrathoracic pressure played a deleterious role in Fontan circulation by decreasing systemic venous return and stroke volume.

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Section: Discussioncontrasting

confidence: 99%

“…It has been shown in echocardiographic and cardiac magnetic resonance studies that there is an increase in venous return, particularly inferior vena cava flow, with inspiration with supine rest (22–24). In addition, changes in thoracic pressure with mechanical V E can affect venous return (25,26). …”

Section: Discussionmentioning

confidence: 99%

The Importance of the Muscle and Ventilatory Blood Pumps During Exercise in Patients Without a Subpulmonary Ventricle (Fontan Operation)

Shafer

García

Babb

et al. 2012

Journal of the American College of Cardiology

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“…Since the nineteenth century, negative pressure ventilation (NPV) has been used in paralyzed patients with respiratory insufficiency. It has been shown to improve both pulmonary blood flow and cardiac output, particularly in the Fontan circulation, and is associated with improved systemic venous return (15,(60)(61)(62)(63). NPV applies sub-atmospheric pressures to the thorax during inspiration, causing the thorax to expand, thereby reducing alveolar pressures, lowering PVR, and augmenting systemic venous return (64).…”

Section: Acute Changes In Pulmonary Vascular Resistance and Positive ...mentioning

confidence: 99%

Impairments in Pulmonary Function in Fontan Patients: Their Causes and Consequences

Laohachai

Ayer

2022

Front. Pediatr.

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Patients with a Fontan circulation lack a sub-pulmonary ventricle with pulmonary blood flow passively redirected to the lungs. In the Fontan circulation, ventilation has a significant influence on pulmonary blood flow and cardiac output both at rest and with exercise. Children and adults with a Fontan circulation have abnormalities in lung function. In particular, restrictive ventilatory patterns, as measured by spirometry, and impaired gas transfer, as measured by the diffusing capacity of carbon monoxide, have been frequently observed. These abnormalities in lung function are associated with reduced exercise capacity and quality of life. Moderate to severe impairment in lung volumes is independently associated with reduced survival in adults with congenital heart disease. Skeletal and inspiratory muscle weakness has also been reported in patients with a Fontan circulation, with the prospect of improving respiratory muscle function through exercise training programs. In this review, we will present data on cardiopulmonary interactions in the Fontan circulation, the prevalence and severity of impaired lung function, and respiratory muscle function in this population. We will discuss potential causes for and consequence of respiratory impairments, and their impact on exercise capacity and longer-term Fontan outcome. We aim to shed light on possible strategies to reduce morbidity by improving respiratory function in this growing population of patients.

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“…8,9 Existing literature dedicated to NPV use is limited to small case series or case reports in homogeneous disease states, such as acute lung injury, neuromuscular disorders, 7,10 neuromuscular disorders, 11,12 central hypoventilation, 4 bronchiolitis, 8 heart failure, and postoperative management of congenital heart disease. 6,[13][14][15] No published data on complication rates of NPV in a general pediatric population are available. Reported complications and limitations of current NPV devices have included hypothermia, skin irritation at contact points, and upper-airway obstruction because tracheal pressures can become more negative during NPV than during spontane-ous respiration.…”

Section: Introductionmentioning

confidence: 99%

Negative-Pressure Ventilation in Pediatric Acute Respiratory Failure

et al. 2017

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Negative Pressure Ventilation as a Therapy for Post-operative Complications in a Patient with Single Ventricle Physiology

Cited by 10 publications

References 7 publications

The Importance of the Muscle and Ventilatory Blood Pumps During Exercise in Patients Without a Subpulmonary Ventricle (Fontan Operation)

The Importance of the Muscle and Ventilatory Blood Pumps During Exercise in Patients Without a Subpulmonary Ventricle (Fontan Operation)

Impairments in Pulmonary Function in Fontan Patients: Their Causes and Consequences

Negative-Pressure Ventilation in Pediatric Acute Respiratory Failure

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