Skip to main content
Top
Published in: Intensive Care Medicine 9/2003

01-09-2003 | Clinical Commentary

Right ventricular function and positive pressure ventilation in clinical practice: from hemodynamic subsets to respirator settings

Authors: François Jardin, Antoine Vieillard-Baron

Published in: Intensive Care Medicine | Issue 9/2003

Login to get access

Excerpt

When used in patients free of previous cardiorespiratory disease, mechanical ventilation with a normal tidal volume does not have any discernible hemodynamic consequences. Conversely, the presence of a pulmonary disease affecting the bronchial tree, lung parenchyma, or both, may induce extreme conditions for mechanical ventilation. In this setting, an adverse hemodynamic effect may seriously complicate respiratory support. …
Appendix
Available only for authorised users
Literature
1.
go back to reference Pinsky M (2003) Pulmonary artery occlusion pressure. Intensive Care Med 29:19–22PubMed Pinsky M (2003) Pulmonary artery occlusion pressure. Intensive Care Med 29:19–22PubMed
2.
go back to reference Pinsky M (2003) Clinical significance of pulmonary artery occlusion pressure. Intensive Care Med 29:175–178PubMed Pinsky M (2003) Clinical significance of pulmonary artery occlusion pressure. Intensive Care Med 29:175–178PubMed
3.
go back to reference Jardin F (2003) Ventricular interdependence: how does it impact on hemodynamic evaluation in clinical practice? Intensive Care Med 29:361–363 Jardin F (2003) Ventricular interdependence: how does it impact on hemodynamic evaluation in clinical practice? Intensive Care Med 29:361–363
4.
go back to reference Page B, Vieillard-Baron A, Beauchet A, Aegerter Ph, Prin S, Jardin F (2003) Low stretch ventilation strategy in acute respiratory distress syndrome/ 8 years of clinical experience in a single center. Crit Care Med 31:765–769PubMed Page B, Vieillard-Baron A, Beauchet A, Aegerter Ph, Prin S, Jardin F (2003) Low stretch ventilation strategy in acute respiratory distress syndrome/ 8 years of clinical experience in a single center. Crit Care Med 31:765–769PubMed
5.
go back to reference Guyton A, Linsdsey A, Abernathy B, Richardson T (1957) Venous return at various right atrial pressures and the normal venous return curve. Am J Physiol 189:609–615 Guyton A, Linsdsey A, Abernathy B, Richardson T (1957) Venous return at various right atrial pressures and the normal venous return curve. Am J Physiol 189:609–615
6.
go back to reference Fessler H, Brower R, Wise R, Premutt S (1991) Effects of positive end-expiratory pressure on the gradient for venous return. Am Rev Respir Dis 145:19–24 Fessler H, Brower R, Wise R, Premutt S (1991) Effects of positive end-expiratory pressure on the gradient for venous return. Am Rev Respir Dis 145:19–24
7.
go back to reference Van den Berg P, Jansen J, Pinsky M (2002) Effect of positive pressure on venous return in volume-loaded cardiac surgical patients. J Appl Physiol 92:1223–12231 Van den Berg P, Jansen J, Pinsky M (2002) Effect of positive pressure on venous return in volume-loaded cardiac surgical patients. J Appl Physiol 92:1223–12231
8.
go back to reference Takata M, Wise R, Robotham J (1990) Effects of abdominal pressure on venous return: abdominal vascular zone conditions. J Appl Physiol 69:1961–1972PubMed Takata M, Wise R, Robotham J (1990) Effects of abdominal pressure on venous return: abdominal vascular zone conditions. J Appl Physiol 69:1961–1972PubMed
9.
go back to reference Fessler H, Brower R, Wise R, Permutt S (1992) Effects of positive end-expiratory pressure on the canine venous return curve. Am Rev Respir Dis 146:4–10PubMed Fessler H, Brower R, Wise R, Permutt S (1992) Effects of positive end-expiratory pressure on the canine venous return curve. Am Rev Respir Dis 146:4–10PubMed
10.
go back to reference Jellinek H, Krenn H, Oczenski W, Veit F, Schwartz S, Fitzgerald D (2000) Influence of positive airway pressure on the pressure gradient for venous return in humans. J Appl Physiol 88:926–932PubMed Jellinek H, Krenn H, Oczenski W, Veit F, Schwartz S, Fitzgerald D (2000) Influence of positive airway pressure on the pressure gradient for venous return in humans. J Appl Physiol 88:926–932PubMed
11.
go back to reference Vieillard-Baron A, Augarde R, Prin S, Page B, MD, Beauchet A, Jardin F (2001) Influence of superior vena caval zone conditions on cyclic changes in right ventricular outflow during respiratory support. Anethesiology 95:1083–1088 Vieillard-Baron A, Augarde R, Prin S, Page B, MD, Beauchet A, Jardin F (2001) Influence of superior vena caval zone conditions on cyclic changes in right ventricular outflow during respiratory support. Anethesiology 95:1083–1088
12.
go back to reference Permutt S, Bromberger-Barnea B, Bane H (1962) Alveolar pressure, pulmonary venous pressure, and the vascular waterfall. Med Thorac 19:239–260 Permutt S, Bromberger-Barnea B, Bane H (1962) Alveolar pressure, pulmonary venous pressure, and the vascular waterfall. Med Thorac 19:239–260
13.
go back to reference Vieillard-Baron A, Loubières Y, Schmitt JM, Page B, Dubourg O, Jardin F (1999) Cyclic changes in right ventricular output impedance during mechanical ventilation. J Appl Physiol 87:1644–1650PubMed Vieillard-Baron A, Loubières Y, Schmitt JM, Page B, Dubourg O, Jardin F (1999) Cyclic changes in right ventricular output impedance during mechanical ventilation. J Appl Physiol 87:1644–1650PubMed
14.
go back to reference Jardin F, Brun-Ney D, Cazaux P, Dubourg O, Hardy A, Bourdarias JP (1989) Relation between transpulmonary pressure and right ventricular isovolumetric pressure change during respiratory support. Catheter Cardiovasc Diag 16:215–220 Jardin F, Brun-Ney D, Cazaux P, Dubourg O, Hardy A, Bourdarias JP (1989) Relation between transpulmonary pressure and right ventricular isovolumetric pressure change during respiratory support. Catheter Cardiovasc Diag 16:215–220
15.
go back to reference Jullien T, Valtier B, Hongnat JM, Dubourg O, Bourdarias JP, Jardin F (1995) Incidence of tricuspid regurgitation and vena caval backward flow in mechanically ventilated patients. A color Doppler and contrast echocardiographic study. Chest 107:488–493PubMed Jullien T, Valtier B, Hongnat JM, Dubourg O, Bourdarias JP, Jardin F (1995) Incidence of tricuspid regurgitation and vena caval backward flow in mechanically ventilated patients. A color Doppler and contrast echocardiographic study. Chest 107:488–493PubMed
16.
go back to reference Artucio H, Hurtado J, Zimet L, de Paula J, Beron M (1997) PEEP-induced tricuspid regurgitation. Intensive Care Med 23:806–807CrossRefPubMed Artucio H, Hurtado J, Zimet L, de Paula J, Beron M (1997) PEEP-induced tricuspid regurgitation. Intensive Care Med 23:806–807CrossRefPubMed
17.
go back to reference Suter P, Fairley H, Isenberg M (1975) Optimum end-expiratory airway pressure in patients with acute lung disease. N Engl J Med 292:284–289PubMed Suter P, Fairley H, Isenberg M (1975) Optimum end-expiratory airway pressure in patients with acute lung disease. N Engl J Med 292:284–289PubMed
18.
go back to reference Jardin F, Farcot JC, Boisante L, Curien N, Margairaz A, Bourdarias JP (1981) Influence of positive end-expiratory pressure on left ventricular performance. N Engl J Med 304:387–392PubMed Jardin F, Farcot JC, Boisante L, Curien N, Margairaz A, Bourdarias JP (1981) Influence of positive end-expiratory pressure on left ventricular performance. N Engl J Med 304:387–392PubMed
19.
go back to reference Schmitt JM, Vieillard-Baron A, Augarde R, Prin S, Page B, Jardin F (2001) PEEP titration in ARDS patients: impact on right ventricular outflow impedance evaluated by pulmonary artery Doppler flow velocity. Critical Care Med 29:1154–1158 Schmitt JM, Vieillard-Baron A, Augarde R, Prin S, Page B, Jardin F (2001) PEEP titration in ARDS patients: impact on right ventricular outflow impedance evaluated by pulmonary artery Doppler flow velocity. Critical Care Med 29:1154–1158
20.
go back to reference Rossi A, Gottfried B, Zocchi L, Higgs B, Lennox S, Calverley M, Begin P, Grassino A, Milic-Emili J (1985) Measurements of static compliance of the total respiratory system in patients with acute respiratory failure during mechanical ventilation. The effect of intrinsic positive end-expiratory pressure. Am Rev Respir Dis 131:672–677PubMed Rossi A, Gottfried B, Zocchi L, Higgs B, Lennox S, Calverley M, Begin P, Grassino A, Milic-Emili J (1985) Measurements of static compliance of the total respiratory system in patients with acute respiratory failure during mechanical ventilation. The effect of intrinsic positive end-expiratory pressure. Am Rev Respir Dis 131:672–677PubMed
21.
go back to reference Vieillard-Baron A, Prin S, Schmitt JM, Augarde R, Page B, Beauchet A, Jardin F (2002) Pressure/volume curves in acute respiratory distress syndrome: clinical demonstration of the influence of expiratory flow limitation on the initial slope. Am J Respir Crit Care Med 165:1107–1112PubMed Vieillard-Baron A, Prin S, Schmitt JM, Augarde R, Page B, Beauchet A, Jardin F (2002) Pressure/volume curves in acute respiratory distress syndrome: clinical demonstration of the influence of expiratory flow limitation on the initial slope. Am J Respir Crit Care Med 165:1107–1112PubMed
22.
go back to reference Morgan B, Guntheroth W, Dillard D (1965) Relationship of pericardial pressure to pleural pressure during quiet respiration and cardiac tamponade. Circ Res 26:493–498 Morgan B, Guntheroth W, Dillard D (1965) Relationship of pericardial pressure to pleural pressure during quiet respiration and cardiac tamponade. Circ Res 26:493–498
23.
go back to reference Jardin F, Brun-Ney D, Hardy A, Aegerter Ph, Beauchet A, Bourdarias JP (1991) Combined thermodilution and two-dimensional echocardiographic evaluation of right ventricular function during respiratory support with PEEP. Chest 99:162–168PubMed Jardin F, Brun-Ney D, Hardy A, Aegerter Ph, Beauchet A, Bourdarias JP (1991) Combined thermodilution and two-dimensional echocardiographic evaluation of right ventricular function during respiratory support with PEEP. Chest 99:162–168PubMed
24.
go back to reference Jellinek H, Krafft P, Fitzgerald R, Schwartz S, Pinsky M (2000) Right atrial pressure predicts hemodynamic response to apneic positive airway pressure. Crit Care Med 28:672–678PubMed Jellinek H, Krafft P, Fitzgerald R, Schwartz S, Pinsky M (2000) Right atrial pressure predicts hemodynamic response to apneic positive airway pressure. Crit Care Med 28:672–678PubMed
25.
go back to reference Dhainaut JF, Devaux J, Monsallier J, Brunet F, Villemant D, Huyghebaert MF (1986) Mechanism of decreased left ventricular preload during continuous positive pressure ventilation. Chest 90:74–80PubMed Dhainaut JF, Devaux J, Monsallier J, Brunet F, Villemant D, Huyghebaert MF (1986) Mechanism of decreased left ventricular preload during continuous positive pressure ventilation. Chest 90:74–80PubMed
26.
go back to reference Jardin F, Delorme G, Hardy A, Auvert B, Beauchet A, Bourdarias JP (1990) Reevaluation of hemodynamic consequences of positive pressure ventilation: emphasis on cyclic right ventricular afterloading by mechanical lung inflation. Anesthesiology 72:966–970PubMed Jardin F, Delorme G, Hardy A, Auvert B, Beauchet A, Bourdarias JP (1990) Reevaluation of hemodynamic consequences of positive pressure ventilation: emphasis on cyclic right ventricular afterloading by mechanical lung inflation. Anesthesiology 72:966–970PubMed
27.
go back to reference Gattinoni L, Pelosi P, Suter P, Pedoto A, Vercesi P, Lissoni A (1998) Acute respiratory distress syndrome caused by pulmonary and extrapulmonary disease. Different syndromes? Am J Respir Crit Care Med 158:3–11 Gattinoni L, Pelosi P, Suter P, Pedoto A, Vercesi P, Lissoni A (1998) Acute respiratory distress syndrome caused by pulmonary and extrapulmonary disease. Different syndromes? Am J Respir Crit Care Med 158:3–11
28.
go back to reference Rose E, Van Benthuysen K, Jackson T, Tucker C, Kaiser D, Grover R, Weil J (1983) Right ventricular performance during increased afterload impaired by hypercapnic acidosis in conscious dogs. Circ Res 52:76–84PubMed Rose E, Van Benthuysen K, Jackson T, Tucker C, Kaiser D, Grover R, Weil J (1983) Right ventricular performance during increased afterload impaired by hypercapnic acidosis in conscious dogs. Circ Res 52:76–84PubMed
29.
go back to reference Hickling K, Henderson S, Jackson R (1990) Low mortality associated with low volume/pressure-limited ventilation with permissive hypercapnia in severe acute respiratory distress syndrome. Intensive Care Med 16:372–377PubMed Hickling K, Henderson S, Jackson R (1990) Low mortality associated with low volume/pressure-limited ventilation with permissive hypercapnia in severe acute respiratory distress syndrome. Intensive Care Med 16:372–377PubMed
30.
go back to reference Amato M, Barbas C, Medeiraos D, Schetino G, Filho L, Kairalla R, Deheinzelin D, Morais C, Fernandes E, Tagaky T, De Carvalho C (1995) Beneficial effect of the ''open lung approach'' with low distending pressures in acute respiratory distress syndrome. Am J Respir Crit Care Med 152:1835–1846PubMed Amato M, Barbas C, Medeiraos D, Schetino G, Filho L, Kairalla R, Deheinzelin D, Morais C, Fernandes E, Tagaky T, De Carvalho C (1995) Beneficial effect of the ''open lung approach'' with low distending pressures in acute respiratory distress syndrome. Am J Respir Crit Care Med 152:1835–1846PubMed
31.
go back to reference Jardin F, Fellahi JL, Beauchet A, Vieillard-Baron A, Loubières Y, Page B (1999) Improved prognosis of acute respiratory distress syndrome 15 years on. Intensive Care Med 25:936–941PubMed Jardin F, Fellahi JL, Beauchet A, Vieillard-Baron A, Loubières Y, Page B (1999) Improved prognosis of acute respiratory distress syndrome 15 years on. Intensive Care Med 25:936–941PubMed
32.
go back to reference Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress Syndrome Network (2000) N Engl J Med 342:1301–1308 Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress Syndrome Network (2000) N Engl J Med 342:1301–1308
33.
go back to reference Jardin F, Gueret P, Dubourg O, Farcot JC, Margairaz A, Bourdarias JP (1985) Two-dimensional echocardiographic evaluation of right ventricular size and contractility in acute respiratory failure. Crit Care Med 13:952–956PubMed Jardin F, Gueret P, Dubourg O, Farcot JC, Margairaz A, Bourdarias JP (1985) Two-dimensional echocardiographic evaluation of right ventricular size and contractility in acute respiratory failure. Crit Care Med 13:952–956PubMed
34.
go back to reference Vieillard-Baron A, Schmitt JM, Beauchet A, Augarde R, Prin S, Page B, Jardin F (2001) Acute cor pulmonale in acute respiratory distress syndrome submitted to protective ventilation: incidence, clinical implications and prognosis. Crit Care Med 29:1551–1555PubMed Vieillard-Baron A, Schmitt JM, Beauchet A, Augarde R, Prin S, Page B, Jardin F (2001) Acute cor pulmonale in acute respiratory distress syndrome submitted to protective ventilation: incidence, clinical implications and prognosis. Crit Care Med 29:1551–1555PubMed
35.
go back to reference Gattinoni L, Presenti A, Torresin A, Baglioni S, Rivolta M, Rossi F, Scarani F, Marcolin R, Cappelletti G (1986) Adult respiratory distress syndrome profiles by computed tomography. J Thoracic Imaging 1:25–30 Gattinoni L, Presenti A, Torresin A, Baglioni S, Rivolta M, Rossi F, Scarani F, Marcolin R, Cappelletti G (1986) Adult respiratory distress syndrome profiles by computed tomography. J Thoracic Imaging 1:25–30
36.
go back to reference Richecoeur J, Q Lu Q, S Vieira, Puybasset L, Kalfon P, Coriat P, Rouby JJ (1998) Expiratory washout versus optimization of mechanical ventilation during permissive hypercapnia in patients with severe acute respiratory distress syndrome. Am J Respir Crit Care Med 160:77–85 Richecoeur J, Q Lu Q, S Vieira, Puybasset L, Kalfon P, Coriat P, Rouby JJ (1998) Expiratory washout versus optimization of mechanical ventilation during permissive hypercapnia in patients with severe acute respiratory distress syndrome. Am J Respir Crit Care Med 160:77–85
37.
go back to reference Vieillard-Baron A, Prin S, Augarde R, Desfonds P, Page B, Beauchet A, MD, Jardin F (2002) Increasing respiratory rate to improve CO2 clearance during mechanical ventilation is not a panacea in acute respiratory failure. Crit Care Med 30:1407–1412PubMed Vieillard-Baron A, Prin S, Augarde R, Desfonds P, Page B, Beauchet A, MD, Jardin F (2002) Increasing respiratory rate to improve CO2 clearance during mechanical ventilation is not a panacea in acute respiratory failure. Crit Care Med 30:1407–1412PubMed
38.
go back to reference Prin S, Chergui K, Augarde R, Page B, Jardin F, Vieillard-Baron A (2002) Ability and safety of a heated humidifier to control hypercapnic acidosis in severe ARDS. Intensive Care Med 28:1756–1760CrossRefPubMed Prin S, Chergui K, Augarde R, Page B, Jardin F, Vieillard-Baron A (2002) Ability and safety of a heated humidifier to control hypercapnic acidosis in severe ARDS. Intensive Care Med 28:1756–1760CrossRefPubMed
39.
go back to reference Scherrer-Crosbie M, Streckenbach S, Zapol W (2001) Acute cor pulmonale in acute respiratory distress syndrome: a dreaded complication of the past? Crit Care Med 29:1641–1642 Scherrer-Crosbie M, Streckenbach S, Zapol W (2001) Acute cor pulmonale in acute respiratory distress syndrome: a dreaded complication of the past? Crit Care Med 29:1641–1642
40.
go back to reference Rouby JJ, Lu Q, Goldstein I (2002) Selecting the right level of positive end-expiratory pressure in patients with acute respiratory distress syndrome. Am J Respir Crit Care Med 165:1182–1186 Rouby JJ, Lu Q, Goldstein I (2002) Selecting the right level of positive end-expiratory pressure in patients with acute respiratory distress syndrome. Am J Respir Crit Care Med 165:1182–1186
41.
go back to reference Jardin F, Bourdarias JP (1995) Right heart catheterization at bedside: a critical view. Intensive Care Med 21:291–295PubMed Jardin F, Bourdarias JP (1995) Right heart catheterization at bedside: a critical view. Intensive Care Med 21:291–295PubMed
42.
go back to reference Vieillard-Baron A, Prin S, Chergui K, Dubourg O, Jardin F (2002) Echo-doppler demonstration of acute cor pulmonale at the bedside in the medical intensive care unit. Am J Respir Crit Care Med 166:1310–1319CrossRefPubMed Vieillard-Baron A, Prin S, Chergui K, Dubourg O, Jardin F (2002) Echo-doppler demonstration of acute cor pulmonale at the bedside in the medical intensive care unit. Am J Respir Crit Care Med 166:1310–1319CrossRefPubMed
Metadata
Title
Right ventricular function and positive pressure ventilation in clinical practice: from hemodynamic subsets to respirator settings
Authors
François Jardin
Antoine Vieillard-Baron
Publication date
01-09-2003
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 9/2003
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-003-1873-1

Other articles of this Issue 9/2003

Intensive Care Medicine 9/2003 Go to the issue

Announcements

September 2003