Top

Published in:

01-02-2009 | Review

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

Authors: François Feihl, Alain F. Broccard

Published in: Intensive Care Medicine | Issue 2/2009

Abstract

In Part I of this review, we have covered basic concepts regarding cardiorespiratory interactions. Here, we put this theoretical framework to practical use. We describe mechanisms underlying Kussmaul’s sign and pulsus paradoxus. We review the literature on the use of respiratory variations of blood pressure to evaluate volume status. We show the possibilities of attaining the latter aim by investigating with ultrasonography how the geometry of great veins fluctuates with respiration. We provide a Guytonian analysis of the effects of PEEP on cardiac output. We terminate with some remarks on the potential of positive pressure breathing to induce acute cor pulmonale, and on the cardiovascular mechanisms that at times may underly the failure to wean a patient from the ventilator.

In analogy with West lung zones, see Part I, Section “Respiration and cardiac function; RV afterload”.

O’Rourke RA, Silverman ME, Schlant RC (1994) Chap 10: general examination of the patient. In: Schlant RC, Wayne Alexander R (eds) The heart, arteries and veins. McGraw-Hill, New York, p 240

Fessler HE (1997) Heart-lung interactions: applications in the critically ill (review). Eur Respir J 10:226–237PubMedCrossRef

Takata M, Beloucif S, Shimada M, Robotham JL (1992) Superior and inferior vena caval flows during respiration: pathogenesis of Kussmaul’s sign. Am J Physiol 262:H763–H770PubMed

Scharf SM (1992) Cardiopulmonary interactions. In: Scharf SM (ed) Cardiopulmonary physiology in critical care. Marcel Dekker, New York, pp 333–355

Wise RA (1994) Historical perspectives on the mechanical interactions of respiration and circulation. In: Perret C (ed) Les interactions cardio-pulmonaires. Arnette, Paris, pp 3–15

Reddy PS, Curtiss EI (1990) Cardiac tamponade. Cardiol Clin 8:627–637PubMed

Jardin F, Farcot JC, Boisante L, Prost JF, Gueret P, Bourdarias JP (1982) Mechanism of paradoxic pulse in bronchial asthma. Circulation 66:887–894PubMed

Blaustein AS, Risser TA, Weiss JW, Parker JA, Holman BL, McFadden ER (1986) Mechanisms of pulsus paradoxus during resistive respiratory loading and asthma. J Am Coll Cardiol 8:529–536PubMedCrossRef

Vaska K, Wann LS, Sagar K, Klopfenstein HS (1992) Pleural effusion as a cause of right ventricular diastolic collapse. Circulation 86:609–617PubMed

10.

Silverman HJ, Haponik EF (1986) Pulsus paradoxus in pulmonary embolism: reversal with thrombolytic therapy. Crit Care Med 14:165–166PubMedCrossRef

11.

Ward GL, Heiselman DE, White LJ (1992) Pulsus paradoxus in anaphylactic shock due to urokinase administration. Chest 101:589PubMedCrossRef

12.

Hooper TL, Lawson RA (1986) Volvulus of the stomach—an unusual cause of pulsus paradoxus. Postgrad Med J 62:377–379PubMedCrossRef

13.

Baum VC, Tarnoff H, Hoffman JI (1980) Pulsus paradoxus in a patient with tricuspid atresia and hypoplastic right heart. Circulation 62:651–652PubMed

14.

Dornhorst AC, Howard P, Leathart GL (1952) Pulsus paradoxus. Lancet 1:746–748PubMedCrossRef

15.

Shabetai R, Fowler NO, Guntheroth WG (1970) The hemodynamics of cardiac tamponade and constrictive pericarditis. Am J Cardiol 26:480–489PubMedCrossRef

16.

Winer HE, Kronzon I (1979) Absence of paradoxical pulse in patients with cardiac tamponade and atrial septal defects. Am J Cardiol 44:378–380PubMedCrossRef

17.

Hoit BD, Gabel M, Fowler NO (1990) Cardiac tamponade in left ventricular dysfunction. Circulation 82:1370–1376PubMed

18.

Diebel L, Wilson RF, Heins J, Larky H, Warsow K, Wilson S (1994) End-diastolic volume versus pulmonary artery wedge pressure in evaluating cardiac preload in trauma patients. J Trauma 37:950–955PubMedCrossRef

19.

Tavernier B, Makhotine O, Lebuffe G, Dupont J, Scherpereel P (1998) Systolic pressure variation as a guide to fluid therapy in patients with sepsis-induced hypotension. Anesthesiology 89:1313–1321PubMedCrossRef

20.

Michard F, Boussat S, Chemla D, Anguel N, Mercat A, Lecarpentier Y, Richard C, Pinsky MR, Teboul JL (2000) Relation between respiratory changes in arterial pulse pressure and fluid responsiveness in septic patients with acute circulatory failure. Am J Respir Crit Care Med 162:134–138PubMed

21.

Pinsky MR (2003) Pulmonary artery occlusion pressure. Intensive Care Med 29:19–22PubMedCrossRef

22.

Hoyt JD, Leatherman JW (1997) Interpretation of the pulmonary artery occlusion pressure in mechanically ventilated patients with large respiratory excursions in intrathoracic pressure. Intensive Care Med 23:1125–1131PubMedCrossRef

23.

Qureshi AS, Shapiro RS, Leatherman JW (2007) Use of bladder pressure to correct for the effect of expiratory muscle activity on central venous pressure. Intensive Care Med 33:1907–1912PubMedCrossRef

24.

Feihl F, Perret C (1995) Right heart catheterization at bedside: a note of cautious optimism (comment). Intensive Care Med 21:296–298PubMedCrossRef

25.

Monnet X, Rienzo M, Osman D, Anguel N, Richard C, Pinsky MR, Teboul JL (2006) Passive leg raising predicts fluid responsiveness in the critically ill. Crit Care Med 34:1402–1407PubMedCrossRef

26.

De Backer D, Pinsky MR (2007) Can one predict fluid responsiveness in spontaneously breathing patients? Intensive Care Med 33:1111–1113PubMedCrossRef

27.

Monnet X, Teboul JL (2008) Passive leg raising. Intensive Care Med 34:659–663PubMedCrossRef

28.

Brower R, Wise RA, Hassapoyannes C, Bromberger-Barnea B, Permutt S (1985) Effect of lung inflation on lung blood volume and pulmonary venous flow. J Appl Physiol 58:954–963PubMedCrossRef

29.

Jardin F, Farcot JC, Gueret P, Prost JF, Ozier Y, Bourdarias JP (1983) Cyclic changes in arterial pulse during respiratory support. Circulation 68:266–274PubMed

30.

Vieillard-Baron A, Chergui K, Augarde R, Prin S, Page B, Beauchet A, Jardin F (2003) Cyclic changes in arterial pulse during respiratory support revisited by Doppler echocardiography. Am J Respir Crit Care Med 168:671–676PubMedCrossRef

31.

Perel A, Pizov R, Cotev S (1987) Systolic blood pressure variation is a sensitive indicator of hypovolemia in ventilated dogs subjected to graded hemorrhage. Anesthesiology 67:498–502PubMedCrossRef

32.

Pizov R, Ya’ari Y, Perel A (1989) The arterial pressure waveform during acute ventricular failure and synchronized external chest compression. Anesth Analg 68:150–156PubMed

33.

Pizov R, Cohen M, Weiss Y, Segal E, Cotev S, Perel A (1996) Positive end-expiratory pressure-induced hemodynamic changes are reflected in the arterial pressure waveform. Crit Care Med 24:1381–1387PubMedCrossRef

34.

Coriat P, Vrillon M, Perel A, Baron JF, Le Bret F, Saada M, Viars P (1994) A comparison of systolic blood pressure variations and echocardiographic estimates of end-diastolic left ventricular size in patients after aortic surgery (see comments). Anesth Analg 78:46–53PubMedCrossRef

35.

Michard F, Chemla D, Richard C, Wysocki M, Pinsky MR, Lecarpentier Y, Teboul JL (1999) Clinical use of respiratory changes in arterial pulse pressure to monitor the hemodynamic effects of PEEP. Am J Respir Crit Care Med 159:935–939PubMed

36.

Feissel M, Teboul JL, Merlani P, Badie J, Faller JP, Bendjelid K (2007) Plethysmographic dynamic indices predict fluid responsiveness in septic ventilated patients. Intensive Care Med 33:993–999PubMedCrossRef

37.

Duperret S, Lhuillier F, Piriou V, Vivier E, Metton O, Branche P, Annat G, Bendjelid K, Viale JP (2007) Increased intra-abdominal pressure affects respiratory variations in arterial pressure in normovolaemic and hypovolaemic mechanically ventilated healthy pigs. Intensive Care Med 33:163–171PubMedCrossRef

38.

Szold A, Pizov R, Segal E, Perel A (1989) The effect of tidal volume and intravascular volume state on systolic pressure variation in ventilated dogs. Intensive Care Med 15:368–371PubMedCrossRef

39.

Reuter DA, Bayerlein J, Goepfert MS, Weis FC, Kilger E, Lamm P, Goetz AE (2003) Influence of tidal volume on left ventricular stroke volume variation measured by pulse contour analysis in mechanically ventilated patients. Intensive Care Med 29:476–480PubMed

40.

Renner J, Cavus E, Meybohm P, Tonner P, Steinfath M, Scholz J, Lutter G, Bein B (2007) Stroke volume variation during hemorrhage and after fluid loading: impact of different tidal volumes. Acta Anaesthesiol Scand 51:538–544PubMedCrossRef

41.

Preisman S, Kogan S, Berkenstadt H, Perel A (2005) Predicting fluid responsiveness in patients undergoing cardiac surgery: functional haemodynamic parameters including the Respiratory Systolic Variation Test and static preload indicators. Br J Anaesth 95:746–755PubMedCrossRef

42.

Soubrier S, Saulnier F, Hubert H, Delour P, Lenci H, Onimus T, Nseir S, Durocher A (2007) Can dynamic indicators help the prediction of fluid responsiveness in spontaneously breathing critically ill patients? Intensive Care Med 33:1117–1124PubMedCrossRef

43.

Magder S, Georgiadis G, Cheong T (1992) Respiratory variations in right atrial pressure predict the response to fluid challenge. J Crit Care 7:76–85CrossRef

44.

Charron C, Caille V, Jardin F, Vieillard-Baron A (2006) Echocardiographic measurement of fluid responsiveness. Curr Opin Crit Care 12:249–254PubMedCrossRef

45.

Mandelbaum A, Ritz E (1996) Vena cava diameter measurement for estimation of dry weight in haemodialysis patients. Nephrol Dial Transplant 11(Suppl 2):24–27PubMed

46.

Haciomeroglu P, Ozkaya O, Gunal N, Baysal K (2007) Venous collapsibility index changes in children on dialysis. Nephrology (Carlton) 12:135–139CrossRef

47.

Feissel M, Michard F, Faller JP, Teboul JL (2004) The respiratory variation in inferior vena cava diameter as a guide to fluid therapy. Intensive Care Med 30:1834–1837PubMedCrossRef

48.

Barbier C, Loubieres Y, Schmit C, Hayon J, Ricome JL, Jardin F, Vieillard-Baron A (2004) Respiratory changes in inferior vena cava diameter are helpful in predicting fluid responsiveness in ventilated septic patients. Intensive Care Med 30:1740–1746PubMed

49.

Vieillard-Baron A, Augarde R, Prin S, Page B, Beauchet A, Jardin F (2001) Influence of superior vena caval zone condition on cyclic changes in right ventricular outflow during respiratory support. Anesthesiology 95:1083–1088PubMedCrossRef

50.

Vieillard-Baron A, Chergui K, Rabiller A, Peyrouset O, Page B, Beauchet A, Jardin F (2004) Superior vena caval collapsibility as a gauge of volume status in ventilated septic patients. Intensive Care Med 30:1734–1739PubMed

51.

Fessler HE, Brower RG, Wise RA, Permutt S (1992) Effects of positive end-expiratory pressure on the canine venous return curve. Am Rev Respir Dis 146:4–10PubMed

52.

Guyton AC, Jones CE, Coleman TG (1973) Circulatory physiology: cardiac output and its regulation. W. B. Saunders Company, Philadelphia

53.

Guyton AC (1955) Determination of cardiac output by equating venous return curves with cardiac response curves. Physiol Rev 35:123–129PubMed

54.

Qvist J, Pontoppidan H, Wilson RS, Lowenstein E, Laver MB (1975) Hemodynamic response to mechanical ventilation with PEEP: the effect of hypervolemia. Anesthesiology 42:45–55PubMedCrossRef

55.

Grace MP, Greenbaum DM (1982) Cardiac performance in response to PEEP in patients with cardiac dysfunction. Crit Care Med 10:358–360PubMedCrossRef

56.

Bradley TD, Holloway RM, McLaughlin PR, Ross BL, Walters J, Liu PP (1992) Cardiac output response to continuous positive airway pressure in congestive heart failure. Am Rev Respir Dis 145(2 Pt 1):377–382PubMed

57.

Rasanen J, Heikkila J, Downs J, Nikki P, Vaisanen I, Viitanen A (1985) Continuous positive airway pressure by face mask in acute cardiogenic pulmonary edema. Am J Cardiol 55:296–300PubMedCrossRef

58.

Naughton MT, Rahman MA, Hara K, Floras JS, Bradley TD (1995) Effect of continuous positive airway pressure on intrathoracic and left ventricular transmural pressures in patients with congestive heart failure. Circulation 91:1725–1731PubMed

59.

Lenique F, Habis M, Lofaso F, Dubois-Rande JL, Harf A, Brochard L (1997) Ventilatory and hemodynamic effects of continuous positive airway pressure in left heart failure. Am J Respir Crit Care Med 155:500–505PubMed

60.

Huberfeld SI, Genovese J, Tarasiuk A, Scharf SM (1995) Effect of CPAP on pericardial pressure and respiratory system mechanics in pigs. Am J Respir Crit Care Med 152:142–147PubMed

61.

Pinsky MR, Summer WR, Wise RA, Permutt S, Bromberger-Barnea B (1983) Augmentation of cardiac function by elevation of intrathoracic pressure. J Appl Physiol 54:950–955PubMed

62.

Rasanen J, Vaisanen IT, Heikkila J, Nikki P (1985) Acute myocardial infarction complicated by left ventricular dysfunction and respiratory failure. The effects of continuous positive airway pressure. Chest 87:158–162PubMedCrossRef

63.

Genovese J, Huberfeld S, Tarasiuk A, Moskowitz M, Scharf SM (1995) Effects of CPAP on cardiac output in pigs with pacing-induced congestive heart failure. Am J Respir Crit Care Med 152:1847–1853PubMed

64.

Mehta S, Liu PP, Fitzgerald FS, Allidina YK, Douglas Bradley T (2000) Effects of continuous positive airway pressure on cardiac volumes in patients with ischemic and dilated cardiomyopathy. Am J Respir Crit Care Med 161:128–134PubMed

65.

Scharf SM (2001) Ventilatory support in the failing heart. In: Scharf SM, Pinsky MR, Magder S (eds) Respiratory-circulatory interactions in health and disease. Marcel Dekker, New York, pp 519–550

66.

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 72:966–970PubMedCrossRef

67.

Vieillard-Baron A, Loubieres 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

68.

Jardin F, Vieillard-Baron A (2007) Is there a safe plateau pressure in ARDS? The right heart only knows. Intensive Care Med 33:444–447PubMedCrossRef

69.

The Acute Respiratory Distress Syndrome Network (2000) 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. N Engl J Med 342:1301–1308CrossRef

70.

Pinsky MR (2000) Breathing as exercise: the cardiovascular response to weaning from mechanical ventilation (comment). Intensive Care Med 26:1164–1166PubMedCrossRef

71.

Hurford WE, Lynch KE, Strauss HW, Lowenstein E, Zapol WM (1991) Myocardial perfusion as assessed by thallium–201 scintigraphy during the discontinuation of mechanical ventilation in ventilator-dependent patients. Anesthesiology 74:1007–1016PubMedCrossRef

72.

Lemaire F, Teboul JL, Cinotti L, Giotto G, Abrouk F, Steg G, Macquin-Mavier I, Zapol WM (1988) Acute left ventricular dysfunction during unsuccessful weaning from mechanical ventilation. Anesthesiology 69:171–179PubMedCrossRef

73.

Jubran A, Mathru M, Dries D, Tobin MJ (1998) Continuous recordings of mixed venous oxygen saturation during weaning from mechanical ventilation and the ramifications thereof. Am J Respir Crit Care Med 158:1763–1769PubMed

74.

Boles JM, Bion J, Connors A, Herridge M, Marsh B, Melot C, Pearl R, Silverman H, Stanchina M, Vieillard-Baron A, Welte T (2007) Weaning from mechanical ventilation. Eur Respir J 29:1033–1056PubMedCrossRef

75.

Thompson RB, McVeigh ER (2006) Cardiorespiratory-resolved magnetic resonance imaging: measuring respiratory modulation of cardiac function. Magn Reson Med 56:1301–1310PubMedCrossRef

Title: Interactions between respiration and systemic hemodynamics. Part II: practical implications in critical care
Authors: François Feihl
Alain F. Broccard
Publication date: 01-02-2009
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 2/2009
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-008-1298-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 2/2009

Pilot safety study of low-dose vasopressin in non-septic critically ill children

Respiratory, metabolic and hemodynamic effects of clonidine in ventilated patients presenting with withdrawal syndrome

Bile acids cause secretory phospholipase A2 activity enhancement, revertible by exogenous surfactant administration

The strong ion gap and outcome after cardiac arrest in patients treated with therapeutic hypothermia: a retrospective study

Effect of SOD-1 over-expression on myocardial function during resuscitated murine septic shock

Remifentanil-propofol analgo-sedation shortens duration of ventilation and length of ICU stay compared to a conventional regimen: a centre randomised, cross-over, open-label study in the Netherlands