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The pulmonary response to trauma and mechanical ventilation: Its consequences on hemodynamic function

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The lung and heart, including the right ventricle (RV) and left ventricle (LV), must be regarded as an integrated system. A change in function of any one, including the addition of mechanical ventilation, will induce a change in function of the other. Interaction between RV and LV primarily via the septum and initially independent of pericardial constraints, is now a fact of life that complicates the evaluation of either left or right ventricular function as an isolated system. In this setting, an increase in LV filling pressure at constant stroke volume need not reflect straightforward myocardial depression. A change in motion of the interventricular septum represents an important variable that modifies the usual evaluation of function based on the Frank-Starling relationship.

The RV is susceptible to large changes in volumes with small changes in filling pressure. These variations can have a significant effect on LV end-diastolic compliance and may result in RV ischemia due to an excessive elevation of RV free wall stress when right coronary artery disease or an inadequate systemic perfusion pressure is present.


Le poumon et le coeur (ventricule droit et ventricule gauche) constitue un véritable complexe. Quand les fonctions de l'un des deux éléments sont altérés l'altération se répercute sur l'autre composant. L'interaction entre le ventricule droit et le ventricule gauche par l'intermédiaire du septum interventriculaire indépendamment des contraintes péricardiques, est un facteur vital qui complique l'appréciation exacte de la fonction de chaque ventricule en tout que système isolé. Dans ce cadre l'augmentation de la pression de remplissage du ventricule gauche à volume constant ne reflète pas directement la repression myocardique. Une modification du mouvement du septum interventriculaire représente une variable importante qui modifie l'appréciation habituelle de la fonction. Le ventricule droit est susceptible de modifications volumétriques importantes même que la pression de remplissage est peu modifiée. Ces variations peuvent avoir un effet significatif sur la phase diastolique terminale du ventricule gauche et peuvent entraîner une ischémie du ventricule droit quand l'artère coronaire droite est altérée ou quand la pression de perfusion est insuffisante.

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Correspondence to Myron B. Laver M.D..

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Laver, M.B. The pulmonary response to trauma and mechanical ventilation: Its consequences on hemodynamic function. World J. Surg. 7, 31–41 (1983). https://doi.org/10.1007/BF01655910

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  • Left Ventricle
  • Right Ventricle
  • Filling Pressure
  • Interventricular Septum
  • Phase Diastolique