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

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Abstract

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.

Résumé

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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References

  1. 1.

    Laver, M.B., Strauss, H.W., Pohost, G.M.: Right and left ventricular geometry: Adjustments during acute respiratory failure. Crit. Care Med.7:509, 1979

  2. 2.

    Laver, M.B., Pohost, G.M., Strauss, H.W.: Hemo-dynamic adjustments in acute respiratory failure: The role of the right ventricle. In Akute Respiratorische Insuffizienz, K. Peter, editor. Anaesthesiol. Intensivmed. Prax.131:104, 1980

  3. 3.

    Clowes, G.H.A., Jr., Farrington, G.H., Zuschneid, W., Cossette, G.R., Saravis, C.: Circulating factors in the etiology of pulmonary insufficiency and right heart failure accompanying severe sepsis (peritonitis). Ann. Surg.171:663, 1970

  4. 4.

    Craddock, P.R., Fehr, J., Brigham, K.L., Kronenberg, R.S., Jacob, H.S.: Complement and leukocyteme diated pulmonary dysfunction in hemodialysis. N. Engl. J. Med.296:769, 1977

  5. 5.

    Hammond, G.L.: Acute respiratory failure. Surg. Clin. North Am.60:1133, 1980

  6. 6.

    Jacob, H.S., Craddock, P.R., Hammerschmidt, D.E., Moldow, C.F.: Complement-induced granulocyte aggregation. N. Engl. J. Med.302:789, 1980

  7. 7.

    Badke, F.R.: Left ventricular dimensions and function during right ventricular pressure overload. Am. J. Physiol.242 (Heart Circ. Physiol. 11):H611, 1982

  8. 8.

    Brinker, J.A., Weiss, J.L., Lappe, D.L., Rabson, J.L., Summer, W.R., Permutt, S., Weisfeldt, M.L.: Leftward septal displacement during right ventricular loading in man. Circulation61:626, 1980

  9. 9.

    Kerber, R.E., Dippel, W.F., Abboud, F.M.: Abnormal motion of the interventricular septum in right ventricular volume overload. Circulation48:86, 1973

  10. 10.

    Laks, M.M., Garner, D., Swan, H.J.C.: Volumes and compliances measured simultaneously in the right and left ventricles of the dog. Circ. Res.20:565, 1967

  11. 11.

    Scharf, S.M., Brown, R.: Influence of the right ventricle on canine left ventricular function with PEEP. J. Appl. Physiol.52:254, 1982

  12. 12.

    Qvist, J., Mygind, T., Crottogini, A., Jordening, H.: Ventricular volumes in experimental acute lung disease. Schweiz. Med. Wochenschr.111:1809, 1981

  13. 13.

    Spadaro, J., Bing, O.H.L., Gaasch, W.H., Weintraub, R.M.: Pericardial modulation of right and left ventricular diastolic interaction. Circ. Res.48:233. 1981

  14. 14.

    Cassidy, S.S., Mitchell, J.H., Johnson, R.L., Jr.: Dimensional analysis of right and left ventricles during positive-pressure ventilation in dogs. Am. J. Physiol.242 (Heart Circ. Physiol.11):H549, 1982

  15. 15.

    Fewell, J.E., Abendschein, D.R., Carlson, C.J., Rapaport, E., Murray, J.F.: Mechanism of decreased right and left ventricular end-diastolic volumes during continuous positive-pressure ventilation in dogs. Circ. Res.47:467, 1980

  16. 16.

    Scharf, S.M., Brown, R., Tow, D.E., Parisi, A.F.: Cardiac effects of increased lung volume and decreased pleural pressure in man. J. Appl. Physiol.47:257, 1979

  17. 17.

    Martyn, J.A.J., Snider, M.T., Szyfelbein, S.K., Burke, J.F., Laver, M.B.: Right ventricular dysfunction in acute thermal injury. Ann. Surg.191:330, 1980

  18. 18.

    Tennant, R., Wiggers, C.J.: The effect of coronary occlusion on myocardial contraction. Am. J. Physiol.112:351, 1935

  19. 19.

    Cosio, F.G., Martinez, J.P., Serrano, C.M., de la Calzada, C.S., Alcaine, C.C.: Abnormal septal motion in cardiac tamponade with pulsus paradoxus. Chest71:787, 1977

  20. 20.

    Lerman, B.B., Talano, J.V., Meyers, S.N., Lesch, M.: Reciprocal changes in ventricular dimensions related to respiration. Arch. Intern. Med.140:685, 1980

  21. 21.

    Scharf, S.M., Bianco, J.A., Tow, D.E., Brown, R.: The effects of large negative intrathoracic pressure on left ventricular function in patients with coronary artery disease. Circulation63:871, 1981

  22. 22.

    Snider, M.T., Rie, M.A., Lauer, J., Zapol, W.M.: Normoxic pulmonary vasoconstriction in ARDS: Detection by sodium nitroprusside (N) and isoproterenol (I) infusions. Am. Rev. Resp. Dis.121:191, 1980

  23. 23.

    Green, R., Zapol, W.M., Snider, M.T., Reid, L., Snow, R., O'Connell, R.S., Novelline, R.A.: Early bedside detection of pulmonary vascular occlusion during acute respiratory failure. Am. Rev. Resp. Dis.122:593, 1981

  24. 24.

    Snider, M.T., Rie, M.A., Bingham, J.B., Lauer, J., Urbina, A., Strauss, H.W.: Right ventricular performance in ARDS: Radionuclide scintiscan and thermal dilution studies. Am. Rev. Resp. Dis.121:192, 1980

  25. 25.

    Vlahakes, G.J., Turley, K., Hoffman, J.I.E.: The pathophysiology of failure in acute right ventricular hypertension: Hemodynamic and biochemical correlations. Circulation63:87, 1981

  26. 26.

    Liberthson, R.R., Boucher, C.A., Strauss, H.W., Dinsmore, R.E., McKusick, K.A., Pohost, G.M.: Right ventricular function in adult atrial septal defect. Am. J. Cardiol.47:56, 1981

  27. 27.

    Lugaresi, E., Coccagna, G., Cirignotta, F.: Snoring and its clinical implications. In Sleep Apnea Syndromes, C. Guilleminault, W.C. Dement, editors, New York, Alan R. Liss, Inc., 1978, pp. 13–21

  28. 28.

    Bergofsky, E.H., Bass, B.G., Ferretti, R., Fishman, A.P.: Pulmonary vasoconstriction in response to precapillary hypoxemia. J. Clin. Invest.42:1201, 1963

  29. 29.

    Parsons, G.H., Green, J.F.: Mechanisms of pulsus paradoxus in upper airway obstruction. J. Appl. Physiol.45:598, 1978

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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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Keywords

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