Abstract
Purpose
To compare the hemodynamic effects of medical antishock trousers (MAST) inflation in mechanically ventilated patients with normal and poor left ventricular function.
Methods
Twelve patients requiring respiratory support were divided into two groups according to baseline transesophageal echocardiography (TEE) measurements: normal left ventricular dimensions and fractional area of contraction (FAC=61 ± 5%) (n=7) and dilated cardiomyopathy with reduced FAC (21 ± 1%) (n=5). All patients were studied when two successive levels of load (mild load by inflation of the leg compartment of MAST at 50 cmH2O and high load by adding the abdominal compartment of MAST inflated at 30 cmH2O) were applied. Global left ventricular systolic function was assessed on the TEE transgastric short-axis view. End-systolic wall stress (ESWS) was used as an indicator of left ventricular afterload.
Results
Total respiratory, lung and chest wall compliances were reduced by 48%, 51% and 27% respectively at the high load level (P < 0.05). Whereas no hemodynamic changes occurred at mild load, the high load level produced an increase in left ventricular afterload as evidenced by concomitant increases in diastolic arterial blood pressure (66 ± 6 to 79 ± 6 mmHg,P < 0.05) and ESWS (69 ± 12 to 74 ± 12 Kdyn·cm−2·m−2,P < 0.05). In patients with dilated cardiomyopathy, this increase in afterload impaired the left ventricular systolic function and end-systolic area increased (19.0 ± 2.5 to 21.4 ± 2.9 cm2·m−2,P < 0.05) while FAC decreased (22 ± 2 to 16 ± 2%,P < 0.05). Left ventricular end-diastolic area remained unchanged during the study in both groups.
Conclusion
MAST inflation impairs respiratory mechanics and global left ventricular systolic function in cardiac patients without changes in left ventricular preload.
Résumé
Objectif
Comparer les effets circulatoires du pantalon antichoc (PAC) chez des patients ventilés à fonction ventriculaire gauche (VG) normale et altérée.
Méthodes
Douze patients ventilés ont été répartis en deux groupes selon les données de l’échocardiographie transesophagienne (ETO): dimensions VG et fraction de raccourcissement de surface (FRS) normales (n = 7) ou myocardiopathie dilatée (FRS = 21 ± 1%) (n = 5). Deux niveaux de charge ont été appliqués: charge légère obtenue en gonflant les membres inférieurs du PAC à 50 mmHg et charge élevée en ajoutant le compartiment abdominal gonflé à 30 mmHg. La performance globale VG a été mesurée par ETO et le calcu de la contrainte télésystolique (CSVG) utilisé pour l’appréciation de la postcharge.
Résultats
Les compliances respiratoire totale, pulmonaire et pariétale sont abaissées pour le niveau de charge élevé. Si le niveau de charge légère n’a pas entraîné de modifications hémodynamiques, la charge élevée a provoqué une augmentation de la post charge VG objectivée par l’augmentation de la pression artérielle diastolique (66 ± 6 à 79 ± 6 mmHg,P < 0,05) et de la CSVG (69 ± 12 à 74 ± 12 Kdyn·cm−2·m−2,P < 0,05). Chez les patients dilatés, cette élévation de postcharge s’est accompagnée d’une détérioration de la performance VG: augmentation de la surface télésystolique VG (19,0 ± 2,5 à 21,4 ± 2,9 cm−2·m−2,P < 0,05) et diminution de la FRS (22 ± 2 à 16 ± 2 %,P < 0,05). Les dimensions diastoliques VG n’ont pas varié au cours de l’étude.
Conclusion
Le PAC altère la mécanique respiratoire et génère une élévation de postcharge VG qui détériore la fonction systolique globale chez les patients cardiaques sans modifier la précharge VG.
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Fellahi, JL., Valtier, B., Beauchet, A. et al. Hemodynamic effects of medical antishock trousers during mechanical ventilation. Can J Anesth 46, 423–428 (1999). https://doi.org/10.1007/BF03012940
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DOI: https://doi.org/10.1007/BF03012940