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

  • François Feihl
  • Alain F. Broccard


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.


Right Ventricular Continuous Positive Airway Pressure Superior Vena Cava Respir Crit Stroke Volume Variation 
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Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • François Feihl
    • 1
  • Alain F. Broccard
    • 2
  1. 1.Division of Clinical PathophysiologyUniversity Hospital (CHUV) and Lausanne University (UNIL)LausanneSwitzerland
  2. 2.Medical Intensive Care Unit, Regions Hospital Pulmonary and Critical Care DivisionRegions HospitalSt PaulUSA

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