Cardiopulmonary Interactions in Critical Illness

  • L. D. H. Wood
  • J. B. Hall
Conference paper
Part of the Anaesthesiologie und Intensivmedizin / Anaesthesiology and Intensive Care Medicine book series (A+I, volume 178)


Understanding the mechanical interaction between respiration and circulation rests on understanding the individual elements. The pathophysiology of the circulation is best described by the control of the cardiac output by the systemic vessels, by the relationship between ventricular mechanics and cardiac output, and the coupling of the mechanical properties of systemic vessels with ventricular pumping function. Similarly, understanding the pathophysiology of respiration in critical illness is aided by a review of lung mechanics, pulmonary blood flow, and shunt in conditions of airflow obstruction and pulmonary edema. Because the central circulation including the heart is encased in a potential space between the lungs and chest wall (the pleural space), alterations in lung mechanics affecting intrathoracic pressure directly impinge on the central circulation and influence factors determining venous return. Furthermore, since pulmonary blood flow traverses small vessels surrounded by alveolar pressure, changes in alveolar pressure alter the distribution of pulmonary blood flow. On the other hand, vascular pressures in the central circulation in fluence lung liquid flux, cardiac output, and so indirectly influence intrapulmonary shunt. It is the purpose of this session to review aspects of these interactions, emphasizing the effects of alveolar pressure and the effects of vascular pressure on cardiorespiratory functions in critical illness. There will necessarily be some small overlap with the previous lecture discussing effects of intrathoracic pressure. The conceptual framework for this lecture is outlined below, including appropriate references.


Cardiac Output Critical Illness Pulmonary Blood Flow Intrathoracic Pressure Central Circulation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Res N, Sillye G, Aubier M, Rassidakis A, Roussos C (1983) Regional blood flow distribution in dogs during induced hypotension and low output. J Clin Invest 72: 935–947CrossRefGoogle Scholar
  2. Weber KT, et al (1981) Contractile mechanics and interaction of the right and left ventricles. Am J Cardiol 47: 689–95Google Scholar
  3. Hall JB, Wood LDH (1984) Acute hypoxemic respiratory failure. Med Grand Rounds 3: 183–185Google Scholar
  4. Wood LDH, Prewitt RM (1981) Cardiovascular management in hypoxemic respiratory failure. Am J Cardiol 47: 963–972PubMedCrossRefGoogle Scholar
  5. Prewitt RM, Wood LDH (1981) Effect of PEEP on left ventricular mechanics in patients with hypoxemic respiratory failure. Anaesthesiology 55: 409–415CrossRefGoogle Scholar
  6. Goldberg HS, Rabson J (1981) Control of the cardiac output by the systemic vessels. Am J Cardiol 47: 696–702PubMedCrossRefGoogle Scholar
  7. Robotham JL(1981) Cardiovascular disturbances in chronic respiratory insufficiency. Am J Cardiol 47: 941–949PubMedCrossRefGoogle Scholar
  8. Sandoval J, Long GR, Skoog C, Wood LDH, Oppenheimer L (1983) Independent influence of blood flow rate and mixed venous PO2 on shunt fraction. J Appl Physiol 55 (4): 1128–1133PubMedGoogle Scholar
  9. Breen PH, Schumacker PT, Hedenstierna G, Ali J, Wagner PD, Wood LDH (1982) How does increased cardiac output increase shunt in pulmonary edema? J Appl Physiol 53 (5): 1273–1280PubMedGoogle Scholar
  10. Malo J, Ali J, Wood LDH (1984) How does positive end-expiratory pressure reduce intrapulmonary shunt in canine pulmonary edema? J Appl Physiol: Respirat Environ Exerc Physiol 57 (4): 1002–1010Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1985

Authors and Affiliations

  • L. D. H. Wood
  • J. B. Hall

There are no affiliations available

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