Accuracy of Tissue Doppler Estimation of the Right Atrial Pressure in Anesthetized, Paralyzed, and Mechanically Ventilated Patients

2006 ◽  
Vol 97 (11) ◽  
pp. 1654-1656 ◽  
Author(s):  
Isabelle Michaux ◽  
Miodrag Filipovic ◽  
Karl Skarvan ◽  
Stephan Schneiter ◽  
Manfred D. Seeberger
Keyword(s):  
Tissue Doppler ◽  
Atrial Pressure ◽  
Right Atrial ◽  
Right Atrial Pressure ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
The Right ◽  
Ventilated Patients

Pressure-flow and volume-flow relationships of the systemic circulation of the dog

1975 ◽  
Vol 229 (3) ◽  
pp. 761-769 ◽  
Author(s):  
JF Green
Keyword(s):  
Volume Flow ◽  
Back Pressure ◽  
Atrial Pressure ◽  
Right Atrial ◽  
Right Atrial Pressure ◽  
Sodium Pentobarbital ◽  
Pressure Flow ◽  
Group I ◽  
Group Ii ◽  
The Right

Mean systemic pressure-flow (Ps-Q) and volume-flow (V-Q) relationships of the systemic vascular bed were determined in two groups of dogs anesthetized with sodium pentobarbital (group I) and with methoxyflurane (group II). All blood returning to the heart (Q) was removed from the right atrial appendage and passed through a Starling resistor, a pump, a flowmeter , and then returned directly into the pulmonary artery. Ps was estimated from plateau values of right atrial pressure obtained during stop-flow procedures. Both the Ps-Q and V-Q relationships were nonlinear. This nonlinearity may be attributed to a redistribution of blood flow between systemic vascular compartments of unequal time constants. With group II, the Ps-Q and V-Q curves were shifted markedly to the right along the Ps and V axes, respectively. Evidence is presented which suggests that this shift was due to an effective back pressure other than right atrial pressure produced by a hepatic waterfall. The beta-adrenergic antagonist practolol increased the effective back pressure and augmented the shift in the Ps-Q and V-Q curves.

Haemodynamic assessments in mechanically ventilated patients

2020 ◽  
pp. 321-326
Author(s):  
Antoine Vieillard-Baron
Keyword(s):  
Pulse Pressure ◽  
Positive Pressure Ventilation ◽  
Superior Vena ◽  
Vena Cava ◽  
Positive Pressure ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Pulmonary Capillaries ◽  
The Right ◽  
Ventilated Patients

Knowledge of heart–lung interactions is key to manage haemodynamics in mechanically ventilated patients (see also Chapter 5). It allows intensivists to understand the meaning of blood and pulse pressure respiratory variations (PPV). Unlike spontaneous breathing, positive pressure ventilation increases blood pressure and pulse pressure during inspiration following by a decrease during expiration. This is called reverse pulsus paradoxus and includes a ‘d-down’ and a ‘d-up’ effect. No variation means no effect of mechanical ventilation on the heart and especially on the right heart. In case of significant PPV, tidal volume usually reduces right ventricular stroke volume by way of reducing preload where systemic venous return is decreased (fluid expansion is useful to restore haemodynamics, when impaired) or increasing afterload (obstruction of pulmonary capillaries due to alveolar inflation and, in this case, fluid expansion is useless or even sometimes deleterious). Clinical examination as well as evaluation of respiratory variations of superior vena cava by echo, helps to distinguish between these two situations. By studying the beat-by-beat changes in echo parameters induced by positive pressure ventilation heartbeat by heartbeat, echocardiography is perfectly suited to study heart–lung interactions and then to propose an appropriate optimization in case of haemodynamic impairment.

Acute, reversible tricuspid insufficiency: creation in canine model

1991 ◽  
Vol 260 (2) ◽  
pp. H638-H641 ◽  
Author(s):  
T. E. Kinney ◽  
G. N. Olinger ◽  
K. B. Sagar ◽  
L. E. Boerboom
Keyword(s):  
Right Atrium ◽  
Color Doppler ◽  
Canine Model ◽  
Atrial Pressure ◽  
Right Atrial ◽  
Right Atrial Pressure ◽  
Atrioventricular Canal ◽  
Control Value ◽  
Tricuspid Insufficiency ◽  
The Right

Relatively few methods have been described for the creation of valvular insufficiency in an animal model. Those presented involve limitations such as permanent destruction of the valves or lack of control over the degree of regurgitation produced. We describe a method of acute reversible tricuspid insufficiency that can be easily created and controlled in anesthetized dogs. The model employs a wire spiral that is advanced through the atrioventricular canal from the right atrium. The spiral causes regurgitation by preventing complete apposition of the valve leaflets while permitting retrograde flow to occur through the spiral lumen. The degree of regurgitation can be controlled by the use of spirals of different sizes. Creation of tricuspid insufficiency is demonstrated by the onset of right atrial pressure V waves, a "ballooning" of the right atrium during ventricular systole, palpation of an atrial thrill, or by color Doppler echocardiography. In 14 dogs, right atrial pressure increased from a control value of 9 +/- 3 (mean +/- SD) mmHg to 10 +/- 3 and 12 +/- 3 mmHg, respectively, with spirals of 1.5 and 2.2 cm in diameter (both P less than 0.05). With the 2.2-cm spiral, aortic blood pressure decreased from a control value of 104 +/- 20 to 83 +/- 17 mmHg (P less than 0.05), and cardiac output decreased from 73 +/- 26 to 59 +/- 19 ml.min-1.kg-1 (P less than 0.05). This model is reversible, allows repeated trials of various grades of regurgitation, does not require ventriculotomy, and is relatively nonarrhythmogenic.

scholarly journals Supraclavicular Approach Is an Easy and Safe Method of Subclavian Vein Catheterization Even in Mechanically Ventilated Patients

2009 ◽  
Vol 111 (2) ◽  
pp. 334-339 ◽  
Author(s):  
Tomasz Czarnik ◽  
Ryszard Gawda ◽  
Tadeusz Perkowski ◽  
Rafal Weron
Keyword(s):  
Confidence Interval ◽  
Complication Rate ◽  
Central Venous Catheterization ◽  
Central Venous ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Supraclavicular Approach ◽  
Venous Catheterization ◽  
The Right ◽  
Ventilated Patients

Background Central venous catheters are commonly inserted for hemodynamic monitoring, volume monitoring, administration of medications, long-term total parenteral nutrition, access for renal replacement therapy, cardiopulmonary resuscitation, and difficult peripheral catheterization. The primary outcome of this study was to define venipuncture, catheterization and entire procedure success rates, and finally complication rate of subclavian venous catheterization via the supraclavicular approach with special focus on mechanically ventilated patients. The secondary outcome was to potentially make recommendations regarding this technique of central venous catheterization in mechanically ventilated patients. Methods The methodology of this prospective cohort study included subclavian venous catheterization via the supraclavicular approach. The technique of cannulation was the same for both the right and left sides, but the right claviculosternocleidomastoid angle was the preferred catheterization site. All procedures were performed by the first three authors, each of whom had different levels of experience. Each physician had performed at least 20 procedures before starting the study. Results In the majority of patients, venipuncture occurred during the first attempt. In 362 patients, catheterization attempts were performed, in whom 311 catheterizations (85.6%) were successful during the first attempt. The overall subclavian venous catheterization via supraclavicular approach procedure complication rate reached 1.7% (95% confidence interval 0.6-3.6%). The overall subclavian venous catheterization via the supraclavicular approach procedure success rate reached 88.9% (95% confidence interval 85.1-91.9%, n = 359). Conclusions Subclavian venous catheterization via the supraclavicular approach is an excellent method of central venous access in mechanically ventilated patients. The procedure success rate and the significant complication rate are comparable to other techniques of central venous catheterization.

scholarly journals The Impact of Deep Y Descent on Hemodynamics in Patients With Heart Failure and Preserved Left Ventricular Systolic Function

2021 ◽  
Vol 8 ◽  
Author(s):  
Daisuke Harada ◽  
Hidetsugu Asanoi ◽  
Takahisa Noto ◽  
Junya Takagawa
Keyword(s):  
Heart Rate ◽  
Systolic Function ◽  
Left Ventricular Systolic Function ◽  
Left Ventricular ◽  
Atrial Pressure ◽  
Right Atrial ◽  
Right Atrial Pressure ◽  
Pressure Waveform ◽  
Ventricular Systolic Function ◽  
The Right

Background: Influence of right ventricular diastolic function on the hemodynamics of heart failure (HF). We aimed to clarify the hemodynamic features of deep Y descent in the right atrial pressure waveform in patients with HF and preserved left ventricular systolic function.Methods: In total, 114 consecutive inpatients with HF who had preserved left ventricular systolic function (left ventricular ejection fraction ≥ 50%) and right heart catheterization were retrospectively enrolled in this study. The patients were divided into two groups according to right atrial pressure waveform, and those with Y descent deeper than X descent in the right atrial pressure waveform were assigned to the deep Y descent group. We enrolled another seven patients (two men, five women; mean age, 87 ± 6) with HF and preserved ejection fraction, and implanted a pacemaker to validate the results of this study.Results: The patients with deep Y descent had a higher rate of atrial fibrillation, higher right atrial pressure and mean pulmonary arterial pressure, and lower stroke volume and cardiac index than those with normal Y descent (76 vs. 7% p < 0.001, median 8 vs. 5 mmHg p = 0.001, median 24 vs. 21 mmHg p = 0.036, median 33 vs. 43 ml/m2p < 0.001, median 2.2 vs. 2.7 L/m2, p < 0.001). Multiple linear regression revealed a negative correlation between stroke volume index and pulmonary vascular resistance index (wood unit*m2) only in the patients with deep Y descent (estimated regression coefficient: −1.281, p = 0.022). A positive correlation was also observed between cardiac index and heart rate in this group (r = 0.321, p = 0.038). In the other seven patients, increasing the heart rate (from median 60 to 80/min, p = 0.001) significantly reduced the level of BNP (from median 419 to 335 pg/ml, p = 0.005).Conclusions: The hemodynamics of patients with HF with deep Y descent and preserved left ventricular systolic function resembled right ventricular restrictive physiology. Optimizing the heart rate may improve hemodynamics in these patients.

Sign in / Sign up

Export Citation Format

Share Document