Elevated mean systemic filling pressure due to intermittent positive-pressure ventilation

1992 ◽  
Vol 262 (4) ◽  
pp. H1116-H1121 ◽  
Author(s):  
E. Chihara ◽  
S. Hashimoto ◽  
T. Kinoshita ◽  
M. Hirose ◽  
Y. Tanaka ◽  
...  
Keyword(s):  
Blood Volume ◽  
Positive Pressure Ventilation ◽  
Venous Return ◽  
Intermittent Positive Pressure Ventilation ◽  
Spontaneous Respiration ◽  
Positive Pressure ◽  
Circulating Blood Volume ◽  
Mean Systemic Filling Pressure ◽  
Systemic Filling ◽  
Systemic Filling Pressure

To clarify the effect of intermittent positive-pressure ventilation (IPPV) on systemic circulation, mean systemic filling pressure (Psf) and circulating blood volume were measured together with other hemodynamic parameters of capacitance vessel. Change in circulating blood volume was determined by dilution with 51Cr-labeled erythrocytes. Vascular compliance (Cvas) was measured from the change in Psf caused by a bolus injection of blood. These parameters were measured during both spontaneous respiration and IPPV in male Wistar rats anesthetized with pentobarbital sodium. The shift from spontaneous respiration to IPPV reduced cardiac output (CO) by 20.9%. Psf increased significantly, from 7.1 +/- 1.2 to 8.6 +/- 1.1 mmHg. Central venous pressure (Pcv) also increased significantly. The pressure gradient for venous return decreased by 15.6% (from 6.4 to 5.4 mmHg). The resistance to venous return did not change significantly, but there was a significant increase in total peripheral resistance. Neither Cvas nor circulating blood volume was changed significantly by IPPV. These results indicate that during IPPV the increased Pcv attenuates the pressure gradient for venous return and decreases CO and that the compensatory increase in Psf is caused by a blood shift from unstressed to stressed blood volume.

Respiratory Effect on the Blood Volume of Pulmonary Capillaries

1988 ◽  
Vol 110 (2) ◽  
pp. 150-154 ◽  
Author(s):  
Jen-shih Lee ◽  
Timothy Fallon ◽  
Margaret Hunter ◽  
Qiang Ye ◽  
Lian-pin Lee
Keyword(s):  
Blood Volume ◽  
Positive Pressure Ventilation ◽  
Transpulmonary Pressure ◽  
Intermittent Positive Pressure Ventilation ◽  
Positive Pressure ◽  
Respiratory Effect ◽  
Negative Pressure Ventilation ◽  
Aortic Blood ◽  
Pulmonary Capillaries ◽  
Ventilation Method

We measured the density variations of aortic blood from rabbits ventilated by a positive end inspiratory pressure of 6 mmHg or a negative box pressure of the same magnitude. When calculated from the density variations, the fluctuations in blood volume of the pulmonary capillaries within one cycle as induced by an intermittent positive pressure ventilation were found to be similar to the ones induced by an intermittent negative pressure ventilation. Using these volumetric fluctuations as a means to assess the transpulmonary pressure and the transmural pressure across the pulmonary capillaries, we conclude that the switching of the ventilation method did not alter the cyclic fluctuations of these pressures.

Continuous positive-pressure ventilation does not alter ventricular pressure-volume relationship

1981 ◽  
Vol 240 (6) ◽  
pp. H821-H826 ◽  
Author(s):  
J. E. Fewell ◽  
D. R. Abendschein ◽  
C. J. Carlson ◽  
E. Rapaport ◽  
J. F. Murray
Keyword(s):  
Mechanical Properties ◽  
Positive Pressure Ventilation ◽  
Venous Return ◽  
Intermittent Positive Pressure Ventilation ◽  
Left Ventricular ◽  
Positive Pressure ◽  
Volume Relationship ◽  
Pressure Volume Relationship ◽  
The Right ◽  
Continuous Positive Pressure

To determine whether alterations in the mechanical properties (i.e., stiffening) of the right and left ventricles contribute to the decrease in right and left ventricular end-diastolic volumes during continuous positive-pressure ventilation (CPPV), we studied six dogs anesthetized with chloralose urethane and ventilated with a volume ventilator. We varied ventricular volumes by withdrawing or infusing blood. Pressure-volume curves, constructed by plotting transmural ventricular end-diastolic pressures against ventricular end-diastolic volumes, did not change during CPPV (12 cmH2O positive end-expiratory pressure) compared to intermittent positive-pressure ventilation (IPPV, 0 cmH2O end-expiratory pressure). We conclude that decreased ventricular end-diastolic volumes during CPPV result primarily from a decrease in venous return. Alterations in the mechanical properties of the ventricles do not play a significant role in this response.

Assessment of venous return curve and mean systemic filling pressure in postoperative cardiac surgery patients*

2009 ◽  
Vol 37 (3) ◽  
pp. 912-918 ◽  
Author(s):  
Jacinta J. Maas ◽  
Bart F. Geerts ◽  
Paul C. M. van den Berg ◽  
Michael R. Pinsky ◽  
Jos R. C. Jansen
Keyword(s):  
Cardiac Surgery ◽  
Venous Return ◽  
Filling Pressure ◽  
Mean Systemic Filling Pressure ◽  
Systemic Filling ◽  
Systemic Filling Pressure

scholarly journals Impact of positive pressure ventilation on mean systemic filling pressure in critically ill patients after death

2017 ◽  
Vol 122 (6) ◽  
pp. 1373-1378 ◽  
Author(s):  
Xavier Repessé ◽  
Cyril Charron ◽  
Guillaume Geri ◽  
Alix Aubry ◽  
Alexis Paternot ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Critically Ill ◽  
Venous Return ◽  
Filling Pressure ◽  
Positive End Expiratory Pressure ◽  
Mean Systemic Filling Pressure ◽  
Tidal Ventilation ◽  
Heart Beating ◽  
Systemic Filling ◽  
Systemic Filling Pressure

Mean systemic filling pressure (Pms) defines the pressure measured in the venous-arterial system when the cardiac output is nil. Its estimation has been proposed in patients with beating hearts by building the venous return curve, using different pairs of right atrial pressure/cardiac output during mechanical ventilation. We raised the hypothesis according to which the Pms is altered by tidal ventilation and positive end-expiratory pressure (PEEP), which would challenge this extrapolation method based on cardiopulmonary interactions. We conducted a two-center, noninterventional, observational, and prospective study, using an arterial and a venous catheter to measure the pressure in the circulatory system at the time of death in critically ill, mechanically ventilated patients with a PEEP. Arterial (Part) and venous pressures (Pra) were recorded in five conditions: at end expiration and end inspiration with and without PEEP and finally once the ventilator was disconnected. Part and Pra did not differ in any experimental conditions. Tidal ventilation increased Pra and Part by 2.4 and 1.9 mmHg, respectively, whereas PEEP increased both values by 1.2 and 1 mmHg, respectively. After disconnection of the ventilator, Pra and Part were 10.0 ± 4.2 and 9.9 ± 4.2 mmHg, respectively. Pms increases during mechanical ventilation, with an effect of tidal ventilation and PEEP. This calls into question the validity of its evaluation in heart-beating patients using cardiopulmonary interactions during mechanical ventilation. NEW & NOTEWORTHY The physiology of the mean systemic filling pressure (Pms) is not well understood in human beings. This study is the first report of a tidal ventilation- and positive end-expiratory pressure-related increase in Pms in critically ill patients. The results challenge the utility and the value estimating Pms in heart-beating patients by reconstruction of the venous return curve using varying inflation pressures.

scholarly journals Right atrial pressure and venous return during cardiopulmonary bypass

2017 ◽  
Vol 313 (2) ◽  
pp. H408-H420 ◽  
Author(s):  
Per W. Moller ◽  
Bernhard Winkler ◽  
Samuel Hurni ◽  
Paul Philipp Heinisch ◽  
Andreas Bloch ◽  
...  
Keyword(s):  
Venous Return ◽  
Filling Pressure ◽  
Atrial Pressure ◽  
Right Atrial ◽  
Right Atrial Pressure ◽  
Pump Speed ◽  
Mean Systemic Filling Pressure ◽  
Upstream Pressure ◽  
Systemic Filling ◽  
Systemic Filling Pressure

The relevance of right atrial pressure (RAP) as the backpressure for venous return (QVR) and mean systemic filling pressure as upstream pressure is controversial during dynamic changes of circulation. To examine the immediate response of QVR (sum of caval vein flows) to changes in RAP and pump function, we used a closed-chest, central cannulation, heart bypass porcine preparation ( n = 10) with venoarterial extracorporeal membrane oxygenation. Mean systemic filling pressure was determined by clamping extracorporeal membrane oxygenation tubing with open or closed arteriovenous shunt at euvolemia, volume expansion (9.75 ml/kg hydroxyethyl starch), and hypovolemia (bleeding 19.5 ml/kg after volume expansion). The responses of RAP and QVR were studied using variable pump speed at constant airway pressure (PAW) and constant pump speed at variable PAW. Within each volume state, the immediate changes in QVR and RAP could be described with a single linear regression, regardless of whether RAP was altered by pump speed or PAW ( r2 = 0.586–0.984). RAP was inversely proportional to pump speed from zero to maximum flow ( r2 = 0.859–0.999). Changing PAW caused immediate, transient, directionally opposite changes in RAP and QVR (RAP: P ≤ 0.002 and QVR: P ≤ 0.001), where the initial response was proportional to the change in QVR driving pressure. Changes in PAW generated volume shifts into and out of the right atrium, but their effect on upstream pressure was negligible. Our findings support the concept that RAP acts as backpressure to QVR and that Guyton’s model of circulatory equilibrium qualitatively predicts the dynamic response from changing RAP. NEW & NOTEWORTHY Venous return responds immediately to changes in right atrial pressure. Concomitant volume shifts within the systemic circulation due to an imbalance between cardiac output and venous return have negligible effects on mean systemic filling pressure. Guyton’s model of circulatory equilibrium can qualitatively predict the resulting changes in dynamic conditions with right atrial pressure as backpressure to venous return.

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