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{"title":"Respiratory-Cardiovascular Interactions During Mechanical Ventilation: Physiology and Clinical Implications.","authors":"John Kreit","doi":"10.1002/cphy.c210003","DOIUrl":null,"url":null,"abstract":"<p><p>Positive-pressure inspiration and positive end-expiratory pressure (PEEP) increase pleural, alveolar, lung transmural, and intra-abdominal pressure, which decrease right and left ventricular (RV; LV) preload and LV afterload and increase RV afterload. The magnitude and clinical significance of the resulting changes in ventricular function are determined by the delivered tidal volume, the total level of PEEP, the compliance of the lungs and chest wall, intravascular volume, baseline RV and LV function, and intra-abdominal pressure. In mechanically ventilated patients, the most important, adverse consequences of respiratory-cardiovascular interactions are a PEEP-induced reduction in cardiac output, systemic oxygen delivery, and blood pressure; RV dysfunction in patients with ARDS; and acute hemodynamic collapse in patients with pulmonary hypertension. On the other hand, the hemodynamic changes produced by respiratory-cardiovascular interactions can be beneficial when used to assess volume responsiveness in hypotensive patients and by reducing dyspnea and improving hypoxemia in patients with cardiogenic pulmonary edema. Thus, a thorough understanding of the physiological principles underlying respiratory-cardiovascular interactions is essential if critical care practitioners are to anticipate, recognize, manage, and utilize their hemodynamic effects. © 2022 American Physiological Society. Compr Physiol 12:1-24, 2022.</p>","PeriodicalId":10573,"journal":{"name":"Comprehensive Physiology","volume":"12 3","pages":"3425-3448"},"PeriodicalIF":4.2000,"publicationDate":"2022-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"3","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Comprehensive Physiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1002/cphy.c210003","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PHYSIOLOGY","Score":null,"Total":0}
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Abstract
Positive-pressure inspiration and positive end-expiratory pressure (PEEP) increase pleural, alveolar, lung transmural, and intra-abdominal pressure, which decrease right and left ventricular (RV; LV) preload and LV afterload and increase RV afterload. The magnitude and clinical significance of the resulting changes in ventricular function are determined by the delivered tidal volume, the total level of PEEP, the compliance of the lungs and chest wall, intravascular volume, baseline RV and LV function, and intra-abdominal pressure. In mechanically ventilated patients, the most important, adverse consequences of respiratory-cardiovascular interactions are a PEEP-induced reduction in cardiac output, systemic oxygen delivery, and blood pressure; RV dysfunction in patients with ARDS; and acute hemodynamic collapse in patients with pulmonary hypertension. On the other hand, the hemodynamic changes produced by respiratory-cardiovascular interactions can be beneficial when used to assess volume responsiveness in hypotensive patients and by reducing dyspnea and improving hypoxemia in patients with cardiogenic pulmonary edema. Thus, a thorough understanding of the physiological principles underlying respiratory-cardiovascular interactions is essential if critical care practitioners are to anticipate, recognize, manage, and utilize their hemodynamic effects. © 2022 American Physiological Society. Compr Physiol 12:1-24, 2022.
机械通气期间呼吸-心血管相互作用:生理学和临床意义。
正压吸气和呼气末正压(PEEP)增加胸膜压、肺泡压、肺跨壁压和腹内压,降低左右心室压(RV);LV)预负荷和LV后负荷,并增加RV后负荷。由此引起的心室功能改变的程度和临床意义取决于所输送的潮气量、PEEP总水平、肺和胸壁顺应性、血管内容积、基线左室和左室功能以及腹内压。在机械通气患者中,呼吸-心血管相互作用最重要的不良后果是peep诱导的心输出量、全身氧输送和血压的减少;ARDS患者右心室功能障碍的研究肺动脉高压患者的急性血流动力学衰竭。另一方面,当用于评估低血压患者的容量反应性,以及通过减轻心源性肺水肿患者的呼吸困难和改善低氧血症时,呼吸-心血管相互作用产生的血流动力学变化是有益的。因此,如果重症监护医生要预测、识别、管理和利用呼吸-心血管相互作用的生理原理,透彻理解呼吸-心血管相互作用的生理原理是必不可少的。©2022美国生理学会。物理学报(英文版),2012。
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