Elevated pulmonary artery systolic storage volume associated with improved ventilation-to-perfusion ratios in acute respiratory failure.
The possibility that an elevated pulmonary artery systolic storage volume (PASSV) correlates with improved overall ratios of ventilation-to-perfusion and hence benefits gas exchange in acute respiratory failure was examined. We examined this by assessing the correlation between PASSV and both the physiologic dead space to tidal volume ratio (VD/VT) and intrapulmonary shunt fraction (Qsp/Qt). The VD/VT and Qsp/Qt were used as an index of distribution of ventilation-to-perfusion as well as efficiency of pulmonary gas exchange. Twenty-eight patients suffering from acute respiratory failure were included. All required mechanical ventilation. PASSV was calculated from the pulmonary artery (PA) compliance and mean PA systolic distending pressure. Pulmonary arteriolar pressures were computed by Fourier analysis. PA compliance was derived from the PA time constant and the PA resistance. Storage volume fraction of stroke volume index (PASSV/SVI) was used to compare individual variations. There were inverse linear relationships between PASSV/SVI and VD/VT (r = 0.693, p less than 0.0001), and between PASSV/SVI and Qsp/Qt (r = 0.427, p = 0.012). Also, a direct correlation was found between VD/VT and PA time constant (r = 0.503, p = 0.002). The patients were divided into two groups based on PASSV/SVI to evaluate the effect of other hemodynamic data on PASSV. Comparison of the two groups revealed that VD/VT and Qsp/Qt were lower (p less than 0.0001, and p = 0.018, respectively), PA time constant was higher (p less than 0.001), and right ventricular stroke-work index was higher (p = 0.005) in the group with a high PASSV/SVI. There were no differences in other hemodynamic data between the two groups. These data suggest that an elevated PASSV may indeed benefit gas exchange in acute respiratory failure.
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Department of Anesthesiology, New York Medical College, Westchester County Medical Center, Valhalla 10595.
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D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000703:Analog-Digital Conversion; D000704:Analysis of Variance; D001810:Blood Volume / Q000502:physiology*; D016001:Confidence Intervals; D001330:Electronic Data Processing; D005260:Female; D006801:Humans; D016018:Least-Squares Analysis; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery / Q000502:physiology*; D011659:Pulmonary Gas Exchange / Q000502:physiology; D012126:Respiratory Dead Space / Q000502:physiology; D012131:Respiratory Insufficiency / Q000453:epidemiology / Q000503:physiopathology*; D013599:Systole / Q000502:physiology*; D013990:Tidal Volume / Q000502:physiology; D014692:Ventilation-Perfusion Ratio / Q000502:physiology*