Perfusion of the interventricular septum during ventilation with positive end-expiratory pressure.
OBJECTIVE
To determine whether regional hypoperfusion of the interventricular septum occurs during ventilation with positive end-expiratory pressure.


METHODS
Animal study.


METHODS
Anesthetized, closed chest dogs (n = 8).


METHODS
Induction of experimental adult respiratory distress syndrome (ARDS) and then ventilation with 10, 15, and 20 cm H2O of positive end-expiratory pressure.


RESULTS
Cardiac output and regional interventricular septum blood flow were assessed at control, at induction of experimental ARDS, and at each level of positive end-expiratory pressure. Ventilation with 20 cm H2O of positive end-expiratory pressure decreased cardiac output (-32% vs. control, p less than .05), and did not change absolute, but increased relative (to cardiac output) interventricular septum blood flow. During experimental ARDS and ventilation at 20 cm H2O end-expiratory pressure, there was a redistribution of flow toward the right ventricular free wall (+93%, p less than .001) and the right ventricular part of the interventricular septum (+68%, p less than .01), while flow to the left ventricular interventricular septum and to the left ventricular free wall remained unchanged. Locally hypoperfused interventricular septum areas or findings indicative of interventricular septum ischemia were not observed during positive end-expiratory pressure.


CONCLUSIONS
The decrease in cardiac output during positive end-expiratory pressure is not caused by impaired interventricular septum blood supply. The preferential perfusion of the right ventricular interventricular septum indicates increased local right ventricular interventricular septum oxygen-demand and suggests that during positive end-expiratory pressure, this part of the interventricular septum functionally dissociates from the left ventricular interventricular septum and the left ventricular free wall to support the stressed right ventricle.
Department of Anesthesiology, University of Munich, FRG.
B
B
Zwissler
R
R
Schosser
C
C
Schwickert
P
P
Spengler
M
M
Weiss
V
V
Iber
K
K
Messmer
D000818:Animals; D001775:Blood Circulation; D002302:Cardiac Output; D004195:Disease Models, Animal; D004285:Dogs; D005260:Female; D006346:Heart Septum / Q000503:physiopathology*; D008297:Male; D011175:Positive-Pressure Respiration; D012039:Regional Blood Flow; D012128:Respiratory Distress Syndrome / Q000503:physiopathology*