Mechanical abdomino/heart/lung interaction.
It is generally assumed that inspiration will enhance both superior and inferior vena cava (SVC and IVC) blood flows due to the decrease in right atrial pressure produced by the fall in intrathoracic pressure. However, inspiration can also increase abdominal pressure due to the descent of the diaphragm. Using a model of abdominal vascular zone conditions, analogous to pulmonary vascular zone conditions, the abdominal venous compartment can be viewed as either a capacitor (zone III abdomen) or as a collapsible Starling resistor (zone II abdomen). This dual nature of the abdominal venous bed can explain how an inspiratory increase in abdominal pressure can increase IVC flow with hypervolaemia, but increase IVC flow with hypovolaemia. Combined generalized increases in abdominal pressure and focal forces over the liver can be shown to be an essential element in the pathogenesis of a Kussmaul's sign. Increases in abdominal pressures produced by active diaphragmatic descent can increase the total IVC venous return by enhancing the splanchnic IVC flow under relatively hypervolaemic conditions, but decrease the total IVC venous return by impeding the non-splanchnic IVC flow under hypovolaemic conditions. Results are presented which suggest that the concept of abdominal vascular zone conditions is useful to understand overall directions of changes in total and regional venous return during normal and obstructed breathing and may provide useful analysis of the haemodynamic events which occur in obstructive sleep apnoea.
Robotham
JL
Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.
Takata
M