Heart-lung interactions during positive pressure ventilation: left ventricular pressure-volume momentary response to airway pressure elevation.
BACKGROUND
Left ventricular (LV) pressure and volume changes are known to occur in response to positive airway pressure (PAP). We aimed to further describe the immediate LV response to increased PAP as demonstrated in successive heart cycles with LV pressure and volume alterations. We postulated that these acute systematic LV events during institution of PAP can follow a distinct pattern that would allow calculation of parameters of systolic function, including end-systolic elastance (Ees) and preload recruitable stroke work (PRSW). We also aimed to examine the relationship of PAP-derived Ees and PRSW to the same parameters derived from vascular occlusion.


METHODS
Eight anesthetized adult pigs were studied with invasive circulatory measurements including LV pressure and volume (conductance). The PAP intervention was an airway pressure plateau of 15 cm H2O for 6 s (APP). Venous occlusion was performed by transient balloon inflation in the inferior vena cava (IVCO). Ees and PRSW were derived for each APP and IVCO intervention.


RESULTS
Central circulatory variables during APP and IVCO are reported. LV systolic function parameters could be derived from each of the heart-lung interactions during APP sequences. Ees and PRSW derived from APP showed a significant positive bias in relation to those derived from the IVCO sequence.


CONCLUSIONS
We conclude that the heart-lung interactions during APP of the magnitude and duration shown here can allow derivation of Ees and PRSW. These parameters are not interchangeable with Ees and PRSW derived from IVCO.
Haney
M F
MF
Surgical and Perioperative Sciences, Anaesthesiology and Intensive Care Medicine, Umeå University, Umeå, Sweden. michael.haney.us@vll.se
Johansson
G
G
Häggmark
S
S
Biber
B
B
D000399:Air Pressure; D000818:Animals; D001794:Blood Pressure / Q000502:physiology*; D006321:Heart / Q000502:physiology*; D006439:Hemodynamics / Q000502:physiology; D008168:Lung / Q000502:physiology*; D011175:Positive-Pressure Respiration; D013552:Swine; D014682:Vena Cava, Inferior / Q000502:physiology; D016276:Ventricular Function; D016277:Ventricular Function, Left / Q000502:physiology*