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Hemodynamic Adjustments in Acute Respiratory Failure: The Role of the Right Ventricle

  • M. B. Laver
  • G. M. Pohost
  • H. W. Strauss
Part of the Anaesthesiologie und Intensivmedizin Anaesthesiology and Intensive Care Medicine book series (A+I, volume 131)

Abstract

The hemodynamic responce to the pulmonary vascular changes caused by acute respiratory failure and the associated need for mechanical ventilation continues to puzzle the clinician and challenge the investigator. A major handicap, yet to be resolved, is the availability of an appropriate model in the experimental animal which can be assumed to resemble the patient acutely affected by the disease. Several studies have been published recently on the effects of mechanical ventilation with positive end-expiratory pressure on cardiovascular performance in animals with normal and an acutely altered pulmonary vasculature [26, 29,32,33, 38,39,40]. Relevance of these data to the clinical situation is limited by the fact that the endpoint of therapy in the human includes not only improved gas exchange, but also renal performance. In other words, treatment demands that we combine the necessary airway pressures and ventilatory patterns with a variety of measures intended to maintain a sufficient blood flow consistent with an adequate urine output. This implies blood volume replacement, pharmacological support of myocardial performance, and enhancement of renal cortical blood flow. Thus, the end points used clinically and in the experiment differ. Clinically, we make every effort to sustain blood flow to vital organs; generally, the end point is the quality of renal function. In the animal experiment, we impose a step change in airway pressure or pulmonary vascular integrity and measure hemodynamic performance with or without addition of intravascular volume therapy. Although the final observations are related, neither duration nor magnitude of the hemodynamic support required clinically, resemble the conditions imposed in the experimental animal. A further complication is introduced by the need and effects of general anesthesia utilized in acute animal experiments.

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Copyright information

© Springer-Verlag Berlin Heidelberg 1980

Authors and Affiliations

  • M. B. Laver
  • G. M. Pohost
  • H. W. Strauss

There are no affiliations available

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