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Monitoring pp 55-66 | Cite as

Ejektionsfraktion des rechten Ventrikels (RVEF) mittels Thermodilution: Bestimmung und Beurteilung einer umstrittenen Variablen

  • R. Assmann
  • A. Versprille
  • K. J. Falke
Chapter
  • 22 Downloads
Part of the Anaesthesiologie und Intensivmedizin Anaesthesiology and Intensive Care Medicine book series (A+I, volume 224)

Zusammenfassung

Ein zuverlässiges Monitoring der Funktion des rechten Ventrikels (RV) könnte bei der intensivmedizinischen Behandlung von Patienten mit schwerer pulmonalarterieller Hypertonie von Nutzen sein. Dies ist insbesondere anzunehmen, wenn bei solchen Patienten ein akutes Lungenversagen („adult respiratory distress syndrome“, ARDS) vorliegt und eine maschinelle Beatmung durchgeführt werden muß [12, 15, 20, 25]. Dabei wird die RV-Funktion durch das Zusammentreffen mehrerer Faktoren potentiell schwer beeinträchtigt. Solche Faktoren sind der durch den pulmonalen Prozeß selbst bedingte Anstieg der RV-Nachlast, die bei der Beatmungstherapie eines ARDS häufig erforderlichen hohen Atemwegsdrücke und die drohende Hypoxie bei labilem, oft nur grenzwertigem pulmonalem Gasaustausch. Indikation und Kontrolle hämodynamisch wirksamer Maßnahmen erfordern demnach möglichst präzise Informationen über die aktuelle RV-Funktion.

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Literatur

  1. 1.
    Assmann R, Falke KJ (1987) Cyclic modulation of right ventricular ejection fraction during controlled mechanical ventilation. Intensive Care Med 13:217PubMedGoogle Scholar
  2. 2.
    Assmann R, Falke KJ (1988) Pressure and volume assessment of right ventricular function during mechanical ventilation. Intensive Care Med 14:467PubMedCrossRefGoogle Scholar
  3. 3.
    Craven HD, Wood LDH (1981) Extrapericardial and esophageal pressures with positive end-expiratory pressure in dogs. J Appl Physiol 51:798PubMedGoogle Scholar
  4. 4.
    Cropp JA, Burton AC (1966) Theoretical considerations and model experiments on the validity of indicator dilution methods for measurements of variable flow. Circ Res 18:26PubMedGoogle Scholar
  5. 5.
    Dhainaut JF, Brunet F, Monsallier JF et al. (1987) Bedside evaluation of right ventricular performance using a rapid computerized thermodilution method. Crit Care Med 15:148PubMedCrossRefGoogle Scholar
  6. 6.
    Holt JP (1956) Estimation of residual volume of the ventricle of the dog’s heart by two indicator dilution techniques. Circ Res 4:187PubMedGoogle Scholar
  7. 7.
    Jansen JRC, Schreuder JJ, Bogaard JM, Rooyen W van, Versprille A (1981) Thermodilution technique for measurement of cardiac output during artificial ventilation. J Appl Physiol 50:584Google Scholar
  8. 8.
    Jansen JRC, Versprille A (1986) Improvement of cardiac output estimation by the thermodilution method during mechanical ventilation. Intensive Care Med 12:71PubMedCrossRefGoogle Scholar
  9. 9.
    Jardin F, Farcot JC, Gueret P, Prost JF, Ozier Y, Bourdarias JP (1984) Two-dimensional echocardiographic evaluation of left and right ventricular size and shape during continuous positive airway pressure breathing in normal subjects. J Appl Physiol 56:618Google Scholar
  10. 10.
    Jardin F, Gueret P, Dubourg O, Farcot JC, Margairaz A, Bourdarias JP (1985) Right ventricular volumes by thermodilution in the adult respiratory distress syndrome-a comparative study using two-dimensional echocardiography as a reference method. Chest 88:34PubMedCrossRefGoogle Scholar
  11. 11.
    Kay HR, Afshari M, Barash P et al. (1983) Measurement of ejection fraction by thermal dilution techniques. J Surg Res 34:337PubMedCrossRefGoogle Scholar
  12. 12.
    Laver MB, Strauss HW, Prohost GM (1979) Herbert Shubin memorial lecture — Right and left ventricular geometry; adjustments during acute respiratory failure. Crit Care Med 7:509PubMedCrossRefGoogle Scholar
  13. 13.
    Levett JM, Replogle RL (1979) Thermodilution cardiac output: a critical analysis and review of the literature. J Surg Res 27:392PubMedCrossRefGoogle Scholar
  14. 14.
    Marini JJ, O’Quin R, Culver BH, Butler J (1982) Estimation of transmural cardiac pressures during ventilation with PEEP. J Appl Physiol 53:384PubMedGoogle Scholar
  15. 15.
    Martin C, Saux P, Albanese J, Bonnery JJ, Gouin F (1987) Right ventricular function during positive end-expiratory pressure — Thermodilution evaluation and clinical application. Chest 92:999PubMedCrossRefGoogle Scholar
  16. 16.
    Martyn JAJ, Snider MT, Farago LF, Burke JF (1981) Thermodilution right ventricular volume: a novel and better predictor of volume replacement in acute thermal injury. J Trauma 21:619PubMedCrossRefGoogle Scholar
  17. 17.
    Maruschak GF, Schauble JF (1985) Limitations of thermodilution ejection fraction: Degradation of frequency response by catheter mounting of fast-response thermistors. Crit Care Med 13:679PubMedCrossRefGoogle Scholar
  18. 18.
    Neidhart PP, Suter PM (1988) Changes of right ventricular function with positive end-expiratory pressure (PEEP) in man. Intensive Care Med 14:471PubMedCrossRefGoogle Scholar
  19. 19.
    Okamoto K, Komatsu T, Kumar V, Sanchala V, Kubal K, Bhalodia R, Shibutani K (1986) Effects of intermittent positive-pressure ventilation on cardiac output measurements by thermodilution. Crit Care Med 14:977PubMedCrossRefGoogle Scholar
  20. 20.
    Prewitt RM, Ghignone M (1983) Treatment of right ventricular dysfunction in acute respiratory failure. Crit Care Med 11:346PubMedCrossRefGoogle Scholar
  21. 21.
    Qvist J, Pontoppidan H, Wilson RS, Lowenstein E, Laver MB (1975) Hemodynamic responses to mechanical ventilation with PEEP: the effect of hypervolemia. Anesthesiology 42:45PubMedCrossRefGoogle Scholar
  22. 22.
    Santamore WP, Bove AA, Heckman JL (1984) Right and left ventricular pressure-volume-response to positive end-expiratory pressure. Am J Physiol 246:H 114Google Scholar
  23. 23.
    Scheuer-Leser M, Morquet A, Reul H, Inrich W (1977) Some aspects of pulsation error in blood flow calculations by indicator dilution technique. Med Biol Eng Comput 15:118CrossRefGoogle Scholar
  24. 24.
    Sibbald WJ, Driedger AA (1983) Right ventricular function in acute disease states: Pathophysiologic considerations. Crit Care Med 11:339PubMedCrossRefGoogle Scholar
  25. 25.
    Sibbald WJ, Driedger AA, Cunningham DG, Cheung H (1986) Right and left ventricular performance in acute hypoxemic respiratory failure. Crit Care Med 14:852PubMedCrossRefGoogle Scholar
  26. 26.
    Synder JV, Powner DJ (1982) Effects of mechanical ventilation on the measurement of cardiac output by thermodilution. Crit Care Med 10:677PubMedCrossRefGoogle Scholar
  27. 27.
    Stevens JH, Raffin TA, Mihm FG, Rosenthal MH, Stetz CW (1985) Thermodilution cardiac output measurement — Effects of the respiratory cycle on its reproducibility. JAMA 253:2240PubMedCrossRefGoogle Scholar
  28. 28.
    Teboul JL, Abrouk F, Lemaire F (1988) Right ventricular function in COPD patients during weaning from mechanical ventilation. Intensive Care Med 14:483PubMedCrossRefGoogle Scholar
  29. 29.
    Urban P, Scheidegger D, Gabathuler J, Rütishauser W (1987) Thermodilution determination of right ventricular volume and ejection fraction: A comparison with biplane angiography. Crit Care Med 15:652PubMedCrossRefGoogle Scholar
  30. 30.
    Versprille A (1984) Pulmonary vascular resistance — a meaningless variable. Intensive Care Med 10:51PubMedCrossRefGoogle Scholar
  31. 31.
    Versprille A (1984) Thermodilution in mechanically ventilated patients. Intensive Care Med 10:213PubMedGoogle Scholar
  32. 32.
    Vincent JL, Thirion M, Brimioulle S, Lejeune P, Kahn RJ (1986) Thermodilution measurement of right ventricular ejection fraction with a modified pulmonary artery catheter. Intensive Care Med 12:33PubMedCrossRefGoogle Scholar
  33. 33.
    Vincent JL, Reuse C (1988) Thermodilution for measurement of cardiac output during artificial ventilation. Intensive Care Med 14:253PubMedCrossRefGoogle Scholar
  34. 34.
    Voelker W, Gruber HP, Ickrath O, Unterberg R, Karsch KR (1988) Determination of right ventricular ejection fraction by thermodilution technique — a comparison to biplane cineventriculography. Intensive Care Med 14:461PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1992

Authors and Affiliations

  • R. Assmann
  • A. Versprille
  • K. J. Falke

There are no affiliations available

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