Update 1987 pp 213-222 | Cite as

Pulmonary Blood Flow and Blood Volume During Positive Pressure Ventilation

  • A. Versprille
Part of the Update in Intensive Care and Emergency Medicine book series (UICM, volume 3)


Flow and pressure in the systemic and pulmonary circulation are affected by two types of changes in airway pressure: a static type applied for a relatively long time like positive end-expiratory pressure (PEEP), and a dynamic type of rise and fall during each ventilatory cycle. In both types, the increase in airway pressure will increase intrathoracic and central venous pressure. Consequently, a decrease in venous return occurs [1–8]. However, for both types, the same rise in airway pressure will not have the same quantitative effect, because during PEEP two additional control mechanisms are involved. A lung stretch reflex is increasing the negative effects of central venous pressure on flow and arterial blood pressure [8–10], and control mechanisms elicited by baroreceptor activity are compensating for these negative effects [8, 11]. During a ventilatory cycle, the time of rise and fall in airway pressure is too short to elicit these neurogenic and humoral control mechanisms. Changes in circulation during a ventilatory cycle, therefore, will be mainly due to direct mechanical effects.


Airway Pressure Central Venous Pressure Pulmonary Artery Pressure Venous Return Pulmonary Circulation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Cassidy SS, Robertson CH Jr, Pierce AK, Johnson RL Jr (1978) Cardiovascular effects of positive end-expiratory pressure in dogs. J Appl Physiol 44:743–750PubMedGoogle Scholar
  2. 2.
    Fewell JE, Abendschein DR, Carlson CJ, Murray JF, Rapaport E (1980) Continuous positive-pressure ventilation decreases right and left ventricular end-diastolic volumes in the dog. Circ Res 46:125–132PubMedGoogle Scholar
  3. 3.
    Harboe S, Levang OW, Hysing ES (1979) The effect of positive end-expiratory pressure after three types of open heart surgery. Acta Anaesthesiol Scand 23:165–176PubMedCrossRefGoogle Scholar
  4. 4.
    Hobelmann CF Jr, Smith DE, Virgilio RW, Shapiro AR, Peters RM (1975) Hemodynamic alterations with positive end-expiratory pressure: the contribution of the pulmonary vasculature. J Trauma 15:951–958PubMedCrossRefGoogle Scholar
  5. 5.
    Qvist J, Pontoppidan H, Wilson RS, Lowenstein E, Laver MB. Hemodynamic responses to mechanical ventilation with PEEP: the effect of hypervolemia. Anesthesiology 42:45–55Google Scholar
  6. 6.
    Robotham JL, Lixfield W, Holland L, MacGregor D, Bromberger-Barnea B, Permutt S, Rabson JL (1980) The effects of positive end-expiratory pressure on right and left ventricular performance. Am Rev Respir Dis 121:677–683PubMedGoogle Scholar
  7. 7.
    Scharf SM, Caldini P, Ingram RH Jr Cardiovascular effects of increasing airway pressure in the dog. Am J Physiol 232 (Heart Circ Physiol 1): H35–H43Google Scholar
  8. 8.
    Schreuder JJ, Jansen JRC, Bogaard JM, Versprille A (1982) Hemodynamic effects of positive end-expiratory pressure applied as a ramp. J Appl Physiol 53:1239–1247PubMedGoogle Scholar
  9. 9.
    Cassidy SS, Eschenbacher WL, Johnson RL Jr (1979) Reflex cardiovascular depression during unilateral lung hyperinflation in the dog. J Clin Invest 64:620–626PubMedCrossRefGoogle Scholar
  10. 10.
    Schreuder JJ, Jansen JRC, Versprille A (1984) Contribution of lung stretch depressor reflex to nonlinear fall in cardiac output during PEEP. J Appl Physiol 56:1578–1582PubMedGoogle Scholar
  11. 11.
    Schreuder JJ, Jansen JRC, Versprille A (1985) Hemodynamic effects of PEEP applied as a ramp in normo-, hyper-, and hypovolemia. J Appl Physiol 59:1178–1184PubMedGoogle Scholar
  12. 12.
    Hoffman JIE, Guz A, Charlier AA, Wilcken DEL (1965) Stroke volume in conscious dogs: effect of respiration, posture, and vascular occlusion. J Appl Physiol 20:865–877PubMedGoogle Scholar
  13. 13.
    Morgan BC, Martin WE, Hornbein TF, Crawford EW, Guntheroth WG (1966) Hemodynamic effects of intermittent positive pressure respiration. Anesthesiology 27:584–590PubMedCrossRefGoogle Scholar
  14. 14.
    Nordström L (1972) On automatic ventilation. Part II: Haemodynamic effects of intermittent positive-pressure ventilation with and without an end-expiratory pause. Acta Anaesthesiol Scand (Suppl) 47:29–56CrossRefGoogle Scholar
  15. 15.
    Versprille A, Jansen JRC (1985) Mean systemic filling pressure as a characteristic pressure for venous return. Pflügers Archiv 405:226–233PubMedCrossRefGoogle Scholar
  16. 16.
    Versprille A, Jansen JRC, Schreuder JJ (1982) Dynamic aspects of the interaction between airway pressure and the circulation. In: Prakash O (ed) Applied Physiology in Clinical Respiratory Care, Martinus Nijhoff Publishers BV, The Hague, pp 447–463Google Scholar
  17. 17.
    Wong M, Escobar EE, Martinex G, Butler J, Rapaport E (1967) Effect of continuous pressure breathing on right ventricular volumes. J Appl Physiol 22:1053–1060Google Scholar
  18. 18.
    Guyton AC, Lindsey AW, Kaufmann BN (1955) Effect of mean circulatory filling pressure and other peripheral circulatory factors on cardiac output. Am J Physiol 180:463–468PubMedGoogle Scholar
  19. 19.
    Guyton AC, Jones CE, Coleman TG (1973) Circulatory physiology: Cardiac output and its regulation. W. B. Saunders Company, PhiladelphiaGoogle Scholar
  20. 20.
    Pinsky MR (1984) Instantaneous venous return curves in an intact canine preparation. J Appl Physiol: Respir Environ Excercise Physiol 56:765–771Google Scholar
  21. 21.
    Donald ED, Edis AJ (1971) Comparison of aortic and carotid baroreflexes in the dog. J Physiol 215:521–538PubMedGoogle Scholar
  22. 22.
    Scher AM, Young AC (1963) Servoanalysis of carotid sinus reflex effects on peripheral resistance. Circ Res 12:152–162PubMedGoogle Scholar
  23. 23.
    Hughes JMB (1977) Pulmonary circulation and fluid balance. Chapt. 5 in: Widdicombe JG (ed) Respiratory Physiology II, International Review of Physiology, vol. 14, University Park Press, Baltimore, pp. 135–185Google Scholar
  24. 24.
    Buda AJ, Pinksy MR, Ingels NB, Daughters GT, Stinson EB, Alderman EL (1979) Effect of intrathoracic pressure on left ventricular performance. N Engl J Med 301:453–459PubMedCrossRefGoogle Scholar
  25. 25.
    Summer WR, Permutt S, Sagawa K, Shoukas AA, Bromberger-Barnea B (1979) Effects of spontaneous respiration on canine left ventricular function. Circ Res 45:719–728PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1987

Authors and Affiliations

  • A. Versprille

There are no affiliations available

Personalised recommendations