Influence of Right Ventricular Function on Oxygen Delivery in ARDS

  • H. Steltzer
  • P. Krafft
  • A. F. Hammerle
Conference paper
Part of the Yearbook of Intensive Care and Emergency Medicine 1993 book series (YEARBOOK, volume 1993)

Abstract

The risk of developing adult respiratory distress Syndrome (ARDS) increases with the number of clinical disorders that occur in the patient. Therefore, maintenance and monitoring of oxygenation is an important part of the intensive care in patients with ARDS. In order to prevent multiple organ dysfunction or failure (MOF), oxygen delivery (DO2) and oxygen consumption (VO2) should be adequate to satisfy tissue oxygen demand. Since DO2 depends on hemoglobin level, on pulmonary gas exchange and cardiac Performance, many studies concerning ARDS or sepsisinduced distrubances in pulmonary function and cardiac Performance (especially of the right ventricle, RV) have appeared in the recent literature [1].

Keywords

Dioxide Estima Prostacyclin Renes Cardi 

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References

  1. 1.
    Squara, P, Dhainaut JF, Branet F (1992) Acute right ventricular failure. In: Pinsky MR, Dhainaut JF (eds) Pathophysiologic foundations of critical care, Williams & Wilkins, pp 280–311Google Scholar
  2. 2.
    Patterson SW, Starling EH (1914) On the mechanical factors which determine the Output of the ventricle. J Physiol 48: 357–365PubMedGoogle Scholar
  3. 3.
    Shibutani K, Komatsu T, Kubal K, Sanchala V, Kumar V, Bizzari DV (1983) Critical level of oxygen delivery in anesthetized man. Crit Care Med 11: 640–643PubMedCrossRefGoogle Scholar
  4. 4.
    Komatsu T, Shibutani K, Okamoto K, et al. (1987) Critical level of oygen delivery after cardiopulmonary bypass. Crit Care Med 15: 194–197PubMedCrossRefGoogle Scholar
  5. 5.
    Edwards JD (1991) Oxygen transport in cardiogenic and septic shock. Crit Care Med 19: 658–663PubMedCrossRefGoogle Scholar
  6. 6.
    Mohsenifar Z, Amin D, Jasper AC, Shah PK, Koerner SK (1987) Dependence of oxygen consumption on oxygen delivery in patients with chronic congestive heart failure. Chest 92: 447–450PubMedCrossRefGoogle Scholar
  7. 7.
    Shoemaker WC (1987) Relation of oxygen transport patterns to the pathophysiology and therapy of shock states. Intensive Care Med 13: 230–243PubMedCrossRefGoogle Scholar
  8. 8.
    Diebel LN, Wilson RF, Tagett MG, Kline RA (1992) End–diastolic volume: A better indicator of preload in the critically ill. Arch Surg 127: 817–822Google Scholar
  9. 9.
    Gentzier RD, Briselli MF, Gault JH (1974) Angiographie estimation of right ventricular volume in man. Circulation 50: 324–330Google Scholar
  10. 10.
    Dhainaut JF, Lanore JJ,, de Gournay JM et al. (1988) Right ventricular dysfunction in patients with septic shock. Intensive Care Med 14: 488–491PubMedCrossRefGoogle Scholar
  11. 11.
    Reuse C, Frank N, Contempre, Vincent JL (1988) Right ventricular function in septic shock. Intensive Care Med 14: 486–487PubMedCrossRefGoogle Scholar
  12. 12.
    Mitsuo T, Shimazaki S, Matsuda H (1992) Right ventricular dysfunction in septic patients. Crit Care Med 20: 630–634PubMedCrossRefGoogle Scholar
  13. 13.
    Jardin F, Gueret P, Dubourg O, Farcot JC, Margairaz A, Bourdarias JP (1985) Right ventricular volumes by thermodilution in the adult respiratory distress Syndrome. Chest 88: 34–39PubMedCrossRefGoogle Scholar
  14. 14.
    Steltzer H, Owen AN, Petcold R, Germann P, Hammerle AF (1992) Small volume resuscitation: Echocardiographically guided changes in left ventricular Performance in patients with circulatory shock. Anesthesiology 77: A229Google Scholar
  15. 15.
    Zapol WM, Snider MT (1977) Pulmonary hypertension in acute respiratory failure. New Engl J Med 296: 476–480PubMedCrossRefGoogle Scholar
  16. 16.
    Pontoppidan H, Wilson RS, Rie MA, et al. (1977) Respiratory intensive care. Anesthesiology 47: 96–116PubMedCrossRefGoogle Scholar
  17. 17.
    Vlahakes GJ, Turley K, Hoffmann JIE (1981) The pathophysiology of failure in acute right ventricular hypertension: Hemodynamic and biochemical correlations. Circulation 63: 87–95Google Scholar
  18. 18.
    Sibbald WJ, Driedger AA, Cunningham DG, Cheung H (1986) Right and left ventricular Performance in acute hypoxemic respiratory failure. Crit Care Med 14: 852–857PubMedCrossRefGoogle Scholar
  19. 19.
    Radermacher P, Santak B, Wüst HJ, Tarnow J, Falke KJ (1990) Prostacyclin and right ventricular function in patients with pulmonary hypertension associated with ARDS. Intensive Care Med 16: 227–232PubMedCrossRefGoogle Scholar
  20. 20.
    Viquerat CE, Righetti A, Suter PM (1983) Biventricular volumes and function in patients with adult respiratory distress Syndrome ventilated with PEEP. Chest 83: 509–514PubMedCrossRefGoogle Scholar
  21. 21.
    Potkin RT, Hudson LD, Weaver LJ, Trobaugh G (1987) Effect of positive endexpiratory pressure on right and left ventricular function in patients with the adult respiratory distress Syndrome. Am Rev Respir Dis 135: 307–311PubMedGoogle Scholar
  22. 22.
    Jardin F, Brun-Ney D, Hardy A, Aegerter P, Beauchet A, Bourdarias JP (1991) Combined thermodilution and two-dimensional echocardiographic evaluation of right ventricular function during respiratory support with PEEP. Chest 99: 162–168PubMedCrossRefGoogle Scholar
  23. 23.
    Biondi JW, Schulman DS, Souffer R, et al. (1988) The effect of incremental positive endexpiratory pressure on right ventricular hemodynamics and ejection fraction. Anest Anaig 84: 144–151Google Scholar
  24. 24.
    Schulman DS, Biondi JW, Zohgbi S, Zaret BL, Souffer R (1990) Coronary flow limits right ventricular Performance during positive end–expiratory pressure. Am Rev Respir Dis 141: 1531–1537PubMedGoogle Scholar
  25. 25.
    Danek SJ, Lynch JP, Weg JP, Dantzker DR (1980) The dependency of oxygen uptake on oxygen delivery in the adult respiratory distress Syndrome. Am Rev Respir Dis 122: 387–395PubMedGoogle Scholar
  26. 26.
    Kariman K, Burns SR (1985) Regulation of tissue oxygen extraction is disturbed in adult respiratory distress Syndrome. Am Rev Respir Dis 132: 109–114PubMedGoogle Scholar
  27. 27.
    Lorente JA, Renes E, Gömez-Aguinaga MA (1991) Oxygen delivery-dependent oxygen consumption in acute respiratory failure. Crit Care Med 19: 770–775PubMedCrossRefGoogle Scholar
  28. 28.
    Annat G, Viale JP, Percival C, Froment M, Motin J (1986) Oxygen delivery and uptake in the adult respiratory distress Syndrome. Am Rev Respir Dis 133: 999–1001PubMedGoogle Scholar
  29. 29.
    Ronco JJ, Phang PT, Wally KR, Wiggs B, Fenwick JC, Rüssel JA (1991) Oxygen consumption is independent of chaflges in oxygen delivery in severe adult respiratory distress Syndrome. Am Rev Respir Dis 143: 1267–1273PubMedGoogle Scholar
  30. 30.
    Sugimoto H, Ohashi N, Sawada Y, Yoshioka T, Sugimoto T (1984) Effects of positive endexpiratory pressure on tissue gas tension and oxygen transport. Crit Care Med 12: 661–663PubMedCrossRefGoogle Scholar
  31. 31.
    Teboul JL, Annane D, Thuillez C, Depret J, Bellisant E, Richard C (1992) Effects of cardiovascular drugs on oxygen consumption/oxygen delivery relationship in patients with congestive heart failure. Chest 101: 1582–1587PubMedCrossRefGoogle Scholar
  32. 32.
    Bartlett RH, Dechert RE (1990) Oxygen kinetics: Pitfalls in clinical research. J Crit Care 5: 77–80Google Scholar
  33. 33.
    Steltzer H, Hiesmayr M, Mayer N, Krafft P, Hammerle AF (1993) The relationship between oxygen delivery and uptake in the critically ill: Is there a critical or optimal therapeutical value? A metaanalysis. Anesthesia (in press)Google Scholar
  34. 34.
    Russell JA, Ronco JJ, Lockhat D, Beizberg A, Kiess M, Dodek PM (1990) Oxygen delivery and consumption and ventricular preload are greater in survivors than in nonsurvivors of the adult respiratory distress Syndrome. Am Rev Respir Dis 141: 659–665PubMedCrossRefGoogle Scholar
  35. 35.
    Krafft P, Steltzer H, Hiesmayr M, Klimscha W, Hammerle AF (1993) Mixed venous oxygen Saturation in critically ill patients: The role of defined events. Chest (in press)Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1993

Authors and Affiliations

  • H. Steltzer
  • P. Krafft
  • A. F. Hammerle

There are no affiliations available

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