Interactions between respiration and systemic hemodynamics. Part II: practical implications in critical care

In Part I of this review, we have covered basic concepts regarding cardiorespiratory interactions. Here, we put this theoretical framework to practical use. We describe mechanisms underlying Kussmaul’s sign and pulsus paradoxus. We review the literature on the use of respiratory variations of blood...

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Bibliographic Details
Published in:Intensive care medicine 2009-02, Vol.35 (2), p.198-205
Main Authors: Feihl, François, Broccard, Alain F.
Format: Article
Language:English
Subjects:
Abdomen
Airway management
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Anesthesiology
Asthma
Biological and medical sciences
Blood pressure
Blood Pressure - physiology
Cardiac function
Cardiac Output - physiology
Clinical death. Palliative care. Organ gift and preservation
Coronary Circulation - physiology
Critical Care
Critical Care Medicine
Emergency Medicine
Hemodynamics
Hemodynamics - physiology
Humans
Hypertension, Pulmonary - etiology
Intensive
Intensive care
Intensive care medicine
Medical sciences
Medicine
Medicine & Public Health
Pain Medicine
Pediatrics
Pericarditis
Pneumology/Respiratory System
Positive-Pressure Respiration - methods
Pulmonary arteries
Pulmonary Heart Disease - complications
Pulmonary Heart Disease - therapy
Pulse
Respiration
Respiration, Artificial
Respiratory Insufficiency - etiology
Respiratory Insufficiency - therapy
Review
Venous Pressure - physiology
Ventilators
Ventricular Dysfunction, Left - complications
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Summary:In Part I of this review, we have covered basic concepts regarding cardiorespiratory interactions. Here, we put this theoretical framework to practical use. We describe mechanisms underlying Kussmaul’s sign and pulsus paradoxus. We review the literature on the use of respiratory variations of blood pressure to evaluate volume status. We show the possibilities of attaining the latter aim by investigating with ultrasonography how the geometry of great veins fluctuates with respiration. We provide a Guytonian analysis of the effects of PEEP on cardiac output. We terminate with some remarks on the potential of positive pressure breathing to induce acute cor pulmonale, and on the cardiovascular mechanisms that at times may underly the failure to wean a patient from the ventilator.
ISSN:0342-4642
1432-1238
DOI:10.1007/s00134-008-1298-y