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

Feihl, François ; Broccard, Alain

In: Intensive Care Medicine, 2009, vol. 35, no. 2, p. 198-205

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    Titre
    • Interactions between respiration and systemic hemodynamics. Part II: practical implications in critical care
    Auteur
    • Feihl, François. Division of Clinical Pathophysiology, University Hospital (CHUV) and Lausanne University (UNIL), 1011, Lausanne, Switzerland
    • Broccard, Alain. Medical Intensive Care Unit, Regions Hospital Pulmonary and Critical Care Division, Regions Hospital, 55101-2595, St Paul, MN, USA
    Type de document
    • Postprint
    Classification
    • Santé
    Identifiant OAI-PMH
    • oai:doc.rero.ch:320567
    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