Mechanisms of decreased left ventricular preload during continuous positive pressure ventilation in ARDS

Journal Article · Tue Jul 01 00:00:00 EDT 1986 · Chest; (United States)

DOI:https://doi.org/10.1378/chest.90.1.74· OSTI ID:5020071

Dhainaut, J F; Devaux, J Y; Monsallier, J F; Brunet, F; Villemant, D; Huyghebaert, M F

Continuous positive pressure ventilation is associated with a reduction in left ventricular preload and cardiac output, but the mechanisms responsible are controversial. The decrease in left ventricular preload may result exclusively from a decreased systemic venous return due to increased pleural pressure, or from an additional effect such as decreased left ventricular compliance. To determine the mechanisms responsible, we studied the changes in cardiac output induced by continuous positive pressure ventilation in eight patients with the adult respiratory distress syndrome. We measured cardiac output by thermodilution, and biventricular ejection fraction by equilibrium gated blood pool scintigraphy. Biventricular end-diastolic volumes were then calculated by dividing stroke volume by ejection fraction. As positive end-expiratory pressure increased from 0 to 20 cm H/sub 2/O, stroke volume and biventricular end-diastolic volumes fell about 25 percent, and biventricular ejection fraction remained unchanged. At 20 cm H/sub 2/O positive end-expiratory pressure, volume expansion for normalizing cardiac output restored biventricular end-diastolic volumes without markedly changing biventricular end-diastolic transmural pressures. The primary cause of the reduction in left ventricular preload with continuous positive pressure ventilation appears to be a fall in venous return and hence in right ventricular stroke volume, without evidence of change in left ventricular diastolic compliance.

• OSTI ID: 5020071
• Journal Information: Chest; (United States), Vol. 1
• Country of Publication: United States
• Language: English

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