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Cardiac function and haemodynamics during transition to high-frequency oscillatory ventilation

  • M. David (a1), R. S. von Bardeleben (a2), N. Weiler (a3), K. Markstaller (a1), A. Scholz (a1), J. Karmrodt (a1) and B. Eberle (a4)...

Extract

Summary

Background and objective: This prospective observational study analyses cardiovascular changes in adult patients with acute respiratory distress syndrome (ARDS) during transition from pressure-controlled ventilation to high-frequency oscillatory ventilation (HFOV), using transoesophageal echocardiography (TOE) and invasive haemodynamic monitoring.

Methods: Nine patients (median age 65 years; range 42–70) with ARDS were studied. HFOV was started and maintained with an adjusted mean airway pressure of 5 cmH2O above the last measured mean airway pressure during pressure-controlled ventilation. Haemodynamic and TOE measurements were performed in end-expiration during baseline pressure-controlled ventilation, and again 5 and 30 min after the start of during uninterrupted HFOV.

Results: Right atrial pressure increased immediately (P = 0.004). After 30 min, pulmonary arterial occlusion pressure increased (P = 0.008), cardiac index decreased (P = 0.01), stroke volume index decreased (P = 0.02) and both left ventricular end-diastolic and end-systolic area indices decreased (P = 0.02). Fractional area change, left ventricular end-systolic wall stress, heart rate, mean arterial pressure and mean pulmonary artery pressure remained unchanged.

Conclusions: Transition to HFOV at a mean airway pressure of 5 cmH2O above that during pressure-controlled ventilation induced significant, but clinically minor, haemodynamic effects, which are most probably due to airway pressure-related preload reduction.

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Corresponding author

Correspondence to: Matthias David, Department of Anaesthesiology, Johannes Gutenberg University, Langenbeckstrasse 1, D-55116 Mainz, Germany. E-mail: david@mail.uni-mainz.de; Tel: +49 6131 177366; Fax: +49 6131 172628

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Keywords

Cardiac function and haemodynamics during transition to high-frequency oscillatory ventilation

  • M. David (a1), R. S. von Bardeleben (a2), N. Weiler (a3), K. Markstaller (a1), A. Scholz (a1), J. Karmrodt (a1) and B. Eberle (a4)...

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