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

Published online by Cambridge University Press:  28 January 2005

M. David ,
R. S. von Bardeleben ,
N. Weiler ,
K. Markstaller ,
A. Scholz ,
J. Karmrodt  and
B. Eberle
M. David
Affiliation:
Johannes Gutenberg University, Department of Anaesthesiology, Mainz, Germany
R. S. von Bardeleben
Affiliation:
Johannes Gutenberg University, II Medical Department, Cardiology, Mainz, Germany
N. Weiler
Affiliation:
Christian-Albrechts University, Department of Anaesthesiology, Kiel, Germany
K. Markstaller
Affiliation:
Johannes Gutenberg University, Department of Anaesthesiology, Mainz, Germany
A. Scholz
Affiliation:
Johannes Gutenberg University, Department of Anaesthesiology, Mainz, Germany
J. Karmrodt
Affiliation:
Johannes Gutenberg University, Department of Anaesthesiology, Mainz, Germany
B. Eberle
Affiliation:
Inselspital University of Berne, Department of Anaesthesiology, Berne, Switzerland
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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.

Keywords

HIGH FREQUENCY VENTILATION, oscillationACUTE RESPIRATORY DISTRESS SYNDROMETRANSOESOPHAGEAL ECHOCARDIOGRAPHYHAEMODYNAMIC PHENOMENA, cardiac output, pulmonary wedge pressure, blood pressure, heart rate, vascular resistance
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 21 , Issue 12 , December 2004 , pp. 944 - 952
Copyright
© 2004 European Society of Anaesthesiology

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