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Myocardial performance index during rapidly changing loading conditions: impact of different tidal ventilation

Published online by Cambridge University Press:  01 March 2008

J. Renner ,
E. Cavus ,
M. Gruenewald ,
M. Steinfath ,
J. Scholz ,
G. Lutter ,
M. Steffen  and
B. Bein
J. Renner*
Affiliation:
University Hospital Schleswig-Holstein, Department of Anaesthesiology and Intensive Care Medicine, Bielefeld, Germany
E. Cavus
Affiliation:
University Hospital Schleswig-Holstein, Department of Anaesthesiology and Intensive Care Medicine, Bielefeld, Germany
M. Gruenewald
Affiliation:
University Hospital Schleswig-Holstein, Department of Anaesthesiology and Intensive Care Medicine, Bielefeld, Germany
M. Steinfath
Affiliation:
University Hospital Schleswig-Holstein, Department of Anaesthesiology and Intensive Care Medicine, Bielefeld, Germany
J. Scholz
Affiliation:
University Hospital Schleswig-Holstein, Department of Anaesthesiology and Intensive Care Medicine, Bielefeld, Germany
G. Lutter
Affiliation:
University Hospital Schleswig-Holstein, Department of Cardiothoracic and Vascular Surgery, Campus Kiel, Bielefeld, Germany
M. Steffen
Affiliation:
Franziskus Hospital, Department of General Internal Medicine, Bielefeld, Germany
B. Bein
Affiliation:
University Hospital Schleswig-Holstein, Department of Anaesthesiology and Intensive Care Medicine, Bielefeld, Germany
*
Correspondence to: Jochen Renner, Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 21, D-24105 Kiel, Germany. E-mail: renner@anaesthesie.uni-kiel.de; Tel: +49 431597-3739; Fax: +49 431597-3002
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Summary

Background and objectives

The myocardial performance index is a non-geometric, heart rate-independent echocardiography-derived index of left ventricular performance combining systolic and diastolic function. There is an ongoing debate whether the myocardial performance index is affected by preload or not. Moreover, a systematic evaluation of the effect of changing tidal volume ventilation on the myocardial performance index is still lacking. The aim of our study was to assess whether acute changes in preload and/or different depth of tidal volume ventilation affect the myocardial performance index.

Methods

In all, 14 anesthetized pigs (35 ± 2 kg) were studied during changing tidal volumes (VT 5, 10 and 15 mL kg−1) at baseline, after removal of 500 cm3 of blood (haemorrhage) and after retransfusion of shed blood plus additional 500 cm3 6% hydroxyethyl starch (fluid loading). Echocardiographic measurements at each experimental stage included myocardial performance index, left ventricular end-diastolic area and fractional area change. Central venous pressure, pulmonary capillary wedge pressure, cardiac output and stroke volume index were obtained by a pulmonary artery catheter. Global end-diastolic volume was obtained by transpulmonary thermodilution.

Results

Comparing different loading conditions, we found significant changes in cardiac output, stroke volume index, central venous pressure, pulmonary capillary wedge pressure, global end diastolic volume and left ventricular end-diastolic area, indicating clinically relevant changes in preload. In the haemorrhage group, there was a significant reduction in the myocardial performance index (P < 0.05) independent of tidal volume applied and this was reversed after fluid loading. However, myocardial performance index was significantly impaired (P < 0.05) by high tidal volume ventilation (15 mL kg−1), while tidal volumes of 5 and 10 mL kg−1 had no effect.

Conclusions

The myocardial performance index is largely dependent on changes in preload. Moreover, high tidal volume ventilation significantly impaired the myocardial performance index.

Keywords

ECHOCARDIOGRAPHYMYOCARDIAL CONTRACTIONHAEMORRHAGEVENTILATIONVENTRICULAR FUNCTION
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 25 , Issue 3 , March 2008 , pp. 217 - 223
Copyright
Copyright © European Society of Anaesthesiology 2008

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