Estimation of transmural cardiac pressures during ventilation with PEEP.
Estimation of transmural cardiac pressures during ventilation with PEEP.
复制标题
使用 PEEP 通气时估计透壁心脏压。
DOI：
10.1152/jappl.1982.53.2.384
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发表时间：
1982
期刊：
影响因子：
--
通讯作者：
Butler,J
中科院分区：
文献类型：
--
作者：
Marini,JJ;O'Quin,R;Culver,BH;Butler,J
评估呼气末正压 (PEEP) 期间的心室性能需要准确测量透壁心脏压。我们研究了 PEEP 对八只狗通过不同方法估计的心房压力和心近压力的影响。左心房压力通过液压和换能器尖端导管系统测量。通过食管球囊和充满空气和液体的纵隔晶片传感器来估计心旁压力。通过射线照相观察仰卧犬心脏在 PEEP 期间升高和倾斜，使左心房导管和充满液体的纵隔晶片经受静水压增加。食管球囊严重低估了在仰卧位（但不是俯卧位）应用 PEEP 期间发生的压力增量，这可能是因为在肺扩张期间纵隔重量从食管上升。在三名人类受试者中也观察到类似的现象。我们得出的结论是，在仰卧准备中，肺扩张使心脏抬起并倾斜，导致腔内压力的静水压力增加和食管压力增量的减弱。这些效应有助于解释先前归因于 PEEP 的心室顺应性和性能的明显改变。
Assessment of ventricular performance during positive end-expiratory pressure (PEEP) requires accurate measurement of transmural cardiac pressures. We investigated the influence of PEEP on the atrial and juxtacardiac pressures estimated by different methods in eight dogs. Left atrial pressure was measured by hydraulic and transducer-tipped catheter systems. Juxtacardiac pressure was estimated by an esophageal balloon and by air- and fluid-filled mediastinal wafer sensors. The supine canine heart was observed radiographically to lift and tilt during PEEP subjecting the left atrial catheters and the fluid-filled mediastinal wafer to a hydrostatic pressure increase. The esophageal balloon seriously underestimated the pressure increment occurring during the application of PEEP in the supine (but not prone) position, perhaps because mediastinal weight was lifted from the esophagus during lung distension. Similar phenomena were also observed in three human subjects. We conclude that lung distension lifts and tilts the heart in a supine preparation causing a hydrostatic increase of intracavitary pressure and attenuation of the esophageal pressure increment. These effects help to account for the apparent alterations of ventricular compliance and performance previously attributed to PEEP.