DEPRESSION OF CARDIAC-OUTPUT IS A MECHANISM OF SHUNT REDUCTION IN THE THERAPY OF ACUTE RESPIRATORY-FAILURE
DEPRESSION OF CARDIAC-OUTPUT IS A MECHANISM OF SHUNT REDUCTION IN THE THERAPY OF ACUTE RESPIRATORY-FAILURE
复制标题
DOI：
10.1378/chest.77.5.636
复制
发表时间：
1980-01-01
期刊：
影响因子：
9.6
通讯作者：
WEG, JG
中科院分区：
文献类型：
--
作者：
DANTZKER, DR;LYNCH, JP;WEG, JG
本文报告20例成人呼吸窘迫综合征（ARDS）患者机械通气时心输出量变化与肺内分流的关系。采用多种惰性气体技术测定肺内分流水平和通气-灌注（VA/Q）比值的分布。肺血流主要分布于有效换气单位或分流单位。呼气末正压（PEEP）或大潮气量通气导致分流和心输出量减少，而不改变VA/Q分布的总体模式。分流和心输出量的变化在定量和定性上相似，并且发现分流和心输出量的变化与PEEP和高潮气量之间存在强相关性（r [相关系数] = 0.76）。与这些通气模式相关的心输出量降低似乎是ARDS中分流减少的机制。对ARDS气体交换改善的解释必须考虑伴随的血流动力学变化。
The relationship between changes in cardiac output and intrapulmonary shunt associated with mechanical ventilation was evaluated in 20 patients with the adult respiratory distress syndrome (ARDS). The distribution of ventilation-perfusion (.ovrhdot.VA/.ovrhdot.Q) ratios and the level of intrapulmonary shunt were determined by the multiple inert gas technique. Pulmonary blood flow was distributed predominantly to effective gas-exchanging units or shunt units. Positive and end-expiratory pressure (PEEP) or high tidal volume ventilation led to decreases in shunt and cardiac output without altering the overall pattern of .ovrhdot.VA/.ovrhdot.Q distributions. Changes in shunt and cardiac output were quantitatively and qualitatively similar and a strong correlation was found between changes in shunt and cardiac output with PEEP and high tidal volumes (r [correlation coefficient] = 0.76). Cardiac output depression associated with these modes of ventilation appears to be a mechanism of shunt reduction in ARDS. Interpretation of improvements in gas exchange in ARDS must consider concomitant hemodynamic changes.