Pulmonary artery pulsatility is the main cause of cardiogenic oscillations
Pulmonary artery pulsatility is the main cause of cardiogenic oscillations
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DOI：
10.1007/s10877-012-9391-8
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发表时间：
2013-02-01
影响因子：
2.2
通讯作者：
Tusman, Gerardo
中科院分区：
文献类型：
--
作者：
Suarez-Sipmann, Fernando;Santos, Arnoldo;Tusman, Gerardo
心源性振荡的起源，即在气道开口处记录的气道压力（COSpaw）和流量（COSflow）信号中的小波，正在争论中。我们假设这些波起源于肺动脉（PA）压力和流量的周期性变化，而不是心跳到肺部的物理传输。本研究的目的是验证这一假设。在10只麻醉猪中，在完整胸部的基础上呼气屏气时和开胸条件下评估COS：（1）心肺紧密接触，（2）通过将心尖提至胸腔外而不使心肺接触，（3）在主动脉夹持10 s，（4）在主动脉夹持10 s，（5）在主动脉夹持10 s，（6）在主动脉夹持10 s，（7）在主动脉夹持10 s，（8）在主动脉夹持10 s，（9）在主动脉夹持10 s，（10）在主动脉夹持10 s，以及（4）在心脏骤停后的手动按摩期间，在有和没有PA夹持的情况下，将心尖保持在胸腔外。基线COSpaw和COSflow振幅分别为0.70 +/- A 0.08 cmH（2）O和0.51 +/- A 0.06 L/min。在第1步和第2步开胸条件下，两种COS幅度均降低（p < 0.05）。然而，COSpaw和COSflow振幅并不取决于心脏是否与周围肺实质接触或隔离。所有动物夹闭PA后，当肺血流停止时，COSpaw和COSflow均消失。手动心脏按摩再现COS，但他们消失时，PA在这个动作被夹紧。PA脉动性穿过肺部的传输产生在气道开口处测量的COSpaw和COSflow。该信息具有用于呼吸监测的潜在应用。
The genesis of cardiogenic oscillations, i.e. the small waves in airway pressure (COSpaw) and flow (COSflow) signals recorded at the airway opening is under debate. We hypothesized that these waves are originated from cyclic changes in pulmonary artery (PA) pressure and flow but not from the physical transmission of heartbeats onto the lungs. The aim of this study was to test this hypothesis. In 10 anesthetized pigs, COS were evaluated during expiratory breath-holds at baseline with intact chest and during open chest conditions at: (1) close contact between heart and lungs; (2) no heart-lungs contact by lifting the heart apex outside the thoracic cavity; (3) PA clamping at the main trunk during 10 s; and (4) during manual massage after cardiac arrest maintaining the heart apex outside the thorax, with and without PA clamping. Baseline COSpaw and COSflow amplitude were 0.70 +/- A 0.08 cmH(2)O and 0.51 +/- A 0.06 L/min, respectively. Both COS amplitude decreased during open chest conditions in step 1 and 2 (p < 0.05). However, COSpaw and COSflow amplitude did not depend on whether the heart was in contact or isolated from the surrounding lung parenchyma. COSpaw and COSflow disappeared when pulmonary blood flow was stopped after clamping PA in all animals. Manual heart massages reproduced COS but they disappeared when PA was clamped during this maneuver. The transmission of PA pulsatilty across the lungs generates COSpaw and COSflow measured at the airway opening. This information has potential applications for respiratory monitoring.