Cardiorespiratory responses to negative pressure ventilation after tetralogy of fallot repair: A hemodynamic tool for patients with a low-output state
Cardiorespiratory responses to negative pressure ventilation after tetralogy of fallot repair: A hemodynamic tool for patients with a low-output state
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DOI：
10.1016/s0735-1097(98)00598-1
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发表时间：
1999-02-01
影响因子：
24
通讯作者：
Redington, AN
中科院分区：
文献类型：
--
作者：
Shekerdemian, LS;Bush, A;Redington, AN
我们假设一段时间的胸甲负压通气（NPV）将增加心脏输出量的患者在术后早期完全纠正法洛四联症（TOF）。背景舒张期右心室功能障碍可导致低输出量状态在一个重要的少数患者TOF修复后。在这些患者中，舒张期肺动脉血流，其特征是限制性的右心室生理，并在其上的心输出量是如此依赖，是高度敏感的胸内pressure.METHODS的变化，NPV对肺血流量的影响进行了研究，在23个插管的儿童谁最初使用间歇正压通气TOF修复后通气。8例患者右心室生理功能受限。所有患儿均接受15 min的NPV治疗，8例接受延长期（45 min）的NPV治疗。结果短期NPV使肺血流量增加39%，如果延长研究时间，改善进一步持续，45 min后总增加67%。但限制性患者（84%）在较长时间内的净现值最终增加幅度大于非限制性患者（50%）。结论通过操纵重要的心肺相互作用，净现值改善了TOF修复后患者的心输出量，并在选定病例中作为低输出状态管理的血流动力学工具。(C)1999年由美国心脏病学会。
OBJECTIVES We hypothesized that a period of cuirass negative pressure ventilation (NPV) would augment the cardiac output of patients in the early postoperative period after complete correction of tetralogy of Fallot (TOF).BACKGROUND Diastolic right ventricular dysfunction can lead to a low-output state in an important minority of patients after TOF repair. In these patients, the diastolic pulmonary arterial flow, which characterizes restrictive right ventricular physiology, and on which the cardiac output is so dependent, is highly sensitive to changes in intrathoracic pressure.METHODS The effects of NPV on pulmonary blood flow were investigated in 23 intubated children who were initially ventilated using intermittent positive pressure ventilation after TOF repair. Eight patients had restrictive right ventricular physiology. All children received a 15-min period of NPV, and eight received a prolonged period (45 min) of NPV.RESULTS A brief period of NPV increased pulmonary blood flow by 39%, and the improvement further continued if the study period was extended, with a total increase of 67% after 45 min. Patients with restrictive physiology had a somewhat delayed response to NPV, but the ultimate increase during an extended period of NPV was greater in restrictive patients (84%) than nonrestrictive patients (50%).CONCLUSIONS By manipulating important cardiopulmonary interactions, NPV improves the cardiac output of patients after TOF repair, and has a role as a hemodynamic tool in the management of the low-output state in selected cases. (C) 1999 by the American College of Cardiology.