Airway Pressure on Cardiovascular Performance Research Paper

Pages: 9 (2734 words)  ·  Style: APA  ·  Bibliography Sources: ≈ 19  ·  File: .docx  ·  Level: Master's  ·  Topic: Anatomy

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These are the different modes of conventional PPV, non-conventional PPV, and inhaled medical gases. There are many available modes of conventional PPV for the ICU to alter airway pressure. But because infants and children are sensitive to alterations, non-conventional approaches are resorted to. The most common are high-frequency jet ventilation or HFJV and high-frequency oscillatory ventilation or HFOV. HFJV provides similar alveolar ventilation to conventional ventilation by employing rapid respiratory rates and a lower peak inspiratory pressure or PIP, but allows a lower mean airway pressure. This lowering of mean airway pressure is helpful to patients with ventricular abnormalities or dysfunction. On the other hand, HFOV uses a higher mean airway pressure than conventional ventilation and must be used sparingly on such patients (Meliones).

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Changes in intrathoracic processes are transmitted to cardiac structures and can substantially affect and change cardiovascular performance (Meliones, 2000). These alterations occur more dramatically in infants and children than in adults. Adult patients with right ventricular or RV dysfunction and pulmonary artery hypertension may benefit from ventilation strategies, which reduce mean airway pressure and limit PEEP, as these reduce intrathoracic pressure and increase preload. This can be done by minimizing PIP and inspiratory time, and choosing the lowest PEEP, that will maintain functional residual capacity. Alternate modes of ventilation are used for patients with pulmonary hypertension and RV dysfunction on account of the deleterious effects of PPV on RV. HFJV is ideal for patients with RV dysfunction and/or pulmonary artery hypertension because it reduces airway pressure and pulmonary vascular resistance. HFJV apparently decreases mean airway pressure, decreases pulmonary vascular resistance, and increases oxygenation in select patients. These should be observed when mean airway pressure rises. Negative pressure ventilation seems to be preferable for patients with RV dysfunction (Meliones).

Research Paper on Airway Pressure on Cardiovascular Performance Assignment

Cardio-respiratory interactions for patients with left ventricular or LV dysfunction should focus on optimizing LV function (Meliones, 2000). One strategy is thoracic augmentation of LV filling. Another is to reduce mean airway pressure to the lowest possible to allow for the filling of the ventricles. The strategy for patients with congestive heart failure should be to increase PEEP to limit LV preload. Respiratory failure often occurs in patients with RV dysfunction. Lung volumes should, therefore, be maintained by titration of PEEP. But this should be carefully done because of the risk of cardiac output with increases in PEEP. Administering intravenous fluid may be called for in order to optimize oxygen delivery. Patients in this condition should undergo Swan-Ganz catheterization with the goal of optimizing oxygen delivery. Non-conventional modes, like HFJV and HFOV, should be resorted to if the mean airway pressure is significantly high (Meliones).

Relationship

PPV has significant cardiovascular effects, which are suppressed by decreased respiratory compliance (Mirro et al., 1987). This was the chief finding of an investigation conducted on the relation between blood flow and mean airway pressure in two groups of anesthesized newborn piglets. The first had normal respiratory compliance. The second group had pulmonary surfactant, depleted by repeated saline lavage. Cardiac input in the first group decreased from 292 to 134 airway pressure or at 43%. Blood flow to the heart, kidney, and intestines similarly declined. Flow to the brain, hepatic artery and adrenals, however, remained constant. Mean arterial blood pressure significantly decreased only at the highest airway pressure. Sagittal sinus pressure, on the other hand, increased along with mean airway pressure. In comparison, the second group maintained cardiac output up to a mean airway pressure of 15 cm H2O. At this level, cardiac output fell to 40% of original levels. Blood flow to the heart and kidneys went down at a mean airway pressure of 20 cm H2O. Intestinal blood flow decreased at 10 cm H2O. Brain, hepatic arterial and adrenal blood flow was not affected with increases in ventilation pressure in either group (Mirro et al.).

Cardiac output decreased in the piglets before a significant decline in arterial blood pressure occurred (Mirro et al., 1987). This suggests that a wide range of cardiovascular alterations can develop in a clinical setting before a decline in arterial blood pressure is detected. This is the more important finding of this investigation (Mirro et al.).

Cardiac Output and Mean Airway Pressure

Established opinion has been that neonates and infants cannot change their stroke volume significantly and are mainly dependent on changes in heart rate (Gullberg et al., 1999). A study evaluated the relationship between stroke volume and cardiac output during the mechanical ventilation of these two groups, using two different ways of altering mean airway pressure. One was decreasing the mean airway pressure by using pressure support ventilation. The other was increasing mean airway pressure by increasing PEEP. The research team then assessed the changes in cardiac output, heart rate and stroke volume, using the Doppler technique and by measuring blood flow velocity in the ascending aorta (Gullberg et al.).

The team found a significant increase in cardiac output with decreased mean airway pressure (Gullberg et al., 1999). Comparatively, a decrease in cardiac output was also found with increased mean airway pressure. The study concluded that neonates and infants can regulate cardiac output by increasing the stroke volume at least when mean airway changes influence cardiac output (Gullberg et al.).

Recent Advances

These have focused on the impact of ventilation on regional blood flow and cardiovascular responsiveness to PEEP and fluid resuscitation (Pinsky, 2002). New uses present as therapeutic options with reduced risk of complications in patients. Hemodynamic responses differ among individuals and depend on their pre-existing cardiovascular conditions. Critically ill patients often develop complex cardiopulmonary responses to these changes, which limit the overall efficacy of even advanced resuscitative therapies meant to address their cardiopulmonary insufficiency. The findings of many recent studies on the hemodynamic effects of PPV appear to support present understanding of heart-lung interactions and contribute further data on clinical applications and guidelines (Pinsky).

BIBLIOGRAPHY

Byrd, R.P. And Mosenifar, Z. (2010). Mechanical ventilation. Medscape: WebLLC.

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Daoud, E.G. (2007). Airway pressure release ventilation. Vol 2 (4) Annals of Thoracic

Medicine: Pub Med Central. Retrieved on August 12, 2011 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2732103

Gullberg, N. et al. (1999). Changes in stroke volume cause change in cardiac output in neonates and infants when mean airway pressure is altered. Vol 3 number 10 Acta

Anesthesioligica Scandinavia. Retrieved on August 19, 2011 from http://www.ncbi.nlm.nih.gov/pubmed/10593461

Marini, JJ and Ravenscraft, S.A. (1992). Mean airway pressure: physiologic determinants and measurements. Vol 20 (10) Critical Care Medicine: PubMed.

Retrieved on August 12, 2011 from http://www.ncbi.nlm.nih.gov/pubmed/1395670

Meliones, J.V. (2000). The effects of respiratory support on the cardiovascular system.

Chapter 4 Pediatrics: American Academy of Pediatrics. Retrieved on August 12, 2011

from http://www.pediatrics.med.unc.edu/education/imc[eds/rotations/picu.files/Meliones.pdf

Mirro, R., et al. (1987). Relationship between mean airway pressure, cardiac output and organ blood flow tieh normal and decreased respiratory compliance. 111 (1) Journal

of Pediatrics: PubMed. Retrieved on August 19, 2011 from http://www.ncbi.nlm.nih.gov/pubmed/3110385

Pinsky, M. R (2002). Recent advances in the clinical applications of heart-lung interactions. Vol 8 number 1 Current Opinion in Critical Care: Lippincott Williams & Wilkins, Inc. Retrieved on August 17, 2011 from http://jurnals.lww.com/co-criticalcare/abstract/2002/02000/Recent-advances_in_the_clinical_application_of_5.aspx

Weaver, T.E. And Grunstein, R.R. (2008). The proceedings of the American Thoracic

Society. The American Thoracic Society. Retrieved on August 12, 2011 from http://pats.atsjournals.org/cgi/content/full/5/2/173

Williams, E.A. And Whitney, G.M. (2006). Cardiopulmonary interactions. Vol 22

Number 1 SAJCC: South Africa Journal of Critical Care. Retrieved on August 17,

2011 from http://www.sajcc.org/za/index.php/SAJCC/article/download/5/69 [END OF PREVIEW] . . . READ MORE

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