Right atrial pressure and venous return during cardiopulmonary bypass.

Werner Möller, Per; Winkler, Berhard; Hurni, Samuel; Heinisch, Paul Philipp; Bloch, Andreas; Sondergaard, Soren; Jakob, Stephan; Takala, Jukka; Berger, David (2017). Right atrial pressure and venous return during cardiopulmonary bypass. American journal of physiology - heart and circulatory physiology, 313(2), H408-H420. American Physiological Society 10.1152/ajpheart.00081.2017

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The relevance of right atrial pressure (RAP) as the back-pressure for venous return (QVR) and mean systemic filling pressure (MSFP) as up-stream pressure is controversial during dynamic changes of circulation. To examine the immediate response of QVR (sum of caval vein flows) to changes in RAP and pump function we used a closed chest, central cannulation, heart bypass porcine preparation (n=10) with veno-arterial extracorporeal membrane oxygenation (ECMO). MSFP was determined by clamping ECMO tubing with open or closed arterio-venous shunt at Euvolemia, Volume Expansion (9.75 mL/kg hydroxyethyl starch) and Hypovolemia (bleeding 19.5 mL/kg after Volume Expansion). The response of RAP and QVR were studied using variable pump speed at constant airway pressure (PAW) and constant pump speed at variable PAW Within each volume state, the immediate changes in QVR and RAP could be described with a single linear regression, regardless of whether RAP was altered by pump speed or PAW (r2 0.586-0.984). RAP was inversely proportional to pump speed from zero to maximum flow (r2 0.859-0.999). Changing PAW caused immediate, transient, directionally opposite changes in RAP and QVR (RAP p ≤ 0.002; QVR p ≤ 0.001), where the initial response was proportional to the change in QVR driving pressure. Changes in PAW generated volume shifts into and out of the right atrium, but their effect on up-stream pressure was negligible. Our findings support the concept that RAP acts as back-pressure to QVR and that Guyton's model of circulatory equilibrium qualitatively predicts the dynamic response from changing RAP.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiovascular Surgery
04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic of Intensive Care

UniBE Contributor:

Werner Möller, Per; Hurni, Samuel; Heinisch, Paul Philipp; Bloch, Andreas; Jakob, Stephan; Takala, Jukka and Berger, David

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0363-6135

Publisher:

American Physiological Society

Language:

English

Submitter:

Mirella Aeberhard

Date Deposited:

14 Sep 2017 13:51

Last Modified:

08 Jan 2018 14:17

Publisher DOI:

10.1152/ajpheart.00081.2017

PubMed ID:

28550170

Uncontrolled Keywords:

Mean systemic filling pressure Right atrial pressure cardiac output extracorporeal membrane oxygenation venous return

BORIS DOI:

10.7892/boris.101028

URI:

https://boris.unibe.ch/id/eprint/101028

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