Collapsibility of caval vessels and right ventricular afterload: decoupling of stroke volume variation from preload during mechanical ventilation.

Valenti, Elisa; Moller, Per W; Takala, Jukka; Berger, David (2021). Collapsibility of caval vessels and right ventricular afterload: decoupling of stroke volume variation from preload during mechanical ventilation. Journal of applied physiology, 130(5), pp. 1562-1572. American Physiological Society 10.1152/japplphysiol.01039.2020

[img] Text
2021_-_Valenti_-_J_Appl_Physiol_-_PMID_33734829.pdf - Published Version
Restricted to registered users only
Available under License Publisher holds Copyright.

Download (1MB) | Request a copy

Collapsibility of caval vessels and stroke volume and pulse pressure variations (SVV, PPV) are used as indicators of volume responsiveness. Their behavior under increasing airway pressures and changing right ventricular afterload is incompletely understood. If the phenomena of SVV and PPV augmentation are manifestations of decreasing preload, they should be accompanied by decreasing transmural right atrial pressures. Eight healthy pigs equipped with ultrasonic flow probes on the pulmonary artery were exposed to positive end-expiratory pressure of 5 and 10 cmH2O and three volume states (Euvolemia, defined as SVV < 10%, Bleeding, and Retransfusion). SVV and PPV were calculated for the right and PPV for the left side of the circulation at increasing inspiratory airway pressures (15, 20, and 25 cmH2O). Right ventricular afterload was assessed by surrogate flow profile parameters. Transmural pressures in the right atrium and the inferior and superior caval vessels (IVC and SVC) were determined. Increasing airway pressure led to increases in ultrasonic surrogate parameters of right ventricular afterload, increasing transmural pressures in the right atrium and SVC, and a drop in transmural IVC pressure. SVV and PPV increased with increasing airway pressure, despite the increase in right atrial transmural pressure. Right ventricular stroke volume variation correlated with indicators of right ventricular afterload. This behavior was observed in both PEEP levels and all volume states. Stroke volume variation may reflect changes in right ventricular afterload rather than changes in preload.NEW & NOTEWORTHY Stroke volume variation and pulse pressure variation are used as indicators of preload or volume responsiveness of the heart. Our study shows that these variations are influenced by changes in right ventricular afterload and may therefore reflect right ventricular failure rather than pure volume responsiveness. A zone of collapse detaches the superior vena cava and its diameter variation from the right atrium.

Item Type:

Journal Article (Original Article)

Division/Institute:

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

UniBE Contributor:

Valenti, Elisa; Takala, Jukka and Berger, David

Subjects:

600 Technology > 610 Medicine & health

ISSN:

8750-7587

Publisher:

American Physiological Society

Language:

English

Submitter:

Jsabelle Arni

Date Deposited:

08 Jun 2021 11:47

Last Modified:

08 Jun 2021 11:47

Publisher DOI:

10.1152/japplphysiol.01039.2020

PubMed ID:

33734829

Uncontrolled Keywords:

afterload pulse pressure variation right heart failure right ventricle volume responsiveness

BORIS DOI:

10.48350/156339

URI:

https://boris.unibe.ch/id/eprint/156339

Actions (login required)

Edit item Edit item
Provide Feedback