Heart-Lungs interactions: the basics and clinical implications.

IF 5.7 1区 医学 Q1 CRITICAL CARE MEDICINE Annals of Intensive Care Pub Date : 2024-08-12 DOI:10.1186/s13613-024-01356-5
Mathieu Jozwiak, Jean-Louis Teboul
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Abstract

Heart-lungs interactions are related to the interplay between the cardiovascular and the respiratory system. They result from the respiratory-induced changes in intrathoracic pressure, which are transmitted to the cardiac cavities and to the changes in alveolar pressure, which may impact the lung microvessels. In spontaneously breathing patients, consequences of heart-lungs interactions are during inspiration an increase in right ventricular preload and afterload, a decrease in left ventricular preload and an increase in left ventricular afterload. In mechanically ventilated patients, consequences of heart-lungs interactions are during mechanical insufflation a decrease in right ventricular preload, an increase in right ventricular afterload, an increase in left ventricular preload and a decrease in left ventricular afterload. Physiologically and during normal breathing, heart-lungs interactions do not lead to significant hemodynamic consequences. Nevertheless, in some clinical settings such as acute exacerbation of chronic obstructive pulmonary disease, acute left heart failure or acute respiratory distress syndrome, heart-lungs interactions may lead to significant hemodynamic consequences. These are linked to complex pathophysiological mechanisms, including a marked inspiratory negativity of intrathoracic pressure, a marked inspiratory increase in transpulmonary pressure and an increase in intra-abdominal pressure. The most recent application of heart-lungs interactions is the prediction of fluid responsiveness in mechanically ventilated patients. The first test to be developed using heart-lungs interactions was the respiratory variation of pulse pressure. Subsequently, many other dynamic fluid responsiveness tests using heart-lungs interactions have been developed, such as the respiratory variations of pulse contour-based stroke volume or the respiratory variations of the inferior or superior vena cava diameters. All these tests share the same limitations, the most frequent being low tidal volume ventilation, persistent spontaneous breathing activity and cardiac arrhythmia. Nevertheless, when their main limitations are properly addressed, all these tests can help intensivists in the decision-making process regarding fluid administration and fluid removal in critically ill patients.

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心肺相互作用:基础知识和临床意义。
心肺相互作用与心血管系统和呼吸系统之间的相互作用有关。心肺相互作用是由呼吸引起的胸腔内压力变化和肺泡压力变化造成的,胸腔内压力变化会传导到心腔,肺泡压力变化则会影响肺部微血管。在自主呼吸患者中,心肺相互作用的结果是吸气时右心室前负荷和后负荷增加,左心室前负荷减少,左心室后负荷增加。在机械通气的患者中,心肺相互作用的结果是在机械充气时右心室前负荷减少,右心室后负荷增加,左心室前负荷增加,左心室后负荷减少。在生理上和正常呼吸时,心肺相互作用不会导致明显的血液动力学后果。然而,在某些临床情况下,如慢性阻塞性肺病急性加重、急性左心衰竭或急性呼吸窘迫综合征,心肺相互作用可能会导致严重的血液动力学后果。这与复杂的病理生理机制有关,包括吸气时胸内压明显减低、吸气时肺动脉转压明显升高以及腹内压升高。心肺相互作用的最新应用是预测机械通气患者的液体反应性。利用心肺相互作用开发的第一个测试方法是脉压的呼吸变化。随后,又开发了许多其他利用心肺相互作用的动态体液反应性测试,如基于脉搏轮廓的每搏容量的呼吸变化或下腔静脉或上腔静脉直径的呼吸变化。所有这些测试都有相同的局限性,最常见的是低潮气量通气、持续的自主呼吸活动和心律失常。尽管如此,如果能适当解决其主要局限性,所有这些测试都能帮助重症监护医生在危重病人的输液和排液过程中做出决策。
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来源期刊
Annals of Intensive Care
Annals of Intensive Care CRITICAL CARE MEDICINE-
CiteScore
14.20
自引率
3.70%
发文量
107
审稿时长
13 weeks
期刊介绍: Annals of Intensive Care is an online peer-reviewed journal that publishes high-quality review articles and original research papers in the field of intensive care medicine. It targets critical care providers including attending physicians, fellows, residents, nurses, and physiotherapists, who aim to enhance their knowledge and provide optimal care for their patients. The journal's articles are included in various prestigious databases such as CAS, Current contents, DOAJ, Embase, Journal Citation Reports/Science Edition, OCLC, PubMed, PubMed Central, Science Citation Index Expanded, SCOPUS, and Summon by Serial Solutions.
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