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2020, Number 5

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Med Crit 2020; 34 (5)

From physiology to ventilator, heart lung interaction during mechanical ventilation

Ochoa SH, Martínez MI, Cabrera PD, Lugo BKS, Díaz GEJ

Language: Spanish
References: 31
Page: 283-292
PDF size: 377.85 Kb.


ABSTRACT

The heart-lung interaction was observed by Hales since the 18th century. This system works simply as a circuit and a pump. By occupying the same physical space: the rib cage, changes in pressure within it will affect the system formed by the heart and lung. During the respiratory cycle the thoracic pressure varies, affecting the blood pressure gradient that enters and leaves the chest. Each of the components of the preload and afterload should be studied separately. To later understand the interdependence of the right ventricle as left and its impact on the pulmonary circulation. Ventilation with positive pressure increases intrathoracic pressure, determines decreased filling of the right ventricle, conditioning an increase in its afterload and decreasing pulmonary blood flow. All changes that occur during mechanical ventilation can trigger hemodynamic instability. The right ventricle having its reduced vascular resistance and preload is particularly subject to these changes. The use of a reduced tidal volume among other strategies, are used in order to reduce the mechanical effects suffered by the right ventricle.


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