Intermittent positive pressure ventilation increases diastolic pulmonary arterial pressure in advanced COPD.
作者信息
Wrobel Jeremy P, Thompson Bruce R, Stuart-Andrews Christopher R, Kee Kirk, Snell Gregory I, Buckland Mark, Williams Trevor J
机构信息
Department of Medicine, Monash University, Melbourne, Australia; Allergy, Immunology & Respiratory Medicine, The Alfred, Melbourne, Australia; Advanced Lung Disease Unit, Royal Perth Hospital, Perth, Australia.
Department of Medicine, Monash University, Melbourne, Australia; Allergy, Immunology & Respiratory Medicine, The Alfred, Melbourne, Australia.
出版信息
Heart Lung. 2015 Jan-Feb;44(1):50-6. doi: 10.1016/j.hrtlng.2014.10.006. Epub 2014 Nov 20.
OBJECTIVES
To measure the impact of intermittent positive pressure ventilation (IPPV) on diastolic pulmonary arterial pressure (dPAP) and pulmonary pulse pressure in patients with advanced COPD.
BACKGROUND
The physiological effects of raised intrathoracic pressures upon the pulmonary circulation have not been fully established.
METHODS
22 subjects with severe COPD receiving IPPV were prospectively assessed with pulmonary and radial arterial catheterization. Changes in dPAP were assessed from end-expiration to early inspiration during low and high tidal volume ventilation.
RESULTS
Inspiration during low tidal volume IPPV increased the median [IQR] dPAP by 3.9 [2.5-4.8] mm Hg (P < 0.001). During high tidal volume, similar changes were observed. The IPPV-associated change in dPAP was correlated with baseline measures of PaO2 (rho = 0.65, P = 0.005), pH (rho = 0.64, P = 0.006) and right atrial pressure (rho = -0.53, P = 0.011).
CONCLUSIONS
In severe COPD, IPPV increases dPAP and reduces pulmonary pulse pressure during inspiration.
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