Cardiovascular Effects of Conventional Positive Pressure Ventilation and Airway Pressure Release Ventilation

doi:10.1378/chest.93.5.911

Chest

Volume 93, Issue 5, May 1988, Pages 911-915

https://doi.org/10.1378/chest.93.5.911 Get rights and content

The hemodynamic sequelae of conventional positive pressure ventilation (CPPV), airway pressure release ventilation (APRV), and spontaneous breathing were compared with continuous positive airway pressure (CPAP) in ten anesthetized dogs who had ventilatory failure with and without parenchymal lung injury. The APRV corrected respiratory acidosis without significantly effecting arterial blood oxygenation, venous admixture, cardiovascular function, or tissue oxygen utilization. Application of CPPV precipitated marked depressions in blood pressure, stroke volume, and cardiac output. A concomitant decrease in venous admixture did not compensate for these adverse cardiovascular effects. Deterioration of tissue oxygen delivery resulted in oxygen supply-demand imbalance during CPPV. The results of this experimental study indicate that if ventilatory augmentation of subjects who require CPAP is desired, APRV will enhance alveolar ventilation without compromising circulatory function and tissue oxygen balance, whereas CPPV will impair cardiovascular function significantly.

Section snippets

SUBJECTS AND METHODS

Ten mongrel dogs were anesthetized intravenously with 25 mg/kg pentobarbital. Anesthesia was maintained with an intravenous infusion of pentobarbital 4 mg/kg/h. The right femoral artery was cannulated for continuous measurement of systemic blood pressure and for arterial blood sampling. A pulmonary artery catheter was inserted from the right external jugular vein, for measurement of pulmonary artery pressure, right atrial pressure, and pulmonary artery occluded pressure, and for sampling mixed

RESULTS

The variables reflecting pulmonary function are presented in Table 1, and those reflecting cardiovascular function are shown in Table 2. Oleic acid produced moderate to severe acute lung injury in all dogs, as evidenced by significant deterioration of oxygenation, increased QSP/QT, tachypnea, elevated pulmonary vascular resistance, and morphologic changes in the lungs. Patchy areas of subpleural hemorrhage, and blood-tinged froth in the airways were found by postmortem examination of all

DISCUSSION

This investigation compared the hemodynamic effects of APRV, CPPV, and spontaneous breathing, administered with an unchanged level of CPAP. The results show that ventilation can be controlled using APRV, without compromising cardiopulmonary function. In contrast, CPPV impaired circulatory function and tissue oxygen balance.

Unlike any other mechanical ventilatory technique, with the exception of external negative pressure devices, the respiratory cycle during APRV is associated with a decrease

ACKNOWLEDGMENTS

We gratefully acknowledge the technical assistance of Roger Dzwonczyk, M.S.B.M.E., Deborah A. Frolicher, B.S., and Michael R. Hodges.

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Chest

Clinical InvestigationsCardiovascular Effects of Conventional Positive Pressure Ventilation and Airway Pressure Release Ventilation

Section snippets

SUBJECTS AND METHODS

RESULTS

DISCUSSION

ACKNOWLEDGMENTS

Am J Cardiol

Progr Cardiovasc Dis

Inspiratory work with and without continuous positive airway pressure in patients with acute respiratory failure

Anesthesiology

Physiological studies of the effects of intermittent positive pressure ventilation on cardiac output in man

Am J Physiol

Hemodynamic responses to mechanical ventilation with PEEP: the effect of hypervolemia

Anesthesiology

Airway pressure release ventilation: a new method of ventilatory support (Editorial)

Crit Care Med

Clinical Investigations
Cardiovascular Effects of Conventional Positive Pressure Ventilation and Airway Pressure Release Ventilation