Volume 77, Issue 5, Pages (May 1980)

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Presentation transcript:

Volume 77, Issue 5, Pages 636-642 (May 1980) Depression of Cardiac Output is a Mechanism of Shunt Reduction in the Therapy of Acute Respiratory Failure David R. Dantzker, M.D., F.C.C.P., Joseph P. Lynch, M.D., John G. Weg, M.D., F.C.C.P. CHEST Volume 77, Issue 5, Pages 636-642 (May 1980) DOI: 10.1378/chest.77.5.636 Copyright © 1980 The American College of Chest Physicians Terms and Conditions

FIGURE 1 Three V ˙ A / Q ˙ distributions from a patient with ARDS as PEEP was increased from 0 to 16 cm H2O. There is a fall in shunt from 43.8 percent to 14.2 percent; a fall in cardiac output from 9.0 L/min to 4.5 L/min but no change in the pattern of the distributions. CHEST 1980 77, 636-642DOI: (10.1378/chest.77.5.636) Copyright © 1980 The American College of Chest Physicians Terms and Conditions

FIGURE 2 The relationship between the changes in cardiac output and shunt for 12 patients with ARDS is shown as PEEP was increased. CHEST 1980 77, 636-642DOI: (10.1378/chest.77.5.636) Copyright © 1980 The American College of Chest Physicians Terms and Conditions

FIGURE 3 (right). Three V ˙ A / Q ˙ distributions from a patient with ARDS as the tidal volume was increased from 10 ml/kg to 20 ml/kg. The shunt decreased from 50.3 percent to 25.9 percent and the cardiac output from 7.6 L/min to 5.8 L/min while the shape of the distribution remained unchanged. CHEST 1980 77, 636-642DOI: (10.1378/chest.77.5.636) Copyright © 1980 The American College of Chest Physicians Terms and Conditions

FIGURE 4 The relationship between the changes in cardiac output and shunt as tidal volume was increased in eight patients with ARDS. CHEST 1980 77, 636-642DOI: (10.1378/chest.77.5.636) Copyright © 1980 The American College of Chest Physicians Terms and Conditions

FIGURE 5 The change in cardiac output is plotted against the change in shunt for all 20 patients studied. The closed circles are the patients studied at increasing PEEP and the open circles, increasing tidal volume. CHEST 1980 77, 636-642DOI: (10.1378/chest.77.5.636) Copyright © 1980 The American College of Chest Physicians Terms and Conditions