J Clin Monit Comput - The effects of cardiac output and pulmonary arterial hypertension on volumetric capnography derived-variables during normoxia and hypoxia.

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Resumo

The aim of this study was to test the effect of cardiac output (CO) and pulmonary artery hypertension (PHT) on volumetric capnography (VCap) derived-variables. Nine pigs were mechanically ventilated using fixed ventilatory settings. Two steps of PHT were induced by IV infusion of a thromboxane analogue: PHT25 [mean pulmonary arterial pressure (MPAP) of 25 mmHg] and PHT40 (MPAP of 40 mmHg). CO was increased by 50% from baseline (COup) with an infusion of dobutamine=5 ?g kg(-1) min(-1) and decreased by 40% from baseline (COdown) infusing sodium nitroglycerine=30 ?g kg(-1) min(-1) plus esmolol 500 ?g kg(-1) min(-1). Another state of PHT and COdown was induced by severe hypoxemia (FiO2 0.07). Invasive hemodynamic data and VCap were recorded and compared before and after each step using a mixed random effects model. Compared to baseline, the normalized slope of phase III (SnIII) increased by 32% in PHT25 and by 22% in PHT40. SnIII decreased non-significantly by 4% with COdown. A combination of PHT and COdown associated with severe hypoxemia increased SnIII by 28% compared to baseline. The elimination of CO2 per breath decreased by 7% in PHT40 and by 12% in COdown but increased only slightly with COup. Dead space variables did not change significantly along the protocol. At constant ventilation and body metabolism, pulmonary artery hypertension and decreases in CO had the biggest effects on the SnIII of the volumetric capnogram and on the elimination of CO2.

Resumo Limpo

aim studi test effect cardiac output co pulmonari arteri hypertens pht volumetr capnographi vcap derivedvari nine pig mechan ventil use fix ventilatori set two step pht induc iv infus thromboxan analogu pht mean pulmonari arteri pressur mpap mmhg pht mpap mmhg co increas baselin coup infus dobutamin g kg min decreas baselin codown infus sodium nitroglycerin g kg min plus esmolol g kg min anoth state pht codown induc sever hypoxemia fio invas hemodynam data vcap record compar step use mix random effect model compar baselin normal slope phase iii sniii increas pht pht sniii decreas nonsignific codown combin pht codown associ sever hypoxemia increas sniii compar baselin elimin co per breath decreas pht codown increas slight coup dead space variabl chang signific along protocol constant ventil bodi metabol pulmonari arteri hypertens decreas co biggest effect sniii volumetr capnogram elimin co

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