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Cardiac output estimation using pulmonary mechanics in mechanically ventilated patients

The application of positive end expiratory pressure (PEEP) in mechanically ventilated (MV) patients with acute respiratory distress syndrome (ARDS) decreases cardiac output (CO). Accurate measurement of CO is highly invasive and is not ideal for all MV critically ill patients. However, the link betw...

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Detalles Bibliográficos
Autores principales: Sundaresan, Ashwath, Chase, J Geoffrey, Hann, Christopher E, Shaw, Geoffrey M
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2010
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3009970/
https://www.ncbi.nlm.nih.gov/pubmed/21108836
http://dx.doi.org/10.1186/1475-925X-9-80
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author Sundaresan, Ashwath
Chase, J Geoffrey
Hann, Christopher E
Shaw, Geoffrey M
author_facet Sundaresan, Ashwath
Chase, J Geoffrey
Hann, Christopher E
Shaw, Geoffrey M
author_sort Sundaresan, Ashwath
collection PubMed
description The application of positive end expiratory pressure (PEEP) in mechanically ventilated (MV) patients with acute respiratory distress syndrome (ARDS) decreases cardiac output (CO). Accurate measurement of CO is highly invasive and is not ideal for all MV critically ill patients. However, the link between the PEEP used in MV, and CO provides an opportunity to assess CO via MV therapy and other existing measurements, creating a CO measure without further invasiveness. This paper examines combining models of diffusion resistance and lung mechanics, to help predict CO changes due to PEEP. The CO estimator uses an initial measurement of pulmonary shunt, and estimations of shunt changes due to PEEP to predict CO at different levels of PEEP. Inputs to the cardiac model are the PV loops from the ventilator, as well as the oxygen saturation values using known respiratory inspired oxygen content. The outputs are estimates of pulmonary shunt and CO changes due to changes in applied PEEP. Data from two published studies are used to assess and initially validate this model. The model shows the effect on oxygenation due to decreased CO and decreased shunt, resulting from increased PEEP. It concludes that there is a trade off on oxygenation parameters. More clinically importantly, the model also examines how the rate of CO drop with increased PEEP can be used as a method to determine optimal PEEP, which may be used to optimise MV therapy with respect to the gas exchange achieved, as well as accounting for the impact on the cardiovascular system and its management.
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spelling pubmed-30099702011-01-10 Cardiac output estimation using pulmonary mechanics in mechanically ventilated patients Sundaresan, Ashwath Chase, J Geoffrey Hann, Christopher E Shaw, Geoffrey M Biomed Eng Online Research The application of positive end expiratory pressure (PEEP) in mechanically ventilated (MV) patients with acute respiratory distress syndrome (ARDS) decreases cardiac output (CO). Accurate measurement of CO is highly invasive and is not ideal for all MV critically ill patients. However, the link between the PEEP used in MV, and CO provides an opportunity to assess CO via MV therapy and other existing measurements, creating a CO measure without further invasiveness. This paper examines combining models of diffusion resistance and lung mechanics, to help predict CO changes due to PEEP. The CO estimator uses an initial measurement of pulmonary shunt, and estimations of shunt changes due to PEEP to predict CO at different levels of PEEP. Inputs to the cardiac model are the PV loops from the ventilator, as well as the oxygen saturation values using known respiratory inspired oxygen content. The outputs are estimates of pulmonary shunt and CO changes due to changes in applied PEEP. Data from two published studies are used to assess and initially validate this model. The model shows the effect on oxygenation due to decreased CO and decreased shunt, resulting from increased PEEP. It concludes that there is a trade off on oxygenation parameters. More clinically importantly, the model also examines how the rate of CO drop with increased PEEP can be used as a method to determine optimal PEEP, which may be used to optimise MV therapy with respect to the gas exchange achieved, as well as accounting for the impact on the cardiovascular system and its management. BioMed Central 2010-11-25 /pmc/articles/PMC3009970/ /pubmed/21108836 http://dx.doi.org/10.1186/1475-925X-9-80 Text en Copyright ©2010 Sundaresan et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (<url>http://creativecommons.org/licenses/by/2.0</url>), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research
Sundaresan, Ashwath
Chase, J Geoffrey
Hann, Christopher E
Shaw, Geoffrey M
Cardiac output estimation using pulmonary mechanics in mechanically ventilated patients
title Cardiac output estimation using pulmonary mechanics in mechanically ventilated patients
title_full Cardiac output estimation using pulmonary mechanics in mechanically ventilated patients
title_fullStr Cardiac output estimation using pulmonary mechanics in mechanically ventilated patients
title_full_unstemmed Cardiac output estimation using pulmonary mechanics in mechanically ventilated patients
title_short Cardiac output estimation using pulmonary mechanics in mechanically ventilated patients
title_sort cardiac output estimation using pulmonary mechanics in mechanically ventilated patients
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3009970/
https://www.ncbi.nlm.nih.gov/pubmed/21108836
http://dx.doi.org/10.1186/1475-925X-9-80
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