Relationship between mean airway pressure, cardiac output, and organ blood flow with normal and decreased respiratory compliance

Robert Mirro, David Busija, Robert Green, Charles Leffler

Research output: Contribution to journalArticle

60 Citations (Scopus)

Abstract

We investigated the relation between blood flow and mean airway pressure in two groups of anesthetized newborn piglets. The first group had normal respiratory compliance; the second group had pulmonary surfactant depleted by repeated saline lavage, which decreased static respiratory compliance by 42%. In the normal group, cardiac output decreased linearly from 292±43 mL/min/kg at 5 cm H2O airway pressure to 134±37 ml/min/kg at 20 cm H2O airway pressure, a drop of 43% (r2=0.79). Blood flow to the heart, kidney, and intestines had a similar decline, but brain, hepatic artery, and adrenal flow were constant. Mean arterial blood pressure did not decrease significantly until the highest airway pressure was reached, whereas sagittal sinus pressure increased as mean airway pressure increased. In contrast, the surfactant-depleted group maintained cardiac output up to a mean airway pressure of 15 cm H2O. At 20 cm H2O, cardiac output fell to 40% of the original value. Blood flow to the heart and kidneys fell at a mean airway pressure of 20 cm H2O; intestinal blood flow decreased beginning at 10 cm H2O. As in the normal piglets, brain, hepatic arterial, and adrenal blood flow were not affected by increasing ventilation pressure. Our data show that positive pressure ventilation in the neonate has important cardiovascular effects that are blunted when respiratory compliance is decreased. More important, because cardiac output decreased prior to a significant decline in arterial blood pressure, these data suggest that in a clinical setting considerable cardiovascular alterations can occur before a decline in arterial blood pressure is detected.

Original languageEnglish (US)
Pages (from-to)101-106
Number of pages6
JournalThe Journal of Pediatrics
Volume111
Issue number1
DOIs
StatePublished - Jan 1 1987

Fingerprint

Cardiac Output
Compliance
Pressure
Arterial Pressure
Kidney
Pulmonary Surfactants
Positive-Pressure Respiration
Hepatic Artery
Therapeutic Irrigation
Brain
Surface-Active Agents
Intestines
Ventilation
Liver

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health

Cite this

Relationship between mean airway pressure, cardiac output, and organ blood flow with normal and decreased respiratory compliance. / Mirro, Robert; Busija, David; Green, Robert; Leffler, Charles.

In: The Journal of Pediatrics, Vol. 111, No. 1, 01.01.1987, p. 101-106.

Research output: Contribution to journalArticle

@article{d5b0700370d24fd29f24ef1ec09f8185,
title = "Relationship between mean airway pressure, cardiac output, and organ blood flow with normal and decreased respiratory compliance",
abstract = "We investigated the relation between blood flow and mean airway pressure in two groups of anesthetized newborn piglets. The first group had normal respiratory compliance; the second group had pulmonary surfactant depleted by repeated saline lavage, which decreased static respiratory compliance by 42{\%}. In the normal group, cardiac output decreased linearly from 292±43 mL/min/kg at 5 cm H2O airway pressure to 134±37 ml/min/kg at 20 cm H2O airway pressure, a drop of 43{\%} (r2=0.79). Blood flow to the heart, kidney, and intestines had a similar decline, but brain, hepatic artery, and adrenal flow were constant. Mean arterial blood pressure did not decrease significantly until the highest airway pressure was reached, whereas sagittal sinus pressure increased as mean airway pressure increased. In contrast, the surfactant-depleted group maintained cardiac output up to a mean airway pressure of 15 cm H2O. At 20 cm H2O, cardiac output fell to 40{\%} of the original value. Blood flow to the heart and kidneys fell at a mean airway pressure of 20 cm H2O; intestinal blood flow decreased beginning at 10 cm H2O. As in the normal piglets, brain, hepatic arterial, and adrenal blood flow were not affected by increasing ventilation pressure. Our data show that positive pressure ventilation in the neonate has important cardiovascular effects that are blunted when respiratory compliance is decreased. More important, because cardiac output decreased prior to a significant decline in arterial blood pressure, these data suggest that in a clinical setting considerable cardiovascular alterations can occur before a decline in arterial blood pressure is detected.",
author = "Robert Mirro and David Busija and Robert Green and Charles Leffler",
year = "1987",
month = "1",
day = "1",
doi = "10.1016/S0022-3476(87)80354-2",
language = "English (US)",
volume = "111",
pages = "101--106",
journal = "Journal of Pediatrics",
issn = "0022-3476",
publisher = "Mosby Inc.",
number = "1",

}

TY - JOUR

T1 - Relationship between mean airway pressure, cardiac output, and organ blood flow with normal and decreased respiratory compliance

AU - Mirro, Robert

AU - Busija, David

AU - Green, Robert

AU - Leffler, Charles

PY - 1987/1/1

Y1 - 1987/1/1

N2 - We investigated the relation between blood flow and mean airway pressure in two groups of anesthetized newborn piglets. The first group had normal respiratory compliance; the second group had pulmonary surfactant depleted by repeated saline lavage, which decreased static respiratory compliance by 42%. In the normal group, cardiac output decreased linearly from 292±43 mL/min/kg at 5 cm H2O airway pressure to 134±37 ml/min/kg at 20 cm H2O airway pressure, a drop of 43% (r2=0.79). Blood flow to the heart, kidney, and intestines had a similar decline, but brain, hepatic artery, and adrenal flow were constant. Mean arterial blood pressure did not decrease significantly until the highest airway pressure was reached, whereas sagittal sinus pressure increased as mean airway pressure increased. In contrast, the surfactant-depleted group maintained cardiac output up to a mean airway pressure of 15 cm H2O. At 20 cm H2O, cardiac output fell to 40% of the original value. Blood flow to the heart and kidneys fell at a mean airway pressure of 20 cm H2O; intestinal blood flow decreased beginning at 10 cm H2O. As in the normal piglets, brain, hepatic arterial, and adrenal blood flow were not affected by increasing ventilation pressure. Our data show that positive pressure ventilation in the neonate has important cardiovascular effects that are blunted when respiratory compliance is decreased. More important, because cardiac output decreased prior to a significant decline in arterial blood pressure, these data suggest that in a clinical setting considerable cardiovascular alterations can occur before a decline in arterial blood pressure is detected.

AB - We investigated the relation between blood flow and mean airway pressure in two groups of anesthetized newborn piglets. The first group had normal respiratory compliance; the second group had pulmonary surfactant depleted by repeated saline lavage, which decreased static respiratory compliance by 42%. In the normal group, cardiac output decreased linearly from 292±43 mL/min/kg at 5 cm H2O airway pressure to 134±37 ml/min/kg at 20 cm H2O airway pressure, a drop of 43% (r2=0.79). Blood flow to the heart, kidney, and intestines had a similar decline, but brain, hepatic artery, and adrenal flow were constant. Mean arterial blood pressure did not decrease significantly until the highest airway pressure was reached, whereas sagittal sinus pressure increased as mean airway pressure increased. In contrast, the surfactant-depleted group maintained cardiac output up to a mean airway pressure of 15 cm H2O. At 20 cm H2O, cardiac output fell to 40% of the original value. Blood flow to the heart and kidneys fell at a mean airway pressure of 20 cm H2O; intestinal blood flow decreased beginning at 10 cm H2O. As in the normal piglets, brain, hepatic arterial, and adrenal blood flow were not affected by increasing ventilation pressure. Our data show that positive pressure ventilation in the neonate has important cardiovascular effects that are blunted when respiratory compliance is decreased. More important, because cardiac output decreased prior to a significant decline in arterial blood pressure, these data suggest that in a clinical setting considerable cardiovascular alterations can occur before a decline in arterial blood pressure is detected.

UR - http://www.scopus.com/inward/record.url?scp=0023257494&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0023257494&partnerID=8YFLogxK

U2 - 10.1016/S0022-3476(87)80354-2

DO - 10.1016/S0022-3476(87)80354-2

M3 - Article

VL - 111

SP - 101

EP - 106

JO - Journal of Pediatrics

JF - Journal of Pediatrics

SN - 0022-3476

IS - 1

ER -