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Left ventricular external constraint: Relationship between pericardial, pleural and esophageal pressures during positive end-expiratory pressure and volume loading in dogs

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Abstract

Left ventricular (LV) diastolic filling is limited by the constraining effects exerted by the pericardium (PE) and the lung/chest wall. The aim of the present study was to assess the validity of various estimates of external cardiac constraint, compared to pericardial surface pressure (Ppe) measured lateral to the LV myocardium. In nine anesthetized dogs we measured Ppe, pleural surface pressure (Ppl) (lateral to the pericardium) and esophageal pressure (Pes) under conditions of volume loading and positive end-expiratory pressure (PEEP). We measured Ppe and Ppl with flat, liquidcontaining silastic rubber balloons and Pes with an air-containing cylindrical balloon. After instrumentation, the chest was resealed and continuous suction (−5 mm Hg, 1 mm Hg=0.133 kPa) was maintained. Volume loading with incremental intravenous infusions of saline was used to increase LV end-diastolic pressure to 20–25 mm Hg. PEEP of 0, 10 and 20 mm Hg were applied at baseline and after each increment of volume loading. At low volume, increases in PEEP caused simultaneous increases in LV end-diastolic pressure (P<0.01) and in Ppe (P<0.0001) but a reduction in transmural LV pressure (P<0.0005). Ppl and Pes both increased with PEEP (P<0.001 and P<0.01, respectively). However, Ppe always exceeded Ppl, while Pes remained at only approximately 1/3 Ppl throughout. Volume loading caused a significant increase in Ppe (P<0.0001) and a smaller, but significant increase in Ppl (P<0.05). Pes remained unchanged during volume loading. Thus external cardiac constraint increased markedly during volume loading and PEEP as evidenced by a marked elevation of Ppe. Both Ppl and Pes markedly underestimated this increase. Therefore, calculation of transmural LV pressure by subtracting pleural or esophageal pressure from intracavitary pressure can lead to overestimation of LV preload. The decrease in cardiac output during PEEP occurs secondary to decreased preload, i.e. decreased transmural pressure and end-diastolic dimension. Analysis of performance using cardiac function curves does not suggest a change in contractility with PEEP.

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Abbreviations

LV:

Left ventricle

RV:

Right ventricle

EDP:

End-diastolic pressure

P pe :

Pericardial surface pressure

P pl :

Pleural surface pressure

P es :

Esophageal pressure

PEEP:

Positive end-expiratory pressure

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Authors and Affiliations

  1. Department of Medicine and Medical Physiology, The University of Calgary, Health Sciences Centre, 3330 Hospital Drive N.W., T2N 4N1, Calgary, Alberta, Canada

    Iris Kingma, Otto A. Smiseth, Michael A. Frais, Eldon R. Smith & John V. Tyberg

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Kingma, I., Smiseth, O.A., Frais, M.A. et al. Left ventricular external constraint: Relationship between pericardial, pleural and esophageal pressures during positive end-expiratory pressure and volume loading in dogs. Ann Biomed Eng 15, 331–346 (1987). https://doi.org/10.1007/BF02584288

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