Cardiovascular effects of ventilation

By Lara Shekerdemian, Desmond Bohn
The heart and lungs work closely to meet the tissue’s oxygen demands. An essential part of critical care is to maintain optimal cardiopulmonary function with the help of pharmacotherapy ,fluid management, and respiratory support.

Cardiopulmonary interactions (the effects of spontaneous and mechanical ventilation on the circulation) were first documented in 1733, when Stephen Hales showed that the blood pressure of healthy people fell during spontaneous inspiration. Over a century later Kussmaul described pulsus paradoxus (the inspiratory absence of the radial pulse) in patients with tuberculous pericarditis.

This article provides an overview of this broad topic, describes how simple ventilator interventions can sometimes be used to obviate the unnecessary escalation of pharmacological support, and have how in other situations, anticipatory management with fluids or vasoactive agents can minimize cardiovascular compromise during mechanical ventilation. Mechanical ventilation plays a crucial role in the hemodynamic management of critically ill children, and application of the principles that have been described are an essential part of intensive care management.

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