[Cardiopulmonary interactions in the course of mechanical ventilation]

Abstract

Introduction: The haemodynamic consequences of ventilation are multiple and complex and may affect all the determinants of cardiac performance such as heart rate, preload, contractility and afterload. These consequences affect both right and left ventricle and are also related to the biventricular interdependence.

State-of-the-art: Ventilation modifies the lung volume and also the intrathoracic pressure. Variations in lung volume have consequences on the pulmonary vascular resistance, hypoxic pulmonary vasoconstriction and ventricular interdependence. Variations in intrathoracic pressure have a major impact and affect systemic venous return, right ventricular preload, left ventricular preload, right ventricular afterload, left ventricular afterload and myocardial contracility. The haemodynamic consequences of positive pressure ventilation depend on the underlying chronic cardiopulmonary pathologies leading to the acute respiratory failure that was the indication for ventilation.

Conclusion: In this review, we will focus on severe COPD exacerbation, acute left heart failure and weaning from ventilation.

Keywords: Contractility; Contractilité; Heart lung interactions; Interactions cœur–poumons; Intrathoracic pressure; Preload; Pression intra-thoracique; Précharge; Ventilation.