Automated expiratory ventilation assistance through a small endotracheal tube can improve venous return and cardiac output

David A Berlin; Seth Manoach; Clara Oromendia; Paul M Heerdt

doi:10.1186/s40635-018-0217-y

Automated expiratory ventilation assistance through a small endotracheal tube can improve venous return and cardiac output

Intensive Care Med Exp. 2019 Jan 9;7(1):6. doi: 10.1186/s40635-018-0217-y.

Authors

David A Berlin¹, Seth Manoach¹, Clara Oromendia², Paul M Heerdt³

Affiliations

¹ Division of Pulmonary and Critical Care Medicine, Weill Cornell Medicine, 1300 York Avenue, New York, NY, 10065, USA.
² Division of Biostatistics and Epidemiology, Weill Cornell Medicine, 1300 York Avenue, New York, NY, 10065, USA.
³ Division of Applied Hemodynamics, Yale University School of Medicine, 333 Cedar St, P.O. BOX 208051, New Haven, CT, 06520-8051, USA. paul.heerdt@yale.edu.

Abstract

Background: Positive pressure ventilation can decrease venous return and cardiac output. It is not known if expiratory ventilation assistance (EVA) through a small endotracheal tube can improve venous return and cardiac output.

Results: In a porcine model, switching from conventional positive pressure ventilation to (EVA) with - 8 cmH₂0 expiratory pressure increased the venous return and cardiac output. The stroke volume increased by 27% when the subjects were switched from conventional ventilation to EVA [53.8 ± 7.7 (SD) vs. 68.1 ± 7.7 ml, p = 0.003]. After hemorrhage, subjects treated with EVA had higher median cardiac output, higher mean systemic arterial pressure, and lower central venous pressure at 40 and 60 min when compared with subjects treated with conventional ventilation with PEEP 0 cmH₂0. The median cardiac output was 41% higher in the EVA group than the control group at 60 min [2.70 vs. 1.59 L/min, p = 0.029].

Conclusion: EVA through a small endotracheal tube increased venous return, cardiac output, and mean arterial pressure compared with conventional positive pressure ventilation. The effects were most significant during hypovolemia from hemorrhage. EVA provided less effective ventilation than conventional positive pressure ventilation.

Keywords: Cardiac output; Expiratory ventilation assistance; Hemorrhage; Negative pressure ventilation; Venous return.