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Pleural effusion decreases left ventricular pre-load and causes haemodynamic compromise: an experimental porcine study.
- Source :
-
Acta anaesthesiologica Scandinavica [Acta Anaesthesiol Scand] 2012 Aug; Vol. 56 (7), pp. 833-9. Date of Electronic Publication: 2012 May 09. - Publication Year :
- 2012
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Abstract
- Background: Although pleural effusion is a common complication in critically ill patients, detailed knowledge is missing about the haemodynamic impact and the underlining mechanisms. The aim of this study was to evaluate the haemodynamic effect of incremental pleural effusion by means of invasive haemodynamic parameters and transthoracic echocardiography.<br />Methods: This experimental interventional study was conducted using 22 female piglets (17.5-21.5 kg) randomized for right-side (n = 9) and left-side (n = 9) pleural effusion, or sham operation (n = 4). Pleural effusion was induced by infusing incremental volumes of saline into the pleural cavity. Invasive haemodynamic measurements and echocardiographical images were obtained at baseline, a volume of 45 ml/kg, a volume of 75 ml/kg and 45 min after drainage.<br />Results: No difference (all P > 0.147) was found between right- and left-side pleural effusion, and the groups were thus pooled. At 45 ml/kg cardiac output, mean arterial pressure, stroke volume and mixed venous saturation decreased (all P < 0.003); central venous pressure and pulmonary arterial pressure increased (both P > 0.003) at this point. The changes accelerated at 75 ml/kg. At 45 ml/kg left ventricular pre-load in terms of end-diastolic area decreased significantly (P < 0.001). The effect on haemodynamics and cardiac dimensions changed dramatically at 75 ml/kg. Cardiac output, mean arterial pressure, central venous pressure and left ventricular end-diastolic area returned to normal during a recovery period of 45 min (all P > 0.061).<br />Conclusion: Incremental volumes of unilateral pleural effusion induced a significant haemodynamic impact fully reversible after drainage. Pleural effusion causes a significant decrease of left ventricular pre-load in a diverse picture of haemodynamic compromise.<br /> (© 2012 The Authors. Acta Anaesthesiologica Scandinavica © 2012 The Acta Anaesthesiologica Scandinavica Foundation.)
- Subjects :
- Animals
Cardiac Output
Cardiac Tamponade diagnostic imaging
Cardiac Tamponade physiopathology
Echocardiography
Heart Ventricles diagnostic imaging
Pleural Effusion complications
Pulmonary Embolism diagnostic imaging
Pulmonary Embolism physiopathology
Random Allocation
Single-Blind Method
Stroke Volume
Sus scrofa
Swine
Ventricular Dysfunction, Left diagnostic imaging
Ventricular Dysfunction, Left physiopathology
Heart Ventricles physiopathology
Hemodynamics
Pleural Effusion physiopathology
Ventricular Dysfunction, Left etiology
Subjects
Details
- Language :
- English
- ISSN :
- 1399-6576
- Volume :
- 56
- Issue :
- 7
- Database :
- MEDLINE
- Journal :
- Acta anaesthesiologica Scandinavica
- Publication Type :
- Academic Journal
- Accession number :
- 22571346
- Full Text :
- https://doi.org/10.1111/j.1399-6576.2012.02678.x