Dr. Bradley Fuhrman, an expert in pediatric critical care, discusses cardiopulmonary interactions. Topics include the impact of intubation and positive pressure ventilation on cardiovascular physiology, the relationship between right and left ventricular performance, and the muscle connection in pericardial tamponade. The hosts emphasize the importance of seeking medical advice and express excitement about interviewing Fuhrman.
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Positive Pressure Ventilation Effects
Positive pressure ventilation decreases patient's oxygen demand by stopping work of breathing, reducing cardiac output demand.
Increased lung volume raises juxtapacardiac pressure, impedes venous return, but effect depends on lung compliance.
volunteer_activism ADVICE
Ventilation Strategy in Pulmonary Hypertension
For pulmonary hypertension, avoid acidosis and hypercarbia to prevent increased pulmonary vascular resistance.
Ventilate around functional residual capacity (FRC) to minimize vascular resistance, confirmed by post-intubation chest X-ray.
insights INSIGHT
U-Shaped Lung Volume Effect
Lung volume affects pulmonary vascular resistance via alveolar septal and corner vessels with a U-shaped relationship.
Vascular resistance is lowest at FRC and rises when lung volume is above or below FRC.
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Bradley Fuhrman, MD completed his training in pediatrics followed by fellowships in cardiology and neonatology at the University of Minnesota where he went on to found the first PICU and serve as the Chief of critical care at that institution. He has also served as the associate director of the PICU at Children’s Hospital of Pittsburgh, Division Chief of Critical Care at Children’s Hospital Buffalo and Physician-in-Chief at El Paso Children’s Hospital. His career in pediatric critical care exceeds 40 years. He has many peer-reviewed publications with a research career that is focused in cardiac and respiratory physiology. He is also the co-author of Fuhrman and Zimmerman’s Pediatric Critical Care.
Learning Objectives:
By the end of listening to this 2-part series, learners should be able to discuss clinically relevant cardiopulmonary interactions and a fundamental clinical approach to optimizing cardiopulmonary mechanics in patients with:
Spontaneous (negative pressure) respirations with severe work of breathing
Septic shock
Mechanical (positive pressure) ventilation
Pulmonary hypertension with right ventricular systolic dysfunction
Left ventricular systolic dysfunction
Right ventricular diastolic dysfunction
Single ventricle Fontan circulation
References:
Bronicki RA, Penny DJ, Anas NG, Fuhrman B. Cardiopulmonary Interactions. Pediatr Crit Care Med. 2016 Aug;17(8 Suppl 1):S182-93. doi: 10.1097/PCC.0000000000000829. PMID: 27490598.
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Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.comfor detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.
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