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PedsCrit
Cardiopulmonary Interactions with Dr. Bradley Fuhrman -- Part 2
Sep 11, 2023
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.
31:42
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Quick takeaways
- Positive pressure ventilation affects all four major heart-lung interactions, with potential benefits in improving cardiac output and acid-base balance while also increasing venous return and reducing pulmonary vascular resistance.
- In patients with pulmonary hypertension, maintaining normal oxygen and carbon dioxide levels, balancing lung volume near functional residual capacity (FRC), and optimizing alveolar P02 are crucial for minimizing pulmonary vascular resistance and improving patient outcomes.
Deep dives
Positive pressure ventilation and its effects on cardiopulmonary interactions
When moving from negative to positive pressure ventilation, the patient's oxygen demand and demand for cardiac output decrease, resulting in an overall improvement. Positive pressure ventilation affects all four major heart-lung interactions. It increases juxtapacardiac pressure on the right side, which may impede venous return. However, in patients with stiff lungs, the increase in juxtapacardiac pressure may not be significant. On the other hand, patients with normal lung function can experience a substantial increase in juxtapacardiac pressure and reduced venous return. Positive pressure ventilation also raises alveolar pressure, which impedes blood flow through the lungs and increases pulmonary vascular resistance. However, it can be beneficial in restoring acid-base balance and reducing pulmonary vascular resistance. Lastly, positive pressure ventilation affects preload by shifting the ventricular septum to the left and reducing left ventricular volume. However, it may also facilitate emptying of the heart insistally, reducing myocardial workload. Managing high-risk patients going into intubation and understanding these cardiovascular changes is crucial.
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