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European Heart Journal 1991 12(7):1163-1169;
Copyright © 1991 by the European Society of Cardiology.
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© 1991 The European Society of Cardiology

Cardiopulmonary effects of constant-flow ventilation in experimental myocardial ischaemia

T. HACHENBERG*, S. MEYER*, A. SIELENKÄMPER*, G. KNICHWITZ*, W. HAVERKAMP{dagger}, G. HINDRICKS{dagger} and M. WENDT*

*Department of Anaesthesiology and Intensive Care Medicine, Universität Münster Albert-Schiveitzer-Str.33, D-4400-Münster, Germany
{dagger}Department of Cardiology and Angiology, Hospital of the Westfalische Wilhelms-Universität Münster Albert-Schiveitzer-Str.33, D-4400-Münster, Germany

Received 14 May 1990; revised 12 October 1990; .

Correspondence: T. Hachenberg, Department of Anaesthesiology and Intensive Care Medicine, Hospital of the Westfalische wilhelms — Universitat Munster, Albert-Schweitzer-Strasse 33, D-4400. Münster, Germany

Abstract

The cardiopulmonary effects of constant-flow ventilation were investigated in dogs with normal heart function (controlphase, n=14) and after development of acute myocardial ischaemia (ischaeinia phase, n=14). Heated, humidified and oxygen-enriched air was continuously delivered with an inspiratory flow rate of 1·21. kg–1 . min–1 via two catheters positioned within each mainstem bronchus. Continuous positive pressure ventilation with a positive end-expiratory pressure of 0·5 kPa (5 cmH2O) swas used as a reference. During control, neither continuous positive pressure ventilation nor constant-flow ventilation showed impairment of cardiopulmonary performance. Oxygenation and CO2 removal were more efficiently achieved by continuous positive pressure ventilation (P≤0·05). Acute myocardial ischaemia was induced by occlusion of the left anterior descending (LAD) coronary artery; measurements during the ischaemia phase were per formed 60 mm following LAD occlusion. Myocardial ischaemia resulted in moderate changes of cardiac output, left ventricular end-diastolic pressure and dP/dtmax Both modes of ventilation were well tolerated in the ischaemia phase, and cardiovascular performance revealed no significant differences between continuous positive pressure ventilation and constant-flow ventilation. Haemodynamic parameters could be more precisely assessed during constant-flow ventilation. Oxygenation deteriorated, but hypoxaemia did not occur in any animal and CO2 elimination remained unchanged. It is concluded that ‘non-conventional’ ventilation by continuous intrabronchial gas flow maintains adequate gas exchange with no adverse effects on haemodynamics in dogs with acute myocardial ischaemia. Constant-flow ventilation may be advantageous in the experimental setting to study cardiac function without cyclic heart-lung interaction due to airway pressure alterations.

Key Words: Constant-flow ventilation • haemodynamics • gas exchange • myocardial ischaemia


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