Determinants of systemic venous return and the impact of positive pressure ventilation

被引:29
作者
Berger, David [1 ]
Takala, Jukka [1 ]
机构
[1] Univ Bern, Bern Univ Hosp, Inselspital, Dept Intens Care Med, Bern, Switzerland
关键词
Venous return; mean systemic filling pressure; stressed volume; right atrial pressure (RAP); RIGHT ATRIAL PRESSURE; CIRCULATORY FILLING PRESSURE; END-EXPIRATORY PRESSURE; CLASSICAL GUYTON VIEW; CARDIAC-OUTPUT; BLOOD-VOLUME; POINT-COUNTERPOINT; MECHANICAL VENTILATION; VASCULAR COMPLIANCE; CYCLIC CHANGES;
D O I
10.21037/atm.2018.05.27
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Venous return, i.e., the blood flowing back to the heart, is driven by the pressure difference between mean systemic filling pressure and right atrial pressure (RAP). Besides cardiac function, it is the major determinant of cardiac output. Mean systemic filling pressure is a function of the vascular volume. The concept of venous return has a central role for heart lung interactions and the explanation of shock states. Mechanical ventilation during anaesthesia and critical illness may severely affect venous return by different mechanisms. In the first part of the following article, we will discuss the development of the concept of venous return, its specific components mean systemic and mean circulatory filling pressure (MCFP), RAP and resistance to venous return (RVR). We show how these pressures relate to the volume state of the circulation. Various interpretations and critiques are elucidated. In the second part, we focus on the impact of positive pressure ventilation on venous return and its components, including latest results from latest research.
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页数:10
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