Journal of Applied Physiology AJP: Regulatory, Integrative and Comparative Physiology
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J Appl Physiol 88: 926-932, 2000;
8750-7587/00 $5.00
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Vol. 88, Issue 3, 926-932, March 2000

Influence of positive airway pressure on the pressure gradient for venous return in humans

H. Jellinek1, H. Krenn1, W. Oczenski1, F. Veit2, S. Schwarz1, and R. D. Fitzgerald3

1 Department of Anesthesiology and Intensive Care Medicine, 2 First Department of Surgery, and 3 Ludwig Boltzmann Institute of Economics of Medicine in Anesthesia and Intensive Care, Community Hospital of Lainz, A-1130 Vienna, Austria

To study the effect of positive airway pressure (Paw) on the pressure gradient for venous return [the difference between mean systemic filling pressure (Pms) and right atrial pressure (Pra)], we investigated 10 patients during general anesthesia for implantation of defibrillator devices. Paw was varied under apnea from 0 to 15 cmH2O, which increased Pra from 7.3 ± 3.1 to 10.0 ± 2.3 mmHg and decreased left ventricular stroke volume by 23 ± 22%. Episodes of ventricular fibrillation, induced for defibrillator testing, were performed during 0- and 15-cmH2O Paw to measure Pms (value of Pra 7.5 s after onset of circulatory arrest). Positive Paw increased Pms from 10.2 ± 3.5 to 12.7 ± 3.2 mmHg, and thus the pressure gradient for venous return (Pms - Pra) remained unchanged. Echocardiography did not reveal signs of vascular collapse of the inferior and superior vena cava due to lung expansion. In conclusion, we demonstrated that positive Paw equally increases Pra and Pms in humans and alters venous return without changes in the pressure gradient (Pms - Pra).

mean systemic filling pressure; positive end-expiratory pressure; right atrial pressure; mechanical ventilation


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