monitorage du retentissement hémodynamique · 1800 1600 1400 1200 z 1000 800 0 600 —16 normal...

Monitorage du retentissement hémodynamique

Antoine Vieillard-Baron, Boulogne, France

Ventilation spontanée

ATM 2018

2016

Ventilation en pression positive

dUP

dDown

PEEP 0

Jardin Catheterization and Cardiovascular Diagnosis 1989

PEEP 15

Am J Respir Crit Care Med 2003

Am J Physiol 1957

RVS = PSM – POD/R

112 patients

Fessler HE Am Rev Respir Dis 1991

Jellinek H, JAP 2000

Nanas and Magder 1992

Am J Physiol 1959

Crit Care Med 2012

Coriat Anesth Analg 1994

CI 2.5 L/min/m2 CI 4.5 L/min/m2CI 3.7 L/min/m2

ZEEP PEEP 5 PEEP 5 expansion

TPP(cmH2O)

PVR

WHITTENBERGER J Appl Physiol 1960

Zone 1

Zone 2

Zone 3

WEST J Appl Physiol 1964

PALV > PAP > PVP

PAP > PALV > PVP

PAP > PVP > PALV

Scharf Am J Physiol 1977

Preload effect Afterload effect

Intensive Care Med 2016

PPV 19%

CI 1.7 L/min/m2PPV 27%

Anesthesiology 1994

Intensive Care Med 2009

Baseline T1

PaCO2 52 mmHg 71 mmHgpH 7.30 7.17Pplateau 22cmH2O 23cmH2O

DrivingP 17cmH2O 12cmH2O

RV/LV 0.64 0.85

Henri MondorAmbroise Paré

D1, 10 p.m PaCO2: 88 mmHg

BD 14 mmol/l

D2, 7 a.mPaCO2: 55 mmHg

BD 2.3 mmol/l

Acta Anaesthesiol Scand 2015

Reis Miranda AJRCCM 2015

LV AFTERLOAD EFFECT?

McGregor N Engl J Med 1979

JACC, 2018

http://www.echo-rea.uvsq.fr