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