Key result
Low-pressure pneumatic antishock garments elevate ventricular filling pressures, but positive pressure respiration blunts the LV response.
Why the study?
The hemodynamic effects of low pressure PASG application with and without positive pressure respiration in normovolemic patients were not well characterized.
Does positive pressure respiration alter the hemodynamic response to pneumatic antishock garment application in normovolemic patients after CABG?
Does positive pressure respiration alter the hemodynamic response to pneumatic antishock garment application in normovolemic patients after CABG?
Low-pressure PASG application creates an autotransfusion effect that increases filling pressures without improving cardiac index, an effect that is blunted by concurrent positive pressure respiration.
Pneumatic antishock garment (PASG) application has been recommended for treatment of hypovolemic hypotension and intraperitoneal or retroperitoneal hemorrhage. Often these patients require positive pressure respiration (PPR). This study measured the hemodynamic response of low pressure PASG application, with and without PPR, in normovolemic man and the effects of PASG application on serum lactate. Ten patients after coronary artery bypass surgery were studied with PPR and PASG application (3 to 20 hours post-surgery), and PASG alone (24 to 30 hours post-surgery). PASG pressures of 0,5,10,20, and 0 mm Hg were applied for 10 minutes each after which LAP, PCWP, CVP, mean arterial pressure, heart rate, cardiac index, and serum lactate level were measured. PASG application produced significant elevations in right and left ventricular filling pressures. The left ventricular filling pressure response was significantly less with positive pressure respiration. The CVP and LAP increase did not result in a greater cardiac index. Serum lactate levels rose slightly during PASG application. Low-pressure PASG application results in an 'autotransfusion' effect which is greater without PPR.
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Burchard et al. (1985) studied Post coronary artery bypass surgery (n=10). Pneumatic antishock garment (PASG) application vs. PASG with vs without positive pressure respiration (PPR) was evaluated on Hemodynamic response (LAP, PCWP, CVP, mean arterial pressure, heart rate, cardiac index) and serum lactate level. Low-pressure pneumatic antishock garment application significantly elevated ventricular filling pressures, though the left ventricular response was significantly less with positive pressure respiration.
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