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Human cardiovascular dose-response to supplemental oxygen
Linköpings universitet, Institutionen för medicin och hälsa, Anestesiologi med intensivvård. Linköpings universitet, Hälsouniversitetet.
Linköpings universitet, Institutionen för klinisk och experimentell medicin, Brännskadevård. Linköpings universitet, Hälsouniversitetet.
Linköpings universitet, Institutionen för medicin och hälsa, Anestesiologi med intensivvård. Linköpings universitet, Hälsouniversitetet.
Linköpings universitet, Institutionen för medicin och hälsa, Klinisk fysiologi. Linköpings universitet, Hälsouniversitetet.
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2007 (Engelska)Ingår i: Acta Physiologica, ISSN 1748-1708, E-ISSN 1748-1716, Vol. 191, nr 1, s. 15-24Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Aim: The aim of the study was to examine the central and peripheral cardiovascular adaptation and its coupling during increasing levels of hyperoxaemia. We hypothesized a dose-related effect of hyperoxaemia on left ventricular performance and the vascular properties of the arterial tree.

Methods: Oscillometrically calibrated arterial subclavian pulse trace data were combined with echocardiographic recordings to obtain non-invasive estimates of left ventricular volumes, aortic root pressure and flow data. For complementary vascular parameters and control purposes whole-body impedance cardiography was applied. In nine (seven males) supine, resting healthy volunteers, aged 23–48 years, data was collected after 15 min of air breathing and at increasing transcutaneous oxygen tensions (20, 40 and 60 kPa), accomplished by a two group, random order and blinded hyperoxemic protocol.

Results: Left ventricular stroke volume [86 ± 13 to 75 ± 9 mL (mean ± SD)] and end-diastolic area (19.3 ± 4.4 to 16.8 ± 4.3 cm2) declined (P < 0.05), and showed a linear, negative dose–response relationship to increasing arterial oxygen levels in a regression model. Peripheral resistance and characteristic impedance increased in a similar manner. Heart rate, left ventricular fractional area change, end-systolic area, mean arterial pressure, arterial compliance or carbon dioxide levels did not change.

Conclusion: There is a linear dose–response relationship between arterial oxygen and cardiovascular parameters when the systemic oxygen tension increases above normal. A direct effect of supplemental oxygen on the vessels may therefore not be excluded. Proximal aortic and peripheral resistance increases from hyperoxaemia, but a decrease of venous return implies extra cardiac blood-pooling and compensatory relaxation of the capacitance vessels.

Ort, förlag, år, upplaga, sidor
2007. Vol. 191, nr 1, s. 15-24
Nyckelord [en]
arterial compliance, end-diastolic area, hyperoxaemia, hyperoxia, normocapnia, stroke volume, vascular resistance
Nationell ämneskategori
Medicin och hälsovetenskap
Identifikatorer
URN: urn:nbn:se:liu:diva-12899DOI: 10.1111/j.1748-1716.2007.01710.xOAI: oai:DiVA.org:liu-12899DiVA, id: diva2:17345
Tillgänglig från: 2008-01-28 Skapad: 2008-01-28 Senast uppdaterad: 2017-12-13
Ingår i avhandling
1. Cardiovascular response to hyperoxemia, hemodilution and burns: a clinical and experimental study
Öppna denna publikation i ny flik eller fönster >>Cardiovascular response to hyperoxemia, hemodilution and burns: a clinical and experimental study
2007 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

The last decades less invasive monitoring and analytical tools have been developed for the evaluation of myocardial mechanics in clinical praxis. In critical care, these are longed-for complements to pulmonary artery catheter monitoring, additionally offering previously inaccessible information. This work is aimed, during fluid-replacement and oxygen therapy, to determine the physiological interface of ventricular and vascular mechanical properties, which result in the transfer of blood from the heart to appropriate circulatory beds. In prospective clinical studies we investigated previously cardiovascular healthy adults during hyperoxemia, and during preoperative acute normovolemic hemodilution or early fluid resuscitation of severe burn victims. Echocardiography was used in all studies, transthoracic for healthy volunteers and transesophageal for patients. For vascular parameters and for control purposes pulmonary artery Swan-Ganz catheter, calibrated external pulse recordings, whole body impedance cardiography, and transpulmonel thermodilution method were applied.

We detected no significant change in blood pressure or heart rate, the two most often used parameters for patient monitoring. During preoperative acute normovolemic hemodilution a reduction of hemoglobin to 80 g/l did not compromise systolic or diastolic myocardial function. Cardiac volumes and flow increased with a concomitant fall in systemic vascular resistance while oxygen delivery seemed maintained. Supplemental oxygen therapy resulted in a linear dose-response between arterial oxygen and cardiovascular parameters, suggesting a direct vascular effect. Cardiac flow decreased and vascular resistance increased from hyperoxemia, and a decrease of venous return implied extracardial blood-pooling. Severe burns result in hypovolemic shock if not properly treated. The commonly used Parkland fluid replacement strategy, with urinary output and mean arterial pressure as endpoints, has recently been questioned. Applying this strategy, only transient early central hypovolemia was recorded, while dimensional preload, global left ventricular systolic function and oxygen delivery or consumption remained within normal ranges during the first 36 hours after accident. Signs of restrictive left ventricular diastolic function were detected in all patients and regional unstable systolic dysfunction was recognized in every other patient, and was consistent with myocardial marker leakage. Severe burns thereby cause myocardial stiffness and systolic regional dysfunction, which may not be prevented only by central normovolemia and adequate oxygenation.

Ort, förlag, år, upplaga, sidor
Institutionen för medicinsk teknik, 2007
Serie
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1013
Nyckelord
Anesthesia, general, Burns, Echocardiography, transesophageal, Hemodilution, emodynamic processes, Hyperoxia
Nationell ämneskategori
Anestesi och intensivvård
Identifikatorer
urn:nbn:se:liu:diva-10633 (URN)978-91-85831-11-1 (ISBN)
Disputation
2007-10-25, Elsa Brännströmssalen Universitetssjukhuset i Linköping, Campus US, Linköpings universitet, Linköping, 13:00 (Engelska)
Opponent
Handledare
Anmärkning
On the day of the defence date the status of article II was: In Press.Tillgänglig från: 2008-01-28 Skapad: 2008-01-28 Senast uppdaterad: 2009-08-22

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Bak, ZoltanSjöberg, FolkeRousseau, AndreasJanerot Sjöberg, BirgittaSteinvall, Ingrid

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Anestesiologi med intensivvårdHälsouniversitetetBrännskadevårdKlinisk fysiologiInstitutionen för klinisk och experimentell medicin
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