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. 1980 Mar;191(3):330–335. doi: 10.1097/00000658-198003000-00012

Right ventricular dysfunction in acute thermal injury.

J A Martyn, M T Snider, S K Szyfelbein, J F Burke, M B Laver
PMCID: PMC1344704  PMID: 7362298

Abstract

The elevated cardiac output (CO) and pulmonary artery hypertension (PAH) observed in thermal injury offers a unique opportunity to study the effects of a combined pressure-flow load on the right ventricle in previously healthy persons. Potential responses include a diminished right ventricular ejection fraction (RVEF), increased right ventricular end-diastolic volume index (RVEDVI), and augmented myocardial oxygen consumption because of increased systolic wall tension. We investigated these factors in 15 nonhypoxic patients without sepsis having 15--75% body surface area burns using flow directed catheters and the thermodilution technique. All patients increased their CO in response in fluid resuscitation, but six patients with an elevated mean pulmonary artery pressure (greater than 20 mmHG and increased pulmonary vascular resistance (greater than 1.2 mmHg/min/L) had right ventricular dysfunction as evidenced by an increase (188 +/- 15 ml/M2) in RVEDVI and a decreased (0.26 +/- 4 ml/M2) RVEF. Patients without PAH had a smaller RVEDVI (115 +/- 4 ML/M2) and larger RVEF (0.39 +/- 0.02). Patients with PAH and RV dysfunction were older, had larger body surface area burns, lower systemic diastolic artery pressures (63 +/- 4 mmHg) and higher heart rates (114 +/- 7 beats/min); RV end-diastolic pressures were minimally elevated (9.5 +/- 1.4 mmHg). The decrease in RVEF and increase in RVEDVI may limit the hemodynamic response to fluid volume replacement and survival.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. AVIADO D. M., Jr, SCHMIDT C. F. Respiratory burns with special reference to pulmonary edema and congestion. Circulation. 1952 Nov;6(5):666–680. doi: 10.1161/01.cir.6.5.666. [DOI] [PubMed] [Google Scholar]
  2. Blaisdell F. W., Stallone R. J. The mechanism of pulmonary damage following traumatic shock. Surg Gynecol Obstet. 1970 Jan;130(1):15–22. [PubMed] [Google Scholar]
  3. Clowes G. H., Jr, Hirsch E., Williams L., Kwasnik E., O'Donnell T. F., Cuevas P., Saini V. K., Moradi I., Farizan M., Saravis C. Septic lung and shock lung in man. Ann Surg. 1975 May;181(5):681–692. doi: 10.1097/00000658-197505000-00024. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Cohn J. N., Guiha N. H., Broder M. I., Limas C. J. Right ventricular infarction. Clinical and hemodynamic features. Am J Cardiol. 1974 Feb;33(2):209–214. doi: 10.1016/0002-9149(74)90276-8. [DOI] [PubMed] [Google Scholar]
  5. Cohn J. N., Tristani F. E., Khatri I. M. Studies in clinical shock and hypotension: VI. Relationship between left and right ventricular function. J Clin Invest. 1969 Nov;48(11):2008–2018. doi: 10.1172/JCI106166. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Demling R. H., Will J. A., Belzer F. O. Effect of major thermal injury on the pulmonary microcirculation. Surgery. 1978 Jun;83(6):746–751. [PubMed] [Google Scholar]
  7. GORLIN R. Recent conceptual advances in congestive heart failure. JAMA. 1962 Feb 10;179:441–449. [PubMed] [Google Scholar]
  8. German J. C., Allyn P. A., Barlett R. H. Pulmonary artery pressure monitoring in acute burn management. Arch Surg. 1973 Jun;106(6):788–791. doi: 10.1001/archsurg.1973.01350180028010. [DOI] [PubMed] [Google Scholar]
  9. HOLMGREN A., JONSSON B., SJOSTRAND T. Circulatory data in normal subjects at rest and during exercise in recumbent position, with special reference to the stroke volume at different work intensities. Acta Physiol Scand. 1960 Aug 25;49:343–363. doi: 10.1111/j.1748-1716.1960.tb01957.x. [DOI] [PubMed] [Google Scholar]
  10. HOLT J. P. Estimation of the residual volume of the ventricle of the dog's heart by two indicator dilution technics. Circ Res. 1956 Mar;4(2):187–195. doi: 10.1161/01.res.4.2.187. [DOI] [PubMed] [Google Scholar]
  11. Hamberg M., Jonsson C. E. Increased synthesis of prostaglandins in the guinea pig following scalding injury. Acta Physiol Scand. 1973 Feb;87(2):240–245. doi: 10.1111/j.1748-1716.1973.tb05386.x. [DOI] [PubMed] [Google Scholar]
  12. Homer L. D., Krayenbuehl H. P. A mathematical model for the estimation of heart volumes from indicator dilution curves. Circ Res. 1967 Mar;20(3):299–305. doi: 10.1161/01.res.20.3.299. [DOI] [PubMed] [Google Scholar]
  13. Kelly D. T., Spotnitz H. M., Beiser G. D., Pierce J. E., Epstein S. E. Effects of chronic right ventricular volume and pressure loading on left ventricular performance. Circulation. 1971 Sep;44(3):403–412. doi: 10.1161/01.cir.44.3.403. [DOI] [PubMed] [Google Scholar]
  14. Lozman J., Powers S. R., Jr, Older T., Dutton R. E., Roy R. J., English M., Marco D., Eckert C. Correlation of pulmonary wedge and left atrial pressures. A study in the patient receiving positive end expiratory pressure ventilation. Arch Surg. 1974 Aug;109(2):270–277. doi: 10.1001/archsurg.1974.01360020130025. [DOI] [PubMed] [Google Scholar]
  15. Maseri A., Enson Y. Mixing in the right ventricle and pulmonary artery in man: evaluation of ventricular volume measurements from indicator washout curves. J Clin Invest. 1968 Apr;47(4):848–859. doi: 10.1172/JCI105778. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. McIntyre K. M., Sasahara A. A. Determinants of right ventricular function and hemodynamics after pulmonary embolism. Chest. 1974 May;65(5):534–543. doi: 10.1378/chest.65.5.534. [DOI] [PubMed] [Google Scholar]
  17. Moncrief J. A. Burns. N Engl J Med. 1973 Mar 1;288(9):444–454. doi: 10.1056/NEJM197303012880905. [DOI] [PubMed] [Google Scholar]
  18. Pruitt B. A., Jr, Mason A. D., Jr, Moncrief J. A. Hemodynamic changes in the early postburn patient: the influence of fluid administration and of a vasodilator (hydralazine). J Trauma. 1971 Jan;11(1):36–46. doi: 10.1097/00005373-197101000-00003. [DOI] [PubMed] [Google Scholar]
  19. RAPAPORT E., WONG M., FERGUSON R. E., BERNSTEIN P., WIEGAND B. D. RIGHT VENTRICULAR VOLUMES IN PATIENTS WITH AND WITHOUT HEART FAILURE. Circulation. 1965 Apr;31:531–541. doi: 10.1161/01.cir.31.4.531. [DOI] [PubMed] [Google Scholar]
  20. ROCHA E SILVA M., ROSENTHAL S. R. Release of pharmacologically active substances from the rat skin in vivo following thermal injury. J Pharmacol Exp Ther. 1961 Apr;132:110–116. [PubMed] [Google Scholar]
  21. Raffa J., Trunkey D. D. Myocardial depression in acute thermal injury. J Trauma. 1978 Feb;18(2):90–93. doi: 10.1097/00005373-197802000-00002. [DOI] [PubMed] [Google Scholar]
  22. SALISBURY P. F. Coronary artery pressure and strength of right ventricular contraction. Circ Res. 1955 Nov;3(6):633–638. doi: 10.1161/01.res.3.6.633. [DOI] [PubMed] [Google Scholar]
  23. Salgado C. R., Galletti P. M. In vitro evaluation of the thermodilution technique for the measurement of ventricular stroke volume and end-diastolic volume. Cardiologia. 1966;49(2):65–78. doi: 10.1159/000168893. [DOI] [PubMed] [Google Scholar]
  24. Swank R. L. Platelet aggregation: its role and cause in surgical shock. J Trauma. 1968 Sep;8(5):872–879. [PubMed] [Google Scholar]
  25. Zapol W. M., Snider M. T. Pulmonary hypertension in severe acute respiratory failure. N Engl J Med. 1977 Mar 3;296(9):476–480. doi: 10.1056/NEJM197703032960903. [DOI] [PubMed] [Google Scholar]

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