Chest
Volume 92, Issue 5, November 1987, Pages 789-795
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Inspiratory Impairment in Right Ventricular Performance during Acute Asthma

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Right ventricular function was investigated in seven asthmatic patients during an acute attack, using simultaneous bedside right heart catheterization and two-dimensional echocardiography (2DE). Hemodynamic and echocardiographic data were compared during four successive periods of the respiratory cycle: inspiration, early expiration, midexpiration, and late expiration. During inspiration, 2DE showed a significant increase in right ventricular area at both end-systole and end-diastole. This inspiratory right ventricular enlargement coexisted with a significant reduction in 2DE stroke area and pulmonary artery pulse pressure suggesting an inspiratory reduction in right ventricular stroke output. A transient depression of right ventricular function during deep inspiratory effort in asthma was thus strongly suggested. The negative pressure surrounding the right ventricle at inspiration is advocated as the causative factor enabling reduction in the hydraulic force effecting right ventricular ejection. The highly negative pleural pressure probably holds the right ventricular free wall and restrains its systolic inward motion, as suggested by the finding of a concomitant inspiratory reduction in right ventricular developed pressure and 2DE fractional area contraction.

Section snippets

Patients

Seven asthmatic patients (mean age, 39 years, ranging from 21 to 55 years) were investigated during a severe attack requiring management in our intensive care unit. Informed consent was obtained from each patient, and the protocol was consistent with the ethical regulations of our hospital. Simultaneous hemodynamic and echocardiographic measurements, performed in the semisupine position, were obtained during the first hour in the ICU while patients were breathing spontaneously. All patients

RESULTS

All asthmatic patients had a clinically detectable paradoxic pulse. They also exhibited a respiratory rate of 21 ± 10 (mean [SD]) breaths per minute, with an I/E ratio at 0.41 ± 0.16. Mean tidal volume was 541 ± 185 ml. Nine ± 7 percent of this tidal volume was exhaled during an early expiratory beat, whereas 51 ± 4 percent and 85 ± 6 percent was exhaled during a mid and a late expiratory beat, respectively. Heart rate was 125 ± 12 beats per minute, and cardiac index 4.15±0.79 L/min/m2.

DISCUSSION

In the present study, right ventricular performance was assessed by correlating bedside right heart catheterization data with two-dimensional echocardiographic measurements of the right ventricle. Both techniques deserve special comments, particularly concerning their use in a group of acutely dyspneic patients. During acute asthma, the inspiratory fall in right heart pressures merely represents the concurrent fall in intrapleural pressure.6 Thus, it would appear more appropriate for our

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    This work was supported in part by a Grant of UER Paris-Ouest.

    Manuscript received October 31; revision accepted March 31.

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