Chest
Inspiratory Impairment in Right Ventricular Performance during Acute Asthma
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.