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BMC Pulmonary Medicine
Article . 2024 . Peer-reviewed
License: CC BY
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BMC Pulmonary Medicine
Article . 2024
Data sources: DOAJ
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Immediate cardiopulmonary responses to consecutive pulmonary embolism: a randomized, controlled, experimental study

Authors: Lyhne, Mads Dam; Schultz, Jacob Gammelgaard; Mortensen, Christian Schmidt; Kramer, Anders; Nielsen-Kudsk, Jens Erik; Andersen, Asger;

Immediate cardiopulmonary responses to consecutive pulmonary embolism: a randomized, controlled, experimental study

Abstract

Abstract Background Acute pulmonary embolism (PE) induces ventilation-perfusion mismatch and hypoxia and increases pulmonary pressure and right ventricular (RV) afterload, entailing potentially fatal RV failure within a short timeframe. Cardiopulmonary factors may respond differently to increased clot burden. We aimed to elucidate immediate cardiopulmonary responses during successive PE episodes in a porcine model. Methods This was a randomized, controlled, blinded study of repeated measurements. Twelve pigs were randomly assigned to receive sham procedures or consecutive PEs every 15 min until doubling of mean pulmonary pressure. Cardiopulmonary assessments were conducted at 1, 2, 5, and 13 min after each PE using pressure-volume loops, invasive pressures, and arterial and mixed venous blood gas analyses. ANOVA and mixed-model statistical analyses were applied. Results Pulmonary pressures increased after the initial PE administration (p < 0.0001), with a higher pulmonary pressure change compared to pressure change observed after the following PEs. Conversely, RV arterial elastance and pulmonary vascular resistance was not increased after the first PE, but after three PEs an increase was observed (p = 0.0103 and p = 0.0015, respectively). RV dilatation occurred following initial PEs, while RV ejection fraction declined after the third PE (p = 0.004). RV coupling exhibited a decreasing trend from the first PE (p = 0.095), despite increased mechanical work (p = 0.003). Ventilatory variables displayed more incremental changes with successive PEs. Conclusion In an experimental model of consecutive PE, RV afterload elevation and dysfunction manifested after the third PE, in contrast to pulmonary pressure that increased after the first PE. Ventilatory variables exhibited a more direct association with clot burden.

Keywords

Male, RC705-779, Swine, Research, Ventricular Dysfunction, Right, Ventilation-perfusion mismatch, Right ventricular afterload, Right ventricular function, Pulmonary Embolism/physiopathology, Diseases of the respiratory system, Disease Models, Animal, Random Allocation, Ventricular Function, Right/physiology, Pulmonary circulation, Gas exchange, Ventricular Function, Right, Animals, Animal model, Vascular Resistance, Female, Vascular Resistance/physiology, Blood Gas Analysis, Pulmonary Embolism, Ventricular Dysfunction, Right/physiopathology

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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
1
Average
Average
Average
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gold