Kristian Wemmelund

Effects of Progressive Hypoventilation on Left Ventricular Appearance: An Alternative Etiology of Acute Sonographic Short-Axis D-Shaping

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  • Viktor Kromann Ringgård
  • ,
  • Anders Høyer Sørensen, Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Denmark and Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark.
  • ,
  • Kristian Borup Wemmelund
  • Erik Sloth
  • ,
  • Peter Juhl-Olsen

OBJECTIVES: The purpose of this study was to evaluate the effects of progressive hypoventilation on echocardiographic measures of the left ventricular (LV) appearance in a porcine model.

METHODS: Ten piglets were included in the experimental group, and 5 served as controls. The experimental group underwent 3 interventions of progressive hypoventilation (baseline: tidal volume, 240 mL; respiratory frequency, 16 minutes(-1) ; first intervention: tidal volume, 240 mL; respiratory frequency, 8 minutes-1; second intervention: tidal volume, 240 mL; respiratory frequency, 4 minutes(-1) ; and third intervention: tidal volume, 120 mL; respiratory frequency, 4 minutes(-1) ). Respiratory resuscitation was initiated if the MAP decreased to 50% of the baseline level or at the end of the third intervention. Transthoracic sonography and invasive measurements were obtained throughout. The primary end point was the LV end-diastolic eccentricity index, a measure of LV D-shaping.

RESULTS: The median LV end-diastolic eccentricity index increased from 1.1 (interquartile range, 1.0-1.1) at baseline to 1.4 (1.3-1.4) 3 minutes after the third intervention (P < .001) and returned to baseline after resuscitation (P = .093). The MAP declined from 87 mm Hg (81-92 mm Hg) to 50 mmHg (33-66 mm Hg) after initiation of the third intervention (P < .001). The mean pulmonary arterial pressure increased from 20 mm Hg (15-21 mm Hg) to 39 mm Hg (38-40 mm Hg) during the second intervention (P < .001).

CONCLUSIONS: Progressive hypoventilation led to a marked D-configuration of the LV and a sharp decrease in systemic blood pressure. After respiratory resuscitation, sonographic measures normalized. These findings were explainable by the pressure changes observed within the left and right ventricles.

Original languageEnglish
JournalJournal of Ultrasound in Medicine
Publication statusPublished - 2017

    Research areas

  • Journal Article

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