Cardiopulmonary_Monitoring
Highlights
- Ernest Starling realized that even when the right heart stops pumping, RV end-diastolic pressure cannot be higher than the upstream MSFP, which normally is in the range of 8–10 mmHg (referenced to the mid-point of the right atrium) (View Highlight)
- a central venous pressure greater than the normal values of MSFP only can occur generally two ways; either volume was given by the clinician or the normal volume intake orally was retained by decreased renal function. (View Highlight)
- An initial adaptive process for the RV in the
face of limited RV function also can be an increase in right atrial size. The large atrium then acts as a volume reservoir, which adds to the compliance of the venous system. This reduces venous pressures and allows for faster filling of the RV. (View Highlight)
- when RV filling is limited, giving volume to increase Pra will not increase cardiac output. (View Highlight)
- echocardiography cannot detect right ventricular limitation because it is not possible to know that the diastolic volume did not change with a volume infusion because of a limitation to filling or because the infused volume was insufficient. Only a pressure change can identify that filling is limited. (View Highlight)
- Right-sided volume limitation only becomes evident on an echocardiogram when the right-sided pressure increases sufficiently to shift the intraventricular septum to the left, but that is too late. Volume limitation of the RV is best identified by a rise in right atrial pressure without a rise in cardiac output. (View Highlight)
- The underlying principle of the series effect is that whatever comes out of the LV had to first have come out of the RV, i.e., conservation of mass. Furthermore, what comes out of the RV had to come back from the venous reservoir. (View Highlight)