zur Navigation zum Inhalt
 
Chirurgie 1. Mai 2010

Influence of body position on hemodynamics in patients with ischemic heart disease undergoing cardiac surgery

INTRODUCTION: The cardiovascular response to decreased or increased preload in high-risk patients with ischemic heart disease enables us to understand the physiologic response to hemorrhage and its treatment. Although numerous studies have failed to show its effectiveness, the head-down position is still widely used to treat patients with hypotension and shock. The aim of our study was to evaluate the influence of body position on hemodynamics in high-risk patients undergoing coronary artery bypass graft surgery.

METHODS: In 16 patients with ischemic hearth disease and poor left ventricular function undergoing coronary artery bypass graft surgery, we measured cardiac output with thermodilution, arterial pressure, central venous pressure (CVP), pulmonary artery wedge pressure (PAWP) and heart rate in three different body positions: the horizontal position, 20° head-up position, 20° head-down position and back in the horizontal position. The measurements were made before and after cardiac surgery.

RESULTS: Before skin incision the change from horizontal to 20° head-up position led to a nonsignificant decrease in cardiac output and a significant decrease in mean arterial pressure, CVP and PAWP. The change from 20° head-up to 20° head-down position led to a significant increase in cardiac output, mean arterial pressure, CVP and PAWP. After skin closure the change from horizontal to 20° head-up position led to a nonsignificant decrease in cardiac output and mean arterial pressure and a significant decrease CVP and PAWP. The change from 20° head-up to 20° head-down position led to a nonsignificant increase in cardiac output and a significant increase in mean arterial pressure, CVP and PAWP. There were no significant changes in heart rate during the changes in position before or after surgery.

CONCLUSIONS: The results of our study showed a hemodynamic response similar to hemorrhage after placing the patients in a 20° head-up position and improving hemodynamics in the head-down position in mechanically ventilated patients undergoing coronary artery bypass graft surgery.

Zu diesem Thema wurden noch keine Kommentare abgegeben.

Mehr zum Thema

<< Seite 1 >>

Medizin heute

Aktuelle Printausgaben