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Lower body positive pressure by anti‐G garment inflation: a suitable method to increase pulmonary capillary wedge pressure in healthy elderly subjects
Author(s) -
Remmen J. J.,
Aengevaeren W. R. M.,
Verheugt F. W. A.,
Bos A.,
Jansen R. W. M. M.
Publication year - 2005
Publication title -
clinical physiology and functional imaging
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.608
H-Index - 67
eISSN - 1475-097X
pISSN - 1475-0961
DOI - 10.1111/j.1475-097x.2004.00582.x
Subject(s) - medicine , supine position , pulmonary wedge pressure , preload , afterload , cardiology , pulmonary artery , anesthesia , pulmonary artery catheter , blood pressure , vascular resistance , cardiac output , hemodynamics
Summary In a study on non‐invasive assessment of pulmonary capillary wedge pressure (PCWP), we sought a method to increase PCWP non‐invasively. We hypothesized that inflation of an anti‐G garment was suitable to increase PCWP non‐invasively in healthy elderly subjects. In 20 subjects, aged 70 ± 4 years (mean ± SD), before, immediately after, and 4 min after anti‐G garment inflation to 52 mmHg, PCWP and mean pulmonary artery pressure (MPAP) were measured with a Swan‐Ganz catheter, and mean arterial blood pressure (MAP) with Finapres, in supine and semi‐recumbent position. Supine, PCWP (mmHg, mean ± SD) increased from 9·9 ± 2·1 to 15·5 ± 3·9** immediately after inflation and 13·4 ± 3·7** at 4 min; semi‐recumbent from 8·9 ± 2·0 to 17·5 ± 3·3** and 14·7 ± 2·9** (* P <0·05, ** P < 0·001 versus before inflation). MPAP (mmHg) increased after inflation: supine 16·9 ± 2·3 to 22·3 ± 4·6** and 20·6 ± 3·9** and semi‐recumbent 15·7 ± 2·8 to 24·3 ± 5·1** and 22·5 ± 3·5**, suggesting that increased preload was the primary effect of anti‐G garment inflation. Supine MAP (mmHg) increased from 96·0 ± 11·3 to 101·4 ± 13·4** and 100·5 ± 12·7* and semi‐recumbent from 102·0 ± 8·9 to 108·3 ± 11·4** and 106·0 ± 11·3*, suggesting an effect of increased afterload as well. The latter was supported by an increase in total peripheral resistance (d s cm −5 ) from 1346 ± 299 to 1441 ± 384 after 4 min ( P = 0·057) and from 1461 ± 341 to 1532 ± 406 ( P = 0·054), supine and semi‐recumbent respectively, while cardiac output remained unchanged. Complications did not occur. We conclude that in healthy elderly subjects, anti‐G garment inflation is a safe, non‐invasive, method to induce a significant increase in PCWP. Our findings justify its application in future studies in which non‐invasive temporary increase in PCWP is required.