Right Ventricular Dysfunction in Acute Thermal Injury

Publisher Website
Google Scholar
Abstract
The elevated cardiac output (CO) and pulmonary artery hypertension (PAH) observed in thermal injury offers a unique opportunity to study the effects of a combined pressure-flow load on the right ventricle in previously healthy persons. Potential responses include a diminished right ventricular ejection fraction (RVEF), increased right ventricular end-diastolic volume index (RVEDVI), and augmented myocardial O2 consumption because of increased systolic wall tension. These factors were studied in 15 nonhypoxic patients without sepsis having 15-75% body surface area burns using flow directed catheters and thermodilution. All patients increased their CO in response in fluid resuscitation, but 6 patients with an elevated mean pulmonary artery pressure (> 20 mmHg) and increased pulmonary vascular resistance (> 1.2 mmHg/min per L) had right ventricular dysfunction as evidenced by an increase (188 .+-. 15 ml/M2) in RVEDVI and a decreased (0.26 .+-. 4 ml/M2) RVEF. Patients without PAH had a smaller RVEDVI (115 .+-. 4 ml/M2) and larger RVEF (0.39 .+-. 0.02). Patients with PAH and RV dysfunction were older, had larger body surface area burns, lower systemic diastolic artery pressures (63 .+-. 4 mmHg) and higher heart rates (114 .+-. 7 beats/min); RV end-diastolic pressures were minimally elevated (9.5 .+-. 1.4 mmHg). The decrease in RVEF and increase in RVEDVI may limit the hemodynamic response to fluid volume replacement and survival.