Pulmonary blood volume and haemodynamic changes with legs raised in chronic lung disease patients

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Abstract
Study objective — The aim was determine the early effect of a posture change from supine (S) to legs raised 30° above the table plane (LR) on haemodynamics in patients with chronic lung disease. Study design — Right heart catherisation was performed as part of a routine evaluation. Pulmonary arterial, pulmonary wedge, right atrial, and systemic arterial pressure were monitored at rest supine and during 8 min (steady values) after LR. Pulmonary blood volume was measured by double dye dilution, at rest S and after 1 and 8 minutes LR, in 14 patients; cardiac output was measured by thermodilution in the remaining 15 subjects, during S and 1, 4, and 8 minutes LR. Subjects — 29 patients with chronic pulmonary disease of various types, mainly chronic bronchitis and emphysema, were studied when in a stable clinical condition, with no signs of heart failure. Measurements and main results — Raising the legs produced a sharp increase in all the pressures measured, with a subsequent decline towards a steady value slightly higher than during S. Pulmonary blood volume increased in all patients initially, but stayed elevated only in the normocapnic patients; in the patients with hypercapnia it decreased from 1 to 8 min LR. The pulmonary blood volume change showed a significant correlation with Paco2(pD/VT ratio (pConclusion — In patients with chronic lung disease who are hypercapnic, the volume/pressure relation following leg raising cannot be expressed by a single distensibility coefficient.

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