Interdépendance ventriculaire : Support physiopathologique et applications cliniques

Ventricular interdependence: from physiology to bedside

Abstract

Ventricular interdependence is frequently encountered in critically ill patients. This phenomenon is related to the anatomy of the heart and in particular by the existence of an inextensible envelope, the pericardium. In pathological situation, it results in abnormal movements of the interventricular septum. Ventricular interdependence has many clinical applications with adverse consequences on hemodynamics. In this review, we detail the main ones, including pulse pressure variations during cardiac tamponade and severe acute asthma, the existence of a cor pulmonale (acute or chronic), as well as the presence of a reversed paradoxical pulse in positively pressured ventilated patients with underlying acute pulmonary hypertension (most often for acute respiratory distress syndrome). 

More than right catheterization, of limited interest in these situations, Doppler echocardiography tends to be the tool of choice because of its ability to accurately evaluate both ventricles, blood flows and their variations during ventilation.

The cornerstone of treatment essentially relies on limiting all factors that may increase pericardial pressures (drainage of a pericardial effusion, limitation of volume expansion, sodium depletion, administration of inhaled nitric oxide, protective ventilation).