Cardiovascular collapse due to ventilation: lack of understanding or failure to anticipate heart-lung interactions?

Abstract

A drop in blood pressure is often observed when mechanical ventilation is initiated. This drop results from the interactions between heart and lungs. It mainly arises from mechanical ventilation effects on the right heart, primarily in relation to a reduction in venous return due to an increase in intramural pressure in the right atrium and an increase in right ventricular afterload caused by an increase in pulmonary vascular resistance. Other factors contribute to the onset of cardiovascular collapse after mechanical ventilation including effects of the sympathicolytic agents used for anesthesia induction at the time of intubation, rapid correction of hypercapnia, and pre-existing hypovolemia. Prevention is based on circulation management before intubation and optimization of the settings on ventilator.