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Role of the Venous Return in Critical Illness and Shock

Part II—Shock and Mechanical Ventilation

Funk, Duane J. MD1,2; Jacobsohn, Eric MD1,2; Kumar, Anand MD1,3

doi: 10.1097/CCM.0b013e31827bfc25
Concise Definitive Review

Objective: To provide a conceptual and clinical review of the physiology of the venous system as it is related to cardiac function in health and disease.

Data: An integration of venous and cardiac physiology under normal conditions, critical illness, and resuscitation.

Summary: The usual clinical teaching of cardiac physiology focuses on left ventricular pathophysiology and pathology. Due to the wide array of shock states dealt with by intensivists, an integrated approach that takes into account the function of the venous system and its interaction with the right heart may be more useful. In part II of this two-part review, we describe the physiology of venous return and its interaction with the right heart function as it relates to mechanical ventilation and various shock states including hypovolemic, cardiogenic, obstructive, and septic shock. In particular, we demonstrate how these shock states perturb venous return/right heart interactions. We also show how compensatory mechanisms and therapeutic interventions can tend to return venous return and cardiac output to appropriate values.

Conclusion: An improved understanding of the role of the venous system in pathophysiologic conditions will allow intensivists to better appreciate the complex circulatory physiology of shock and related therapies. This should enable improved hemodynamic management of this disorder.

1 Section of Critical Care Medicine, Department of Medicine, University of Manitoba, Manitoba, Canada.

2 Department of Anesthesiology and Perioperative Medicine, University of Manitoba, Manitoba, Canada.

3 Section of Critical Care Medicine, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, NJ.

The authors have not disclosed any potential conflicts of interest

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© 2013 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins