Document Detail

Changes in thoracopulmonary compliance and hemodynamic effects of positive end-expiratory pressure in patients with or without heart failure.
MedLine Citation:
PMID:  9328849     Owner:  NLM     Status:  MEDLINE    
PURPOSE: The purpose of this study was to confirm that positive end-expiratory pressure (PEEP) has a different effect on cardiac index (CI) in patients with or without heart failure, even after controlling for differences in thoracopulmonary compliance (Ctp) and minimizing the secondary effects of PEEP related changes in oxygenation and breathing effort. MATERIALS AND METHODS: The hemodynamic effects of PEEP were evaluated in two groups of sedated and paralyzed patients with a low Ctp at 0 PEEP: 12 patients with normal pulmonary artery occlusion pressure (Ppao) and a CI > 2.5 L/min and 12 patients with a CI < 2.5 L/min and increased oxygen extraction ratio, despite a Ppao > 15 mm Hg. RESULTS: In patients with low CI and high Ppao, PEEP had no hemodynamic effect and Ctp remained low at all PEEP levels. However, PEEP-induced CI reduction in patients with normal cardiovascular function was associated with an increase in Ctp with incremental PEEP. Concerning PEEP-related hemodynamic effects, the significance between group differences persisted when data were analyzed after controlling for Ctp changes. However, Ctp changes with PEEP were the most significant correlators and discriminators of the magnitude and direction of PEEP-induced CI change. CONCLUSIONS: We conclude that (1) the observed different effect of PEEP on CI in patients with and without heart failure persists after the elimination of secondary effects due to underlying differences in Ctp, oxygenation, and breathing effort; and (2) PEEP-related changes in Ctp should be taken into consideration when dealing with the cardiovascular effects of PEEP. Our data support the hypothesis that, in addition to the transmission of PEEP to the pleural space, changes in lung volume are a significant determinant of PEEP-induced CI changes.
A Kotanidou; A Armaganidis; S Zakynthinos; A Mavrommatis; C Roussos
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of critical care     Volume:  12     ISSN:  0883-9441     ISO Abbreviation:  J Crit Care     Publication Date:  1997 Sep 
Date Detail:
Created Date:  1997-11-25     Completed Date:  1997-11-25     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8610642     Medline TA:  J Crit Care     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  101-11     Citation Subset:  IM    
Critical Care Department, Evangelismos Hospital, University of Athens Medical School, Greece.
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MeSH Terms
Aged, 80 and over
Airway Resistance
Analysis of Variance
Blood Pressure
Cardiac Output
Discriminant Analysis
Heart Catheterization
Heart Failure / physiopathology*
Lung Compliance
Middle Aged
Positive-Pressure Respiration*
Prospective Studies

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