Document Detail

Effects of positive end-expiratory pressure on right ventricular function in COPD patients during acute ventilatory failure.
MedLine Citation:
PMID:  8905427     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To examine the effects of external positive end-expiratory pressure (PEEP) on right ventricular function in chronic obstructive pulmonary disease (COPD) patients with intrinsic PEEP (PEEPi). DESIGN: Prospective study. SETTING: General intensive care unit in a university teaching hospital. PATIENTS: Seven mechanically ventilated flow-limited COPD patients (PEEPi = 9.7 +/- 1.3 cmH2O, mean +/- SD) with acute respiratory failure. INTERVENTION: Hemodynamic and respiratory mechanic data were collected at four different levels of PEEP (0-5-10-15 cmH2O). MEASUREMENTS AND RESULTS: Hemodynamic parameters were obtained by a Swan-Ganz catheter with a fast response thermistor. Cardiac index (CI) and end-expiratory lung volume (EELV) reductions started simultaneously when the applied PEEP was approximately 90% of PEEPi measured on 0 cmH2O (ZEEP). Changes in transmural intrathoracic pressure (PEEPi,cw) started only at a PEEP value much higher (120%) than PEEPi. The reduction in CI was related to a decrease in the right end-diastolic ventricular volume index (RVEDVI) (r = 0.61; p < 0.001). No correlation between CI and transmural right atrial pressure was observed. The RVEDVI was inversely correlated with PEEP-induced changes in EELV (r = -55; p < 0.001), but no with PEEPi,cw (r = -0.08; NS). The relationship between RVEDVI and right ventricular stroke work index, considered an index of contractility, was significant in three patients, i.e., PEEP did not change contractility. In the other patients, an increase in contractility seemed to occur. CONCLUSIONS: In COPD patients an external PEEP exceeding 90% of PEEPi causes lung hyperinflation and reduces the CI due to a preload effect. The reduction in RVEDVI seems related to changes in EELV, rather than to changes in transmural pressures, suggesting a lung/heart volume interaction in the cardiac fossa. Thus, in COPD patients, application of an external PEEP level lower than PEEPi may affect right ventricular function.
M Dambrosio; G Cinnella; N Brienza; V M Ranieri; R Giuliani; F Bruno; T Fiore; A Brienza
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Intensive care medicine     Volume:  22     ISSN:  0342-4642     ISO Abbreviation:  Intensive Care Med     Publication Date:  1996 Sep 
Date Detail:
Created Date:  1997-02-18     Completed Date:  1997-02-18     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  7704851     Medline TA:  Intensive Care Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  923-32     Citation Subset:  IM    
Istituto di Anestesiologia e Rianimazione, Università degli Studi di Bari, Italy.
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MeSH Terms
Acute Disease
Cardiac Output
Lung Diseases, Obstructive / complications,  physiopathology*,  therapy*
Lung Volume Measurements
Middle Aged
Myocardial Contraction
Positive-Pressure Respiration / methods*
Positive-Pressure Respiration, Intrinsic / complications*
Prospective Studies
Stroke Volume
Ventricular Function, Right*

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