Document Detail

Relief of hypoxemia contributes to a reduction in cardiac index related to the use of positive end-expiratory pressure.
MedLine Citation:
PMID:  8796387     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: We have investigated the role that improvement in arterial oxygenation has, consequent on positive end-expiratory pressure (PEEP), in the reduction of cardiac index (CI) determined by applying PEEP. DESIGN: 2 x 2 factorial trial. SETTING: Department of intensive care medicine at a university hospital. PATIENTS: 13 patients on mechanical ventilation for acute lung injury. INTERVENTIONS: Four experimental conditions, each one characterized by one level of PEEP and one level of PaO2: LOLP = Low PaO2 (approximately 50 mmHg) Low PEEP (approximately 1 cmH2O) LOHP = Low PaO2 (approximately 50 mm Hg) High PEEP (approximately 10 cmH2O) HOLP = High PaO2 (approximately 80 mmHg) Low PEEP (approximately 1 cmH2O) HOHP = High PaO2 (approximately 80 mmHg) High PEEP (approximately 10 cmH2O) MEASUREMENTS AND RESULTS: Hemodynamic and gas exchange data were collected for each experimental condition. CI showed a 13% decline from LOLP (7.0 +/- 1.71/min per m2) to HOHP (6.1 +/- 1.31/min per m2). Both the direct effect of PEEP on the CI (LOLP + HOLP vs LOHP + HOHP, p < 0.01) and the indirect effect related to the improvement in oxygenation (LOLP + LOHP vs HOLP + HOHP, p < 0.01) contributed to the reduction in CI. CONCLUSIONS: In evaluating CI changes induced by PEEP we should take into account the indirect effect of arterial oxygenation upon CI. This should be considered, at least in part, as a physiological adjustment rather than as impaired cardiovascular performance.
M Borelli; R Fumagalli; F Bernasconi; M Cereda; L Gattinoni; A Pesenti
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Intensive care medicine     Volume:  22     ISSN:  0342-4642     ISO Abbreviation:  Intensive Care Med     Publication Date:  1996 May 
Date Detail:
Created Date:  1996-11-19     Completed Date:  1996-11-19     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  7704851     Medline TA:  Intensive Care Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  382-6     Citation Subset:  IM    
University of Milan, Department of Anaesthesia and Intensive Care, S. Gerardo Hospital, Monza (MI), Italy.
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MeSH Terms
Analysis of Variance
Anoxia / blood,  physiopathology*,  therapy*
Blood Gas Analysis
Cardiac Output*
Middle Aged
Oxygen / blood
Positive-Pressure Respiration / adverse effects,  methods*
Pulmonary Gas Exchange
Reg. No./Substance:

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