Tolerable Maximum Positive End Expiratory Pressure in Mechanically Ventilated Patients and Its Impact on Blood Flow across Cardiac Valves: Index Case Report of a Physiology Study
| Autor: | Ashraf M. Elhoufi, Rashid Nadeem, Lamiaa Salama, Kamaleldin Ahmed |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Cardiac output
medicine.medical_specialty business.industry Hemodynamics Blood volume Blood flow respiratory system respiratory tract diseases Preload medicine.anatomical_structure Afterload Internal medicine Mitral valve cardiovascular system medicine Cardiology business therapeutics Positive end-expiratory pressure circulatory and respiratory physiology |
| Zdroj: | Dubai Medical Journal. 2:163-167 |
| ISSN: | 2571-726X |
| Popis: | Introduction: Positive end expiratory pressure (PEEP) exerts variable effects on preload, pulmonary vascular flow, and afterload. Lung recruitment with gradual increase in PEEP improves oxygenation, but it may have variable cardiovascular effects. Method: A patient with respiratory failure from tetanus was recruited after informed consent. The sedated and paralyzed patient was subjected to sequential increase in PEEP with measurement of hemodynamics, ventilator parameters, and echocardiographic parameters (Doppler flow across tricuspid, pulmonic, and mitral valves at end inspiration and end expiration, in addition to blood volume flowing across RVOT and mitral valve). Results: We observed an initial rise in pulmonic and mitral blood flows, followed by a decline back to baseline around PEEP of 20, with an eventual decline associated with a drop in mean MAP Conclusion: Although systemic pressure was maintained at PEEP of 29, pulmonary blood flow started to be compromised at PEEP of 20. Best pulmonary perfusion parameters were achieved at PEEP of 5. |
| Databáze: | OpenAIRE |
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