Changes in thoracopulmonary compliance and hemodynamic effects of positive end-expiratory pressure in patients with or without heart failure
| Autor: | Apostolos Armaganidis, Charis Roussos, Antonis Mavrommatis, Anastasia Kotanidou, Spyros Zakynthinos |
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| Rok vydání: | 1997 |
| Předmět: |
Adult
Male Cardiac Catheterization Cardiac index Hemodynamics Blood Pressure Critical Care and Intensive Care Medicine Positive-Pressure Respiration medicine Humans Lung volumes Prospective Studies Cardiac Output Pulmonary wedge pressure Lung Compliance Positive end-expiratory pressure Aged Aged 80 and over Heart Failure Analysis of Variance business.industry Airway Resistance Discriminant Analysis Oxygenation Middle Aged respiratory system medicine.disease respiratory tract diseases Compliance (physiology) Anesthesia Heart failure Female business therapeutics circulatory and respiratory physiology |
| Zdroj: | Journal of Critical Care. 12:101-111 |
| ISSN: | 0883-9441 |
| DOI: | 10.1016/s0883-9441(97)90039-3 |
| Popis: | 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 15 mm Hg. Results: In patients with low Cl 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. |
| Databáze: | OpenAIRE |
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