Influence of Positive End-Expiratory Pressure on Right and Left Ventricular Performance Assessed by Doppler Two-Dimensional Echocardiography

Huemer, G.; Kolev, Nikola; Kurz, Andrea; Zimpfer, Michael

doi:10.1378/chest.106.1.67

Cited by 85 publications

(42 citation statements)

References 20 publications

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“…They concluded that the hemodynamic effects of positive inspiratory pressure ventilation will depend on the degree of lung inflation, on the inspiratory time, and on the time when measurements are made within the ventilatory cycle. In normal volunteers, Huemer et al (36) employed Doppler hemodynamic indices to show that the fall in cardiac output during PEEP is caused by a reduction in ventricular filling due to decreased venous return. Our data, despite the fall in cardiac index, showed that DO 2 and VO 2 were preserved; in addition, CaO 2 increments due to the PEEPrelated increase in oxygen saturation were also able to partially compensate for the hemodynamic impairment.…”

Section: Discussionmentioning

confidence: 99%

The effects of positive end-expiratory pressure on respiratory system mechanics and hemodynamics in postoperative cardiac surgery patients

Auler

Carmona

Barbas

et al. 2000

Braz J Med Biol Res

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We prospectively evaluated the effects of positive end-expiratory pressure (PEEP) on the respiratory mechanical properties and hemodynamics of 10 postoperative adult cardiac patients undergoing mechanical ventilation while still anesthetized and paralyzed. The respiratory mechanics was evaluated by the inflation inspiratory occlusion method and hemodynamics by conventional methods. Each patient was randomized to a different level of PEEP (5, 10 and 15 cmH 2 O), while zero end-expiratory pressure (ZEEP) was established as control. PEEP of 15-min duration was applied at 20-min intervals. The frequency dependence of resistance and the viscoelastic properties and elastance of the respiratory system were evaluated together with hemodynamic and respiratory indexes. We observed a significant decrease in total airway resistance (13.12 ± 0.79 cmH 2 O l -1 s -1 at ZEEP, 11.94 ± 0.55 cmH 2 O l -1 s -1 (P<0.0197) at 5 cmH 2 O of PEEP, 11.42 ± 0.71 cmH 2 O l -1 s -1 (P<0.0255) at 10 cmH 2 O of PEEP, and 10.32 ± 0.57 cmH 2 O l -1 s -1 (P<0.0002) at 15 cmH 2 O of PEEP). The elastance (E rs ; cmH 2 O/l) was not significantly modified by PEEP from zero (23.49 ± 1.21) to 5 cmH 2 O (21.89 ± 0.70). However, a significant decrease (P<0.0003) at 10 cmH 2 O PEEP (18.86 ± 1.13), as well as (P<0.0001) at 15 cmH 2 O (18.41 ± 0.82) was observed after PEEP application. Volume dependence of viscoelastic properties showed a slight but not significant tendency to increase with PEEP. The significant decreases in cardiac index (l min -1 m -2 ) due to PEEP increments (3.90 ± 0.22 at ZEEP, 3.43 ± 0.17 (P<0.0260) at 5 cmH 2 O of PEEP, 3.31 ± 0.22 (P<0.0260) at 10 cmH 2 O of PEEP, and 3.10 ± 0.22 (P<0.0113) at 15 cmH 2 O of PEEP) were compensated for by an increase in arterial oxygen content owing to shunt fraction reduction (%) from 22.26 ± 2.28 at ZEEP to 11.66 ± 1.24 at PEEP of 15 cmH 2 O (P<0.0007). We conclude that increments in PEEP resulted in a reduction of both airway resistance and respiratory elastance. These results could reflect improvement in respiratory mechanics. However, due to possible hemodynamic instability, PEEP should be carefully applied to postoperative cardiac patients.

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Section: Discussionmentioning

confidence: 99%

The effects of positive end-expiratory pressure on respiratory system mechanics and hemodynamics in postoperative cardiac surgery patients

Auler

Carmona

Barbas

et al. 2000

Braz J Med Biol Res

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“…TTE has been shown to be a reliable method to assess right-ventricular dimensions in patients ventilated with continuous positive airway pressure or positive-pressure ventilation [66,67]. Using this approach, right-ventricular end-diastolic area is obtained on the apical four chambers view [68].…”

Section: Right-ventricular End-diastolic Volume Measured By Echocardimentioning

confidence: 99%

“…TTE has been used in the past to measure left-ventricular end-diastolic volume and/or area [23, 67,73,74] in MV patients. However, no study has evaluated the left-ventricular end-diastolic volume and/or area measured by TTE as predictors of fluid responsiveness in MV patients.…”

Section: Left-ventricular End-diastolic Volume Measured By Echocardiomentioning

confidence: 99%

Fluid responsiveness in mechanically ventilated patients: a review of indices used in intensive care

2003

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“…However, the effect on the LV is insignificant. On the other hand, continuous positive airway pressure (CPAP) can improve LV afterload by reducing transmural LV pressure (Huemer et al 1994). TTE appears as a sensitive noninvasive method which accurately detects changes in central haemodynamics induced by changes in breathing pattern.…”

Section: = 45·csa(max)(3/2)mentioning

confidence: 99%

Doppler Echocardiographic Changes in Respiratory Diseases

Al‐Biltagi¹,

Bediwy²

2011

Establishing Better Standards of Care in Doppler Echocardiography, Computed Tomography and Nuclear Cardiology

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Influence of Positive End-Expiratory Pressure on Right and Left Ventricular Performance Assessed by Doppler Two-Dimensional Echocardiography

Cited by 85 publications

References 20 publications

The effects of positive end-expiratory pressure on respiratory system mechanics and hemodynamics in postoperative cardiac surgery patients

The effects of positive end-expiratory pressure on respiratory system mechanics and hemodynamics in postoperative cardiac surgery patients

Fluid responsiveness in mechanically ventilated patients: a review of indices used in intensive care

Doppler Echocardiographic Changes in Respiratory Diseases

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