Physiologic Consequences of Positive End-Expiratory Pressure (Peep) Ventilation

Powers, Samuel R.; Mannal, R.; M, Neclerio; English, Mark; Marr, Clifford C.; Leather, Robert P.; Ueda, H; Williams, G.; Custead, Wayne G.; Dutton, Robert E.

doi:10.1097/00132586-197410000-00033

Cited by 15 publications

(20 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Clearly, the works of Cournand et al (2) and others (4,9,26) have documented the need for adequate intravascular volume to maintain cardiac output when sustained increases in Paw are used. Also, Versprille and Jansen (33) showed the change in venous return to be volume dependent.…”

Section: Discussionmentioning

confidence: 99%

“…The original studies on venous return (2,3,8,9), showed that venous return was decreased regardless of how Pra was increased. Pra could be increased through IPPV, continuous positive airway pressure (CPAP), or IPPV with positive endexpiratory pressure (PEEP) (3,26). In support of this hypothesis, several investigators have demonstrated that, during PEEP therapy, if volume resuscitation or vasoactive drug infusions restore ventricular filling to their pre-PEEP values, then cardiac output also returns to its pre-PEEP levels (4,18,34).…”

mentioning

confidence: 99%

See 1 more Smart Citation

Effect of positive pressure on venous return in volume-loaded cardiac surgical patients

Berg

Jansen

Pinsky

2002

Journal of Applied Physiology

123

View full text Add to dashboard Cite

The hemodynamic effects of increases in airway pressure (Paw) are related in part to Paw-induced increases in right atrial pressure (Pra), the downstream pressure for venous return, thus decreasing the pressure gradient for venous return. However, numerous animal and clinical studies have shown that venous return is often sustained during ventilation with positive end-expiratory pressure (PEEP). Potentially, PEEP-induced diaphragmatic descent increases abdominal pressure (Pabd). We hypothesized that an increase in Paw induced by PEEP would minimally alter venous return because the associated increase in Pra would be partially offset by a concomitant increase in Pabd. Thus we studied the acute effects of graded increases of Paw on Pra, Pabd, and cardiac output by application of inspiratory-hold maneuvers in sedated and paralyzed humans. Forty-two patients were studied in the intensive care unit after coronary artery bypass surgery during hemodynamically stable, fluid-resuscitated conditions. Paw was progressively increased in steps of 2 to 4 cmH(2)O from 0 to 20 cmH(2)O in sequential 25-s inspiratory-hold maneuvers. Right ventricular (RV) cardiac output (CO(td)) and RV ejection fraction (EF(rv)) were measured at 5 s into the inspiratory-hold maneuver by the thermodilution technique. RV end-diastolic volume and stroke volume were calculated from EF(rv) and heart rate data, and Pra was measured from the pulmonary artery catheter. Pabd was estimated as bladder pressure. We found that, although increasing Paw progressively increased Pra, neither CO(td) nor RV end-diastolic volume changed. The ratio of change (Delta) in Paw to Delta Pra was 0.32 +/- 0.20. The ratio of Delta Pra to Delta CO(td) was 0.05 +/- 00.15 l x min(-1) x mmHg(-1). However, Pabd increased such that the ratio of Delta Pra to Delta Pabd was 0.73 +/- 0.36, meaning that most of the increase in Pra was reflected in increases in Pabd. We conclude that, in hemodynamically stable fluid-resuscitated postoperative surgical patients, inspiratory-hold maneuvers with increases in Paw of up to 20 cmH(2)O have minimal effects on cardiac output, primarily because of an in-phase-associated pressurization of the abdominal compartment associated with compression of the liver and squeezing of the lungs.

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Effect of positive pressure on venous return in volume-loaded cardiac surgical patients

Berg

Jansen

Pinsky

2002

Journal of Applied Physiology

123

View full text Add to dashboard Cite

show abstract

“…Powers, et al, 22 have demonstrated that in approximately one-third of 33 patients studied, the observed fall in output outweighed the improved arterial oxygen content with a subsequent decreased oxygen delivery and fall in tissue oxygen consumption. This phenomenon was also noted by Uzawa and Ashbaugh 27 in an animal model of the respiratory distress syndrome.…”

Section: Put S1~176mentioning

confidence: 95%

Effect of positive end expiratory pressure ventilation on intracranial pressure in man

Jl¹,

Mh²,

Petersons³

et al. 1977

Journal of Neurosurgery

View full text Add to dashboard Cite

THsi study was designed to define the effect of positive end expiratory pressure (PEEP) ventilation on intracranial pressure (ICP). In 25 patients with severe head trauma with and without associated pulmonary injury the following parameters were simultaneously monitored under mechanical ventilation with and without PEEP:ICP, arterial blood pressure, central venous pressure, arterial blood gases, and cardiac rate. In addition, the volume-pressure response (VPR) was evaluted in each patient to assess cerebral elastance. The results indicate a significant increase in ICP with the application of PEEP only in the 12 patients who manifested increased cerebral elastance by VPR. Half of this latter group manifested impairment of cerebral perfusion pressure to levels less than 60 mm Hg. Return to baseline CIP levels was observed with termination of PEEP. No significantly consistent changes in other parameters were noted.

show abstract

“…Seve workers found an increase in the pulmon shunt after high Fio2 administration, explair by a reduction in the functional resid capacity (FRC)13 16 because of absorpt: atelectasis.10 1116-20 This inverse correlation tween FRC and venous admixture has b demonstrated previously.21 22 Otherwise, I shunt may decrease when FIo2 increases. '3 If is obvious that variations of Fio2 modify the Yot value of the shunt, it is also evident that measurements of venous admixture should be performed at the particular Fio2 inhaled by the patient, as indicated by the clinical status.…”

Section: Discussionmentioning

confidence: 82%

Effect of positive end-expiratory pressure on intrapulmonary shunt at different levels of fractional inspired oxygen.

Oliven¹,

Taitelman²,

Zveibil³

et al. 1980

Thorax

View full text Add to dashboard Cite

Physiologic Consequences of Positive End-Expiratory Pressure (Peep) Ventilation

Cited by 15 publications

References 0 publications

Effect of positive pressure on venous return in volume-loaded cardiac surgical patients

Effect of positive pressure on venous return in volume-loaded cardiac surgical patients

Effect of positive end expiratory pressure ventilation on intracranial pressure in man

Effect of positive end-expiratory pressure on intrapulmonary shunt at different levels of fractional inspired oxygen.

Contact Info

Product

Resources

About