Increasing positive end-expiratory pressure from 0 to 20 cm H2O in ventilated patients decreased right ventricular ejection fraction from 42% to 30% and reduced right ventricular contractility.
Does incremental positive end-expiratory pressure alter right ventricular hemodynamics and ejection fraction in ventilated patients?
Low levels of PEEP primarily reduce right ventricular preload, whereas PEEP above 15 cm H2O increases RV afterload and decreases RV contractility in ventilated patients.
Absolute Event Rate: 30% vs 42%
The effects of incremental positive end-expiratory pressure (PEEP) on right ventricular (RV) function were evaluated in 36 (n = 36) ventilated patients. Positive end-expiratory pressure was increased from 0 (baseline) to 20 cm H2O in 5-cm H2O increments and RV hemodynamics and thermally derived right ventricular ejection fraction (RVEF), right ventricular end-diastolic volume index (RVEDVI), and right ventricular end-systolic volume index (RVESVI) were computed. Right ventricular contractility was determined from the analysis of RV systolic pressure-volume relations. Right ventricular ejection fraction declined from 42 +/- 8% at baseline to 30 +/- 9% at 20 cm H2O PEEP. Right ventricular end-diastolic volume index declined between 0 and 5 cm H2O PEEP (103 +/- 42 to 92 +/- 34 ml.m-2) and then increased to 113 +/- 40 at 20 cm H2O PEEP. Right ventricular end-systolic volume index increased from 60 +/- 31 ml.m-2 at baseline to 79 +/- 34 ml.m-2 at 20 cm H2O PEEP. The slope (E) of the relation of RV peak systolic pressure to RV end-systolic volume index decreased from 0.26 mm Hg.m2.ml-1 between PEEP of 0-15 cm H2O to 0.05 mm Hg.m2.m-1 at PEEP greater than 15 cm H2O. It is concluded that low levels of PEEP have a predominant preload reducing effect on the RV. Above 15 cm H2O PEEP, RV volumes increase and E decreases, consistent with increased RV afterload and a decline in RV contractility.
Biondi et al. (Mon,) conducted a other in Ventilated patients (n=36). Incremental positive end-expiratory pressure (PEEP) vs. Baseline (0 cm H2O PEEP) was evaluated on Right ventricular ejection fraction (RVEF). Increasing positive end-expiratory pressure from 0 to 20 cm H2O in ventilated patients decreased right ventricular ejection fraction from 42% to 30% and reduced right ventricular contractility.