Key result
PEEP ventilation at 15 cm H2O significantly decreased left and right ventricular end-diastolic volumes, stroke volumes, and end-systolic atrial volumes on MRI.
Why the study?
The study aimed to use magnetic resonance imaging to assess the effects of ventilation with positive end-expiratory pressure on cardiac and atrial volumes and to determine spatial interactions between the heart, lungs, and chest.
Does positive end-expiratory pressure (PEEP) ventilation alter cardiac volumes and spatial interactions between the heart, lungs, and chest in healthy volunteers?
Does positive end-expiratory pressure (PEEP) ventilation alter cardiac volumes and spatial interactions between the heart, lungs, and chest in healthy volunteers?
Answers are grounded in this paper and cite their sources.
MRI during mechanical ventilation is feasible and demonstrates that PEEP at 7 to 15 cm H2O reduces atrial and ventricular volumes via external cardiac compression by the expanding lungs.
Objectives Magnetic resonance imaging was used to assess the effects of ventilation with positive end-expiratory pressure (PEEP) on cardiac volumes, especially on atrial volumes as well as to determine semiquantitative measurements of spatial interactions between heart, lungs and chest. Design Prospective study with healthy volunteers undergoing mechanical ventilation with different levels of PEEP during magnetic resonance imaging. Setting Magnetic resonance unit, Institute of Diagnostic Imaging, Rudolfinerhaus Hospital. Subjects Twelve healthy volunteers. Interventions Volunteers were imaged, using a multislice-multiphase technique during spontaneous breathing and with PEEP values of 0, 7, and 15 cm H2O. Measurements and main results Atrial as well as ventricular volumes, chest diameters, and midventricular contact between the heart and anterior chest wall were determined on transverse-oblique sections. Atrial volumes showed a progressive decline beginning at a PEEP of 7 cm H2O. Diastolic filling of both ventricles was reduced. A PEEP level of 15 cm H2O induced a significant increase in the sagittal-oblique but not in the transverse-oblique chest diameter. PEEP values of 7 and 15 cm H2O shortened the length of the midventricular contact between the heart and anterior chest wall. Conclusions Left and right ventricular end-diastolic volumes and stroke volumes decreased significantly during ventilation with PEEP at 15 cm H2O, as did end-systolic atrial volumes. Volume changes in association with changes of chest and heart configuration suggest external cardiac compression by the expanding lungs. Furthermore, this study illustrates the feasibility of magnetic resonance imaging in mechanically ventilated patients.
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Leithner et al. (1994) studied Healthy volunteers (n=12). Positive end-expiratory pressure (PEEP) ventilation vs. Spontaneous breathing and PEEP 0 cm H2O was evaluated on Atrial and ventricular volumes, chest diameters, and midventricular contact between the heart and anterior chest wall on MRI. PEEP ventilation at 15 cm H2O significantly decreased left and right ventricular end-diastolic volumes, stroke volumes, and end-systolic atrial volumes on MRI.
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