Key result
Positive end-expiratory pressure (PEEP) levels ≥10 cm H2O significantly decreased plasma atrial natriuretic peptide concentrations, whereas PEEP ≤5 cm H2O did not.
Why the study?
Do different positive end-expiratory pressure (PEEP) levels reduce plasma atrial natriuretic peptide concentrations in mechanically ventilated patients with acute respiratory failure?
RCT (n=27)
randomized
No
Do different positive end-expiratory pressure (PEEP) levels reduce plasma atrial natriuretic peptide concentrations in mechanically ventilated patients with acute respiratory failure?
PEEP levels of ≥10 cm H2O significantly decrease plasma atrial natriuretic peptide concentrations in mechanically ventilated patients, indicating an influence on cardiac endocrine function.
High PEEP may affect cardiac endocrine function during ventilation; extends evidence on cardiopulmonary interactions in acute respiratory failure.
OBJECTIVE: To assess the influence of different positive end-expiratory pressure (PEEP) levels on plasma atrial natriuretic peptide concentrations. DESIGN: Prospective, randomized study. SETTING: Intensive care unit of a university hospital. PATIENTS: Twenty-seven patients who were mechanically ventilated due to acute respiratory failure. INTERVENTION: None. MEASUREMENTS AND MAIN RESULTS: The patients were randomized into three groups: in each group, a defined PEEP level (5, 10, or 15 cm H2O, respectively) was applied, alternating with zero PEEP (0 cm H2O) in consecutive order (reversal experiment). Blood samples for the determination of atrial natriuretic peptide concentrations were drawn from the pulmonary artery and the radial artery catheters. There were no decreases in atrial natriuretic peptide concentrations with a PEEP of 5 cm H2O, but significant decreases could be shown for PEEP values of 10 and 15 cm H2O. The patients of all groups were subjected to PEEP levels of 5, 10, 15, and 20 cm H2O in randomized order (step experiment). The data demonstrated a significant inverse correlation between changes in PEEP levels and changes in plasma atrial natriuretic peptide concentrations. CONCLUSION: The data suggest that the release of atrial natriuretic peptide is influenced by a PEEP of > or = 10 cm H2O, while a PEEP of < or = 5 cm H2O does not disturb this cardiac endocrine function.
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Frass et al. (1993) conducted an RCT in acute respiratory failure requiring mechanical ventilation (n=27). Positive end-expiratory pressure (PEEP) vs. Zero PEEP (0 cm H2O) was evaluated on plasma atrial natriuretic peptide concentrations. Positive end-expiratory pressure (PEEP) levels ≥10 cm H2O significantly decreased plasma atrial natriuretic peptide concentrations, whereas PEEP ≤5 cm H2O did not.
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