Positive end-expiratory pressure (PEEP) increased transmural left ventricular filling pressure for a given cardiac output compared to control, suggesting an adverse effect on ventricular performance.
Does positive end-expiratory pressure affect right and left ventricular performance in mechanically ventilated dogs?
PEEP exerts a nonneuronal adverse effect on both left and right ventricular performance, likely due to mechanical heart-lung interactions.
The cardiovascular effects of positive end-expiratory pressure (PEEP) were studied in mechanically ventilated, vagotomized, Beta-blocked, anesthetized dogs. To compensate for the effect of PEEP on decreasing systemic venous return, acute plasma volume expansion was accomplished returning stroke volume and cardiac output to control values. Left and right ventricular filling pressures (LVFP and RVFP) and aortic pressure were measured relative to pressure (transmural pressure). Ventricular performance was assessed by comparing the transmural ventricular filling pressures at similar stroke volumes. Studies were performed on individual dogs with increasing LVFP produced by Beta-blockade, volume expansion, and obstruction of the descending thoracic aorta. Utilizing these methods we observed that for a given cardiac output, transmural LVFP was higher on PEEP compared to a control state with both normal and elevated control LVFP. On the right side, for a given cardiac output, RVFP was elevated only when the control LVFP was elevated. Our results suggest a nonneuronal adverse effect of PEEP on both left and right ventricular performance. This effect is probably due to mechanical heart-lung interaction since left ventricular (LV) dp/dt showed no change.
Robotham et al. (1980) studied Mechanically ventilated, vagotomized, Beta-blocked, anesthetized dogs. Positive end-expiratory pressure (PEEP) vs. Control state was evaluated on Transmural ventricular filling pressures at similar stroke volumes. Positive end-expiratory pressure (PEEP) increased transmural left ventricular filling pressure for a given cardiac output compared to control, suggesting an adverse effect on ventricular performance.