Increasing Levels of Positive End-expiratory Pressure Cause Stepwise Biventricular Stroke Work Reduction in a Porcine Model

ConclusionsA stepwise increase in PEEP caused stepwise reduction in biventricular stroke work. However, there are important interventricular differences in response to increased PEEP levels. PEEP increased right ventricular afterload leading to uncoupling and right ventricular ejection fraction decline. These findings may support clinical decision-making to further optimize PEEP as a means to balance between improving lung ventilation and preserving right ventricular function.Editor ’s PerspectiveWhat We Already Know about This TopicPositive end-expiratory pressure (PEEP) is commonly applied to avoid atelectasis and improve oxygenation in patients undergoing mechanical ventilation during general anesthesia or while receiving intensive care unit care.It is known that increased PEEP can decrease left ventricular stroke work, but it is not known how stepwise increases in PEEP correspond with biventricular cardiac function.What This Article Tells Us That Is NewThis study of six healthy, anesthetized female pigs found that stepwise increases in PEEP were associated with biventricular decreased stroke work as assessed using biventricular pressure-volume loop recordings.Higher PEEP had divergent effects on rightversus left ventricle for key hemodynamic variables including arterial elastance, ejection fraction, ventriculo-arterial coupling, and end-systolic pressures. The impact of PEEP was more notable and potentially detrimental for the right ventricle compared to the left ventri...
Source: Anesthesiology - Category: Anesthesiology Source Type: research