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Anesth Analg 1988; 67:144-151
© 1988 International Anesthesia Research Society
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The Effect of Incremental Positive End-Expiratory Pressure on Right Ventricular Hemodynamics and Ejection Fraction

James W. Biondi, MD, Douglas S. Schulman, MD, Robert Soufer, MD, Richard A. Matthay, MD, Roberta L. Hines, MD, Harold R. Kay, MD, and Paul G. Barash, MD

Departments of Anesthesiology and Internal Medicin(Cardiology and Pulmonary Divisions), Yale University School of Medicine, New Haven, Connecticut, and the Department of Cardiothoracic Surgery, Hahnemann Medical Center, Philadelphia, Pennsylvania.

Abstract

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 > 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 after load and a decline in RV contractility.

Key Words: HEART, MYOCARDIAL FUNCTION—right ventricle. • VENTILATION—positive end-expiratory pressure.




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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 1988 by the International Anesthesia Research Society.