Impact of Positive End-Expiratory Pressure on Thermodilution-Derived Right Ventricular Parameters in Mechanically Ventilated Critically Ill Patients

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• 作者：Thomas G.V. Cherpanath ; MD^* ; ^{t.g.cherpanath@amc.uva.nl" class="auth_mail" title="E-mail the corresponding author} ; Wim K. Lagrand ; MD ; PhD^* ; Jan M. Binnekade ; PhD^* ; Anton J. Schneider ; MD^&dagger ; ; Marcus J. Schultz ; MD ; PhD^&Dagger ; ; Johan A.B. Groeneveld ; MD ; PhD^§ ;
• 关键词：positive end-expiratory pressure ; right ventricle ; stroke volume variation ; thermodilution ; pulmonary artery catheter ; cardiac output
• 刊名：Journal of Cardiothoracic and Vascular Anesthesia
• 出版年：2016
• 出版时间：June 2016
• 年：2016
• 卷：30
• 期：3
• 页码：632-638
• 全文大小：433 K

文摘

To examine the effect of positive end-expiratory pressure (PEEP) on right ventricular stroke volume variation (SVV), with possible implications for the number and timing of pulmonary artery catheter thermodilution measurements.

Design

Prospective, clinical pilot study.

Setting

Academic medical center.

Participants

Patients who underwent volume-controlled mechanical ventilation and had a pulmonary artery catheter.

Intervention

PEEP was increased from 5-to-10 cmH₂O and from 10-to-15 cmH₂O with 10-minute intervals, with similar decreases in PEEP, from 15-to-10 cmH₂O and 10-to-5 cmH₂O.

Measurements and Main Results

In 15 patients, right ventricular parameters were measured using thermodilution at 10% intervals of the ventilatory cycle at each PEEP level with a rapid-response thermistor. Mean right ventricular stroke volume and end-diastolic volume declined during incremental PEEP and normalized on return to 5 cmH₂O PEEP (p = 0.01 and p = 0.001, respectively). Right ventricular SVV remained unaltered by changes in PEEP (p = 0.26), regardless of incremental PEEP (p = 0.15) or decreased PEEP (p = 0.12). The coefficients of variation in the ventilatory cycle of all other thermodilution-derived right ventricular parameters also were unaffected by changes in PEEP.

Conclusions

This study showed that increases in PEEP did not affect right ventricular SVV in critically ill patients undergoing mechanical ventilation despite reductions in mean right ventricular stroke volume and end-diastolic volume. This could be explained by cyclic counteracting changes in right ventricular preloading and afterloading during the ventilatory cycle, independent of PEEP. Changes in PEEP did not affect the number and timing of pulmonary artery catheter thermodilution measurements.