Related Experiment Video
Updated: Aug 15, 2026
Increasing Pulmonary Artery Pulsatile Flow Improves Hypoxic Pulmonary Hypertension in Piglets
Published on: May 11, 2015
Haemodynamic changes during positive-pressure ventilation in children
A Kardos1, G Vereczkey, C Szentirmai
1Paediatric Intensive Care Unit, Heim Pál Children's Hospital, Ullõi Str. 89, 1086 Budapest, Hungary. dr.kardos@axelero.hu
Insights
Positive-pressure ventilation can affect cardiac function. This study found that increasing positive end-expiratory pressure (PEEP) did not significantly alter hemodynamics in children, but lowering PEEP improved stroke volume index and cardiac index.
Area of Science:
- Pediatric critical care medicine
- Cardiopulmonary physiology
- Mechanical ventilation
Background:
- Positive-pressure ventilation (PPV) is a cornerstone of respiratory support in critically ill children.
- PPV can influence cardiovascular dynamics, particularly in patients with compromised cardiac function.
- Understanding these interactions is crucial for optimizing ventilator settings and patient outcomes.
Purpose of the Study:
- To investigate the impact of varying positive end-expiratory pressure (PEEP) levels on central hemodynamics in mechanically ventilated children without pulmonary pathology.
- To assess changes in cardiac output and tissue perfusion indicators using impedance cardiography (ICG) and central venous oxygen saturation (ScvO2).
Main Methods:
- A prospective study involving 12 children (7-65 months) on mechanical ventilation for non-pulmonary conditions.
- Impedance cardiography (ICG) and central venous saturation (ScvO2) were used to monitor hemodynamic parameters.
- Positive-pressure ventilation with controlled airway pressure was applied, systematically increasing and then decreasing PEEP from 5 to 15 cmH2O.
Main Results:
- Elevating PEEP to 10 and 15 cmH2O did not significantly alter cardiac index (CI).
- Slight, non-significant reductions in stroke volume index (SVI) and ScvO2 were observed with increased PEEP.
- Decreasing PEEP to 5 cmH2O resulted in statistically significant increases in SVI and CI.
Conclusions:
- PEEP titration within the studied range did not induce significant hemodynamic compromise in this pediatric population.
- Lowering PEEP to 5 cmH2O was associated with improved ventricular performance (SVI) and cardiac output (CI).
- ScvO2 remained stable, suggesting preserved tissue oxygen delivery despite hemodynamic fluctuations.
Background:
Positive-pressure ventilation may alter cardiac function. Our objective was to determine with the use of impedance cardiography (ICG) whether altering airway pressure modifies the central haemodynamics in mechanically ventilated children with no pulmonary pathology. Central venous saturation (S(cv)O(2)) was measured as an indicator of tissue perfusion.
Methods:
Twelve children between 7 and 65 months of age, requiring mechanical ventilation as a consequence of a non-pulmonary disease, were enrolled in the study. All patients had a central venous line as a part of their routine management. Using pressure controlled ventilation (PCV) the baseline PEEP value of 5 cmH(2)O (P(b5)) was increased to 10 cmH(2)O (P(i10)) and then to 15 cmH(2)O (P(i15)). After P(i15), PEEP was decreased to 10 (P(d10)) and then to 5 cmH(2)O (P(d5)). Each time period lasted 5 min heart rate (HR), mean arterial blood pressure (MABP), central venous pressure (CVP), end-tidal carbon dioxide (ETCO(2)), mean airway pressure (P(aw)), stroke volume index (SVI), cardiac index (CI) and central venous oxygen saturation (S(cv)O(2)) were recorded at the end of the five periods.
Results:
The values of CI did not change when 10 and 15 cmH(2)O of PEEP were applied. Elevation of PEEP and thus P(aw) caused slight but not significant reductions in SVI and S(cv)O(2) as compared to the baseline (T(b5)). After reducing PEEP in T(d5) we found statistically significant elevations of SVI and CI, as compared to T(i15) heart rate, ETCO(2) and MABP remained unchanged.
Conclusion:
We did not find significant haemodynamic changes following PEEP elevation in ventilated children, as measured using impedance cardiography. Reducing the value of PEEP to 5 cmH(2)O resulted in statistically significant SVI elevations. The values of S(cv)O(2) remained unaffected.
More Related Videos
Related Concept Videos
01:24Pressure Relationships in Thoracic Cavity
Breathing Mechanisms
Both intra-alveolar and intrapleural pressures rely on specific lung properties. The ability to breathe—allowing air to enter the lungs during...
01:19Factors Affecting Pulmonary Ventilation
Alveolar Surface Tension
The alveolar fluid lines the luminal surface of the alveoli and exerts a force called surface tension. This force is caused by the polar water molecules in the liquid being more strongly attracted to each...
01:29Mechanical Ventilation I: Indication and Settings
01:23Mechanical Ventilation II: Invasive Ventilation
Negative-Pressure Ventilators
Negative-pressure ventilators create a vacuum around the chest or body to draw air into the lungs, simulating breathing. This method does not require an...
01:23Mechanical Ventilation III: Noninvasive Ventilation
Noninvasive Positive-Pressure Ventilation (NIPPV)
01:14Ventilatory Modes
There are three ventilatory modes: full support, partial support, and spontaneous. These are described below.
Full Support Modes
Full support modes include controlled mechanical ventilation, continuous mandatory...