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Effects of inverse ratio ventilation with PEEP on kidney function
Marius G Dehne1, Markus Meister, Rainer Röhrig
1Department of Anaesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Hospital Wittlich, 54516, Wittlich, Germany. mg.dehne@verbund-krankenhaus.de
Renal Failure
|May 8, 2010
Summary
Inverse ratio ventilation (IRV) with positive end-expiratory pressure (PEEP) impacts hemodynamics and hormones like renin, decreasing urine output. While parameters remained mostly normal, further studies are needed for longer ventilation periods.
Area of Science:
- Critical Care Medicine
- Nephrology
- Cardiovascular Physiology
Background:
- Positive pressure ventilation (PPV) can negatively affect hemodynamics and renal function.
- Inverse ratio ventilation (IRV) is a highly invasive PPV technique requiring investigation into its effects.
Purpose of the Study:
- To investigate the impact of IRV on hormonal responses and renal function.
- To assess hemodynamic changes during different IRV and PEEP settings.
Main Methods:
- Ten male patients underwent 60-minute periods of five distinct ventilation modes postoperatively.
- Measurements included hemodynamics, urine production, fractional excretion of sodium (FESo), and plasma hormones (ANP, renin, angiotensin II, aldosterone, ADH).
Main Results:
- Increased central venous pressure (CVP), ADH, and renin observed with PEEP 15 cm H2O and I:E ratio 1:2.
- Elevated CVP, renin, and FESo noted with PEEP 15 cm H2O and I:E ratio 2:1.
- Significant decrease in urine production occurred with PEEP 15 cm H2O and I:E ratio 2:1.
Conclusions:
- IRV with PEEP significantly affects hemodynamics and renin levels, reducing urine production in patients with healthy renal/pulmonary systems.
- Most measured parameters remained within normal ranges, except for FESo and renin.
- Longer-term effects and pathological value occurrence require further investigation.
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