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Selective positive end-expiratory pressure and cardiac function in dogs
O J Veddeng1, E S Hysing, O A Smiseth
1Institute for Surgical Research, Department of Anaesthesiology, National Hospital, Oslo, Norway.
Intensive Care Medicine
|January 1, 1990
Summary
Selective positive end-expiratory pressure (PEEP) better preserves cardiac output compared to general PEEP. This method reduces intrathoracic pressure, improving left ventricular filling pressure.
Area of Science:
- Cardiology
- Pulmonology
- Anesthesiology
Background:
- Positive end-expiratory pressure (PEEP) is crucial in mechanical ventilation.
- General PEEP can negatively impact cardiac function.
- Selective PEEP offers a potential alternative for lung ventilation.
Purpose of the Study:
- To compare the hemodynamic effects of general (G) versus selective (S) PEEP.
- To evaluate the impact of right (R) and left (L) selective PEEP on cardiac output.
- To assess changes in intrathoracic pressures and left ventricular filling pressures.
Main Methods:
- 11 anesthetized dogs in a supine position underwent differential lung ventilation.
- General PEEP (GPEEP) and selective PEEP (SPEEP) were applied at 20 cmH2O.
- Cardiac output, pleural pressure, pericardial pressure, and transmural left ventricular end-diastolic pressure (LVEDP) were measured.
Main Results:
- GPEEP significantly decreased cardiac output, while LPEEP had no significant effect and RPEEP caused a moderate decrease.
- SPEEP resulted in less increase in pleural and pericardial pressures compared to GPEEP.
- Transmural LVEDP decreased less with SPEEP than with GPEEP, indicating better cardiac filling.
Conclusions:
- Selective PEEP is superior to general PEEP in maintaining cardiac output during differential lung ventilation.
- The improved cardiac performance with SPEEP is attributed to lower intrathoracic pressures.
- SPEEP represents a potentially safer approach for patients requiring mechanical ventilation with PEEP.