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Right ventricular function during positive end-expiratory pressure. Thermodilution evaluation and clinical
1Department of Anesthesia and Intensive Care, Hopital Sainte-Marguerite, Marseille, France.
Chest
|December 1, 1987
Summary
Positive end-expiratory pressure (PEEP) in mechanical ventilation can decrease right ventricular (RV) function and preload. Bedside thermodilution can measure RV ejection fraction (RVEF) and RV end-diastolic volume (RVEDV) to guide treatment.
Area of Science:
- Cardiology
- Pulmonology
- Critical Care Medicine
Background:
- Positive end-expiratory pressure (PEEP) is used in mechanical ventilation for adult respiratory distress syndrome.
- PEEP can impact right ventricular (RV) function and hemodynamics.
Purpose of the Study:
- To assess the effect of PEEP on RV function in mechanically ventilated patients.
- To evaluate the utility of bedside thermodilution for measuring RV parameters.
Main Methods:
- Studied 13 adult respiratory distress syndrome patients on mechanical ventilation with PEEP.
- Assessed RV function using thermodilution technique to calculate RV ejection fraction (RVEF) and RV end-diastolic volume (RVEDV).
Main Results:
- Increasing PEEP decreased blood pressure, stroke volume, and RV end-diastolic volume in 11 patients, with no change in RVEF.
- Two patients showed decreased blood pressure, stroke volume, RVEF, and increased RV end-diastolic volume with PEEP.
- One patient experienced a significant decrease in cardiac output.
Conclusions:
- RV end-diastolic volume is a key indicator of RV preload.
- Bedside thermodilution can accurately measure RVEDV and RVEF.
- These measurements aid in managing PEEP-induced decreases in cardiac output.