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Positive end expiratory pressure with increased intra-abdominal pressure
Surgery, Gynecology & Obstetrics
|October 1, 1985
Summary
Positive pressure ventilation (PEEP) combined with increased intra-abdominal pressure (IAP) significantly elevates hemodynamic pressures and serum lactate levels in dogs. Reducing PEEP and IAP may improve both hemodynamics and lactate metabolism.
Area of Science:
- Cardiovascular Physiology
- Critical Care Medicine
- Surgical Physiology
Background:
- Positive end-expiratory pressure (PEEP) ventilation and increased intra-abdominal pressure (IAP) independently affect hemodynamics.
- The combined effects of PEEP and elevated IAP on cardiovascular parameters and lactate metabolism are not fully understood.
Purpose of the Study:
- To investigate the hemodynamic and metabolic consequences of combining PEEP with elevated IAP in an animal model.
- To assess the impact on cardiac output, central venous pressure, pulmonary artery pressure, and serum lactate levels.
Main Methods:
- The study utilized a canine model to simulate conditions of elevated IAP and PEEP.
- Hemodynamic parameters including CVP, PCWP, PAP, PVR, and CO were monitored.
- Serum lactate levels were measured to evaluate metabolic changes.
Main Results:
- Combining PEEP with elevated IAP markedly increased CVP, PCWP, mean PAP, and PVR.
- Cardiac output (CO) was depressed, but not more so than with IAP and ventilation without PEEP.
- Serum lactate levels significantly increased when both PEEP and elevated IAP were applied, independent of CO reduction.
Conclusions:
- The combination of PEEP and elevated IAP significantly worsens hemodynamic parameters and increases serum lactate levels in dogs.
- Elevated lactate may be due to inhibited hepatic metabolism rather than reduced cardiac output.
- Reducing both IAP and PEEP may be beneficial for improving hemodynamics and lactate levels.