[Influence of positive end-expiratory pressure ventilation on left ventricular function (author's transl)]

During the last decade several attempts have been made to elucidate the mechanism of the fall in cardiac output observed during positive end-expiratory pressure ventilation (PEEP). some of these studies have given conflicting results, but the weight of experimental and clinical evidence available today points to a coherent physiopathology. PEEP does not alter left ventricular contractility, but it impedes left ventricular filling by reducing pulmonary venous return and left ventricular compliance. In patients under high PEEP, reduction in left ventricular distensibility results from septal shift and flattening of the left ventricle due to right ventricular overload.