Selective positive end-expiratory pressure and right ventricular function in dogs

Differential ventilation with selective positive end-expiratory pressure (PEEP) has been shown to reduce cardiac output less than general PEEP. In previous studies we have demonstrated that during selective PEEP left ventricular preload is better maintained than during general PEEP. The present study was designed to determine whether the different haemodynamic responses to selective and general PEEP also might be due to different effects on RV preload. The study was performed on nine acutely instrumented dogs, in which extraventricular pressure was measured by pericardial balloon transducers. Measures of RV preload were obtained by the use of ultrasonic segment length transducers as well as end-diastolic transmural pressure (RVEDP). The study showed reductions in RVEDP during general and selective right (R) PEEP, accompanied by moderate reductions in RV inflow tract segment lengths. These changes were most marked with general PEEP. Selective LPEEP did not change RV preload significantly. Therefore, better maintained cardiac output with selective PEEP than with general PEEP is partly due to less impairment of right ventricular filling.