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Selective positive end-expiratory pressure and right ventricular function in dogs
O J Veddeng1, C Risøe, F Riddervold
1Department of Anaesthesiology, Medical Department B, Rikshospitalet, Oslo, Norway.
Acta Anaesthesiologica Scandinavica
|February 1, 1994
Summary
Selective positive end-expiratory pressure (PEEP) better maintains cardiac output by causing less impairment to right ventricular filling compared to general PEEP. This study clarifies the hemodynamic benefits of selective PEEP in ventilation strategies.
Area of Science:
- Cardiovascular Physiology
- Respiratory Mechanics
- Critical Care Medicine
Background:
- Selective positive end-expiratory pressure (PEEP) has demonstrated reduced cardiac output reduction compared to general PEEP.
- Previous research indicated superior left ventricular preload maintenance with selective PEEP.
- The impact of selective versus general PEEP on right ventricular (RV) preload remained to be fully elucidated.
Purpose of the Study:
- To investigate whether differential hemodynamic responses to selective and general PEEP are related to distinct effects on RV preload.
- To compare the influence of selective PEEP (right and left) versus general PEEP on RV preload parameters.
Main Methods:
- Acute instrumentation of nine dogs.
- Measurement of extraventricular pressure using pericardial balloon transducers.
- Assessment of RV preload via ultrasonic segment length transducers and end-diastolic transmural pressure (RVEDP).
Main Results:
- Both general and selective right (R) PEEP led to reductions in RVEDP and RV inflow tract segment lengths.
- These reductions were most pronounced with general PEEP.
- Selective left (L) PEEP did not significantly alter RV preload.
Conclusions:
- The superior maintenance of cardiac output observed with selective PEEP, compared to general PEEP, is partly attributable to less compromised right ventricular filling.
- Differential PEEP strategies may offer advantages in preserving RV function during mechanical ventilation.