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PEEP-induced tricuspid regurgitation
H Artucio1, J Hurtado, L Zimet
1Intensive Care Department, Hospital de Clinicas (University Hospital), Universidad de la Republica, Montevideo, Uruguay.
Intensive Care Medicine
|August 1, 1997
Summary
Positive end-expiratory pressure (PEEP) can cause tricuspid regurgitation (TR) in patients with acute lung injury (ALI) and adult respiratory distress syndrome (ARDS). This TR may impact cardiac output assessments, necessitating cautious interpretation of results.
Area of Science:
- Critical Care Medicine
- Cardiology
- Pulmonology
Background:
- Acute Lung Injury (ALI) and Adult Respiratory Distress Syndrome (ARDS) are critical conditions often requiring mechanical ventilation.
- Positive End-Expiratory Pressure (PEEP) is a common ventilatory strategy used in ALI/ARDS management.
- The impact of PEEP on right heart function, specifically tricuspid regurgitation (TR), is not fully elucidated.
Purpose of the Study:
- To investigate the incidence and development of TR in ALI/ARDS patients during mechanical ventilation with PEEP.
- To assess the relationship between increasing PEEP levels and the presence or severity of TR.
- To evaluate the potential consequences of PEEP-induced TR on hemodynamic parameters.
Main Methods:
- A prospective clinical study was conducted in a 10-bed general intensive care unit.
- Seven consecutive patients diagnosed with ALI or ARDS were enrolled.
- PEEP was incrementally increased, and echocardiography was used to detect and grade TR, alongside hemodynamic monitoring.
Main Results:
- Increasing PEEP levels from 4 ± 3 to 17 ± 2 cm H2O led to a significant increase in mean pulmonary artery pressure (PAP).
- In six of seven patients, TR either developed or worsened as PEEP was increased.
- Baseline TR was present in two patients, while five had competent valves initially.
Conclusions:
- The study demonstrates that PEEP can induce or exacerbate TR in ALI/ARDS patients, primarily due to resultant pulmonary hypertension and right ventricular overload.
- The development of TR can affect the accuracy of cardiac output measurements obtained via methods like thermodilution.
- Clinicians should exercise caution when interpreting cardiac performance data in mechanically ventilated ALI/ARDS patients with PEEP, considering the potential confounding effect of TR.