Abstract
Objective: We have investigated the role that improvement in arterial oxygenation has, consequent on positive end-expiratory pressure (PEEP), in the reduction of cardiac index (CI) determined by applying PEEP. Design: 2 × 2 factorial trial. Setting: Department of intensive care medicine at a university hospital. Patients: 13 patients on mechanical ventilation for acute lung injury. Interventions: Four experimental conditions, each one characterized by one level of PEEP and one level of PaO2: LOLP = Low PaO2 (∼ 50 mmHg) Low PEEP (∼ 1 cmH2O) LOHP = Low PaO2 (∼ 50 mmHg) High PEEP (∼ 10 cmH2O) HOLP = High PaO2 (∼ 80 mmHg) Low PEEP (∼ 1 cmH2O) HOHP = High PaO2 (∼ 80 mmHg) High PEEP (∼ 10 cmH2O) Measurements and results: Hemodynamic and gas exchange data were collected for each experimental condition. CI showed a 13% decline from LOLP (7.0 ± 1.71/min per m2) to HOHP (6.1 ± 1.31/min per m2). Both the direct effect of PEEP on the CI (LOLP + HOLP vs LOHP + HOHP, p <0.01) and the indirect effect related to the improvement in oxygenation (LOLP + LOHP vs HOLP + HOHP. p <0.01) contributed to the reduction in CI. Conclusions: In evaluating CI changes induced by PEEP we should take into account the indirect effect of arterial oxygenation upon CI. This should be considered, at least in part, as a physiological adjustment rather than as impaired cardiovascular performance.
| Original language | English |
|---|---|
| Pages (from-to) | 382-386 |
| Number of pages | 5 |
| Journal | Intensive Care Medicine |
| Volume | 22 |
| Issue number | 5 |
| Publication status | Published - 1996 |
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Keywords
- Cardiac index
- Oxygenation
- PEEP
ASJC Scopus subject areas
- Critical Care and Intensive Care Medicine
Cite this
Relief of hypoxamia contributes to a reduction in cardiac index related to the use of positive end-expiratory pressure. / Borelli, M.; Fumagalli, R.; Bernasconi, F.; Cereda, M.; Gattinoni, L.; Pesenti, A.
In: Intensive Care Medicine, Vol. 22, No. 5, 1996, p. 382-386.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Relief of hypoxamia contributes to a reduction in cardiac index related to the use of positive end-expiratory pressure
AU - Borelli, M.
AU - Fumagalli, R.
AU - Bernasconi, F.
AU - Cereda, M.
AU - Gattinoni, L.
AU - Pesenti, A.
PY - 1996
Y1 - 1996
N2 - Objective: We have investigated the role that improvement in arterial oxygenation has, consequent on positive end-expiratory pressure (PEEP), in the reduction of cardiac index (CI) determined by applying PEEP. Design: 2 × 2 factorial trial. Setting: Department of intensive care medicine at a university hospital. Patients: 13 patients on mechanical ventilation for acute lung injury. Interventions: Four experimental conditions, each one characterized by one level of PEEP and one level of PaO2: LOLP = Low PaO2 (∼ 50 mmHg) Low PEEP (∼ 1 cmH2O) LOHP = Low PaO2 (∼ 50 mmHg) High PEEP (∼ 10 cmH2O) HOLP = High PaO2 (∼ 80 mmHg) Low PEEP (∼ 1 cmH2O) HOHP = High PaO2 (∼ 80 mmHg) High PEEP (∼ 10 cmH2O) Measurements and results: Hemodynamic and gas exchange data were collected for each experimental condition. CI showed a 13% decline from LOLP (7.0 ± 1.71/min per m2) to HOHP (6.1 ± 1.31/min per m2). Both the direct effect of PEEP on the CI (LOLP + HOLP vs LOHP + HOHP, p <0.01) and the indirect effect related to the improvement in oxygenation (LOLP + LOHP vs HOLP + HOHP. p <0.01) contributed to the reduction in CI. Conclusions: In evaluating CI changes induced by PEEP we should take into account the indirect effect of arterial oxygenation upon CI. This should be considered, at least in part, as a physiological adjustment rather than as impaired cardiovascular performance.
AB - Objective: We have investigated the role that improvement in arterial oxygenation has, consequent on positive end-expiratory pressure (PEEP), in the reduction of cardiac index (CI) determined by applying PEEP. Design: 2 × 2 factorial trial. Setting: Department of intensive care medicine at a university hospital. Patients: 13 patients on mechanical ventilation for acute lung injury. Interventions: Four experimental conditions, each one characterized by one level of PEEP and one level of PaO2: LOLP = Low PaO2 (∼ 50 mmHg) Low PEEP (∼ 1 cmH2O) LOHP = Low PaO2 (∼ 50 mmHg) High PEEP (∼ 10 cmH2O) HOLP = High PaO2 (∼ 80 mmHg) Low PEEP (∼ 1 cmH2O) HOHP = High PaO2 (∼ 80 mmHg) High PEEP (∼ 10 cmH2O) Measurements and results: Hemodynamic and gas exchange data were collected for each experimental condition. CI showed a 13% decline from LOLP (7.0 ± 1.71/min per m2) to HOHP (6.1 ± 1.31/min per m2). Both the direct effect of PEEP on the CI (LOLP + HOLP vs LOHP + HOHP, p <0.01) and the indirect effect related to the improvement in oxygenation (LOLP + LOHP vs HOLP + HOHP. p <0.01) contributed to the reduction in CI. Conclusions: In evaluating CI changes induced by PEEP we should take into account the indirect effect of arterial oxygenation upon CI. This should be considered, at least in part, as a physiological adjustment rather than as impaired cardiovascular performance.
KW - Cardiac index
KW - Oxygenation
KW - PEEP
UR - http://www.scopus.com/inward/record.url?scp=0029885098&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0029885098&partnerID=8YFLogxK
M3 - Article
C2 - 8796387
AN - SCOPUS:0029885098
VL - 22
SP - 382
EP - 386
JO - Intensive Care Medicine
JF - Intensive Care Medicine
SN - 0342-4642
IS - 5
ER -