Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
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SHR Neuro Krebs Kardio Lipid Stoffw Microb
Berger, D; Wigger, O; de, Marchi, S; Grübler, MR; Bloch, A; Kurmann, R; Stalder, O; Bachmann, KF; Bloechlinger, S.
The effects of positive end-expiratory pressure on cardiac function: a comparative echocardiography-conductance catheter study.
Clin Res Cardiol. 2022; 111(6): 705-719.
Doi: 10.1007/s00392-022-02014-1
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- Co-Autor*innen der Med Uni Graz
- Grübler Martin
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- Abstract:
- BACKGROUND: Echocardiographic parameters of diastolic function depend on cardiac loading conditions, which are altered by positive pressure ventilation. The direct effects of positive end-expiratory pressure (PEEP) on cardiac diastolic function are unknown. METHODS: Twenty-five patients without apparent diastolic dysfunction undergoing coronary angiography were ventilated noninvasively at PEEPs of 0, 5, and 10 cmH2O (in randomized order). Echocardiographic diastolic assessment and pressure-volume-loop analysis from conductance catheters were compared. The time constant for pressure decay (τ) was modeled with exponential decay. End-diastolic and end-systolic pressure volume relationships (EDPVRs and ESPVRs, respectively) from temporary caval occlusion were analyzed with generalized linear mixed-effects and linear mixed models. Transmural pressures were calculated using esophageal balloons. RESULTS: τ values for intracavitary cardiac pressure increased with the PEEP (n = 25; no PEEP, 44 ± 5 ms; 5 cmH2O PEEP, 46 ± 6 ms; 10 cmH2O PEEP, 45 ± 6 ms; p < 0.001). This increase disappeared when corrected for transmural pressure and diastole length. The transmural EDPVR was unaffected by PEEP. The ESPVR increased slightly with PEEP. Echocardiographic mitral inflow parameters and tissue Doppler values decreased with PEEP [peak E wave (n = 25): no PEEP, 0.76 ± 0.13 m/s; 5 cmH2O PEEP, 0.74 ± 0.14 m/s; 10 cmH2O PEEP, 0.68 ± 0.13 m/s; p = 0.016; peak A wave (n = 24): no PEEP, 0.74 ± 0.12 m/s; 5 cmH2O PEEP, 0.7 ± 0.11 m/s; 10 cmH2O PEEP, 0.67 ± 0.15 m/s; p = 0.014; E' septal (n = 24): no PEEP, 0.085 ± 0.016 m/s; 5 cmH2O PEEP, 0.08 ± 0.013 m/s; 10 cmH2O PEEP, 0.075 ± 0.012 m/s; p = 0.002]. CONCLUSIONS: PEEP does not affect active diastolic relaxation or passive ventricular filling properties. Dynamic echocardiographic filling parameters may reflect changing loading conditions rather than intrinsic diastolic function. PEEP may have slight positive inotropic effects. CLINICAL TRIAL REGISTRATION: https://clinicaltrials.gov/ct2/show/NCT02267291 , registered 17. October 2014.
- Find related publications in this database (using NLM MeSH Indexing)
- Catheters - administration & dosage
- Diastole - administration & dosage
- Echocardiography - administration & dosage
- Heart Ventricles - administration & dosage
- Humans - administration & dosage
- Positive-Pressure Respiration - administration & dosage
- Find related publications in this database (Keywords)
- Diastolic function
- Echocardiography
- End-diastolic pressure
- Volume relationship
- End-systolic pressure
- Volume relationship
- Positive end-expiratory pressure
- Mechanical ventilation