Differing responses in right and left ventricular filling, loading and volumes during positive end-expiratory pressure

Journal Article · Sun Oct 01 04:00:00 EDT 1989 · American Journal of Cardiology; (USA)

DOI:https://doi.org/10.1016/0002-9149(89)90763-7· OSTI ID:5261895

Schulman, D S; Biondi, J W; Matthay, R A; Zaret, B L; Soufer, R ^[1]

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1. Yale Univ. School of Medicine, New Haven, CT (USA)

Using a combined hemodynamic and radionuclide technique, 20 patients with varied ventricular function were evaluated during positive end-expiratory pressure (PEEP) application. Left ventricular (LV) and right ventricular (RV) ejection fractions and cardiac output were measured, and ventricular volumes were derived. Seven patients (group 1) who had an increase in LV end-diastolic volume with PEEP and 13 patients (group 2) who had the more typical response, a decrease in LV end-diastolic volume with PEEP, were identified. Compared with group 2, group 1 patients had a higher incidence of coronary artery disease (5 of 7 vs 1 of 13, p less than 0.005) and lower cardiac output (3.9 +/- 1.6 vs 9.1 +/- 3.2 liters/min, p less than 0.005), LV ejection fraction (27 +/- 13 vs 51 +/- 21%, p less than 0.05), RV ejection fraction (15 +/- 6 vs 32 +/- 8%, p less than 0.005) and peak filling rate (1.32 +/- 0.43 vs 3.51 +/- 1.70 end-diastolic volumes/s, p less than 0.05). LV and RV volumes increased and peak filling rate decreased with PEEP in group 1, whereas in group 2 LV volume decreased and RV volume and peak filling rate remained unchanged. Using stepwise regression analysis, the change in LV volume with PEEP was related directly to baseline systemic vascular resistance and inversely to baseline blood pressure. Similarly, the change in peak filling rate with PEEP was inversely related to the change in RV end-diastolic volume. Thus, the hemodynamic response to PEEP is heterogeneous and may be related to LV ischemia.

• OSTI ID: 5261895
• Journal Information: American Journal of Cardiology; (USA), Journal Name: American Journal of Cardiology; (USA) Vol. 64:12; ISSN 0002-9149; ISSN AJCDA
• Country of Publication: United States
• Language: English

Related Subjects

550601* -- Medicine-- Unsealed Radionuclides in Diagnostics
62 RADIOLOGY AND NUCLEAR MEDICINE
BIOLOGICAL MATERIALS
BLOOD
BLOOD CELLS
BLOOD PRESSURE
BODY
BODY FLUIDS
CARDIOVASCULAR DISEASES
CARDIOVASCULAR SYSTEM
DIAGNOSIS
DISEASES
ERYTHROCYTES
HEART
IMAGE PROCESSING
ISOTOPE APPLICATIONS
ISOTOPES
MATERIALS
ORGANS
PATIENTS
PROCESSING
TECHNETIUM ISOTOPES
TRACER TECHNIQUES