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Intensive Care Medicine

, Volume 30, Issue 1, pp 119–126 | Cite as

Assessment of cardiac preload and left ventricular function under increasing levels of positive end-expiratory pressure

  • Thomas Luecke
  • Harry Roth
  • Peter Herrmann
  • Alf Joachim
  • Gerald Weisser
  • Paolo Pelosi
  • Michael Quintel
Experimental

Abstract

Objective

(1) To assess the impact of high intrathoracic pressure on left ventricular volume and function. (2) To test the hypothesis that right ventricular end-diastolic volume (RVEDV) and intrathoracic blood volume (ITBV) represent cardiac preload and are superior to central venous pressure (CVP) or pulmonary capillary wedge pressure (PCWP). The validity of these parameters was tested by means of correlation with left ventricular end-diastolic volume (LVEDV), the true cardiac preload.

Design

Prospective animal study.

Subjects

Fifteen adult sheep.

Interventions

All animals were studied before and after saline washout-induced lung injury, undergoing volume-controlled ventilation with increasing levels of PEEP (0, 7, 14 and 21 cmH2O, respectively).

Measurements and main results

Left ventricular ejection fraction (LVEF), stroke volume (LVSV) and LVEDV were measured using computed tomography. ITBV and RVEDV were obtained by the thermal dye dilution technique. At PEEP 21 cmH2O, LVSV significantly decreased compared to baseline, PEEP 0 and PEEP 7 cmH2O. LVEDV was maintained except for the highest level of PEEP, while LVEF remained unchanged. RVEDV and RVEF also remained unchanged. The overall correlation of RVEDV and ITBV with LVEDV was satisfactory (r=0.56 and r=0.62, respectively) and clearly superior to cardiac filling pressures.

Conclusion

In the present study, (1) ventilation with increasing levels of PEEP did not alter RV function, while LV function was impaired at the highest level of PEEP; (2) unlike cardiac filling pressures, ITBV and RVEDV both provide valid estimates of cardiac preload even at high intrathoracic pressures.

Keywords

Cardiac preload Left ventricular function Acute lung injury Positive end-expiratory pressure 

Notes

Acknowledgements

The authors wish to thank Thomas Bruckner, Dipl. Math., Schwetzingen, Germany, for statistical advice.

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Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Thomas Luecke
    • 1
  • Harry Roth
    • 1
  • Peter Herrmann
    • 1
  • Alf Joachim
    • 1
  • Gerald Weisser
    • 2
  • Paolo Pelosi
    • 3
  • Michael Quintel
    • 1
  1. 1.Department of Anesthesiology and Intensive Care Medicine, Faculty of Clinical MedicineUniversity Hospital of MannheimMannheimGermany
  2. 2.Department of Clinical Radiology, Faculty of Clinical MedicineUniversity Hospital of MannheimMannheimGermany
  3. 3.Department of Clinical and Biological SciencesUniversity of InsubriaVareseItaly

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