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Der Einfluß von PEEP-Beatmung auf Gesamthämodynamik und regionale Organdurchblutung

The effect of PEEP ventilation on hemodynamics and regional blood flow

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Summary

The benficial effects of PEEP on lung function may be counteracted by its hemodynamic sequenlae induced by a reduction of venous return due to the elevated intrathoracic pressure, and by an increased right ventricular afterload secondary to the rise of pulmonary vascular resistance. PEEP redistributes cardiac output in favor of brain, heart, adrenals and intestines, whereas the perfusion of stomach, pancreas and thyroid is diminished out of proportion to the fall of cardiac output. Total renal blood flow is relatively little affected; however, redistribution of intrarenal blood flow will result in a marked salt-water-retention. Reduction of hepatic artery flow, at higher levels of PEEP, may jeopardice liver tissue oxygenation. — Under clinical conditions, individual differences regarding preexisting cardiopulmonary and peripheral-vascular diseases may modify the PEEP-induced hemodynamic alterations in a wide range.

Zusammenfassung

Den günstigen Wirkungen von PEEP auf die Lungenfunktion stehen ausgeprägte hämodynamische Nebenwirkungen gegenüber, deren Ursachen vor allem in einer Verminderung des venösen Rückflusses bei erhöhtem intrathorakalem Druck sowie in einer Zunahme der rechtsventrikulären Nachlast aufgrund des erhöhten pulmonalen Gefäßwiderstandes zu sehen sind. PEEP führt zu einer Umverteilung des reduzierten Herzzeitvolumens zugunsten von Gehirn, Herz, Nebennieren und Darm, während die Durchblutung von Magen, Pankreas und Schilddrüse überproportional vermindert wird. Die Nierengesamtdurchblutung nimmt in der Regel nur geringfügig ab; eine Änderung der intrarenalen Hämodynamik bedingt jedoch eine Beeinträchtigung der Salz-Wasser-Ausscheidung. Die arterielle Durchblutung der Leber kann bei höheren Stufen von PEEP soweit reduziert werden, daß eine ausreichende O2-Versorgung nicht mehr gewährleistet ist. Unter klinischen Bedingungen können individuell unterschiedliche Voraussetzungen die Änderungen von globaler und regionaler Hämodynamik im günstigen wie im ungünstigen Sinne modifizieren.

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  1. Herzchirurg. Univ.-Klinik Klinikum Großhadern, Marchioninistr. 15, D-8000, München 70, Bundesrepublik Deutschland

    J. Beyer

  2. Institut für Chirurgische Forschung der Universität München, Germany

    K. Meßmer

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Beyer, J., Meßmer, K. Der Einfluß von PEEP-Beatmung auf Gesamthämodynamik und regionale Organdurchblutung. Klin Wochenschr 59, 1289–1295 (1981). https://doi.org/10.1007/BF01711178

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