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Relief of hypoxemia contributes to a reduction in cardiac index related to the use of positive end-expiratory pressure

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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:

$$\begin{gathered} LOLP = \underset{\raise0.3em\hbox{$\smash{\scriptscriptstyle-}$}}{L} ow Pa\underset{\raise0.3em\hbox{$\smash{\scriptscriptstyle-}$}}{O} _2 ( \sim 50mmHg) \hfill \\ \underset{\raise0.3em\hbox{$\smash{\scriptscriptstyle-}$}}{L} ow \underset{\raise0.3em\hbox{$\smash{\scriptscriptstyle-}$}}{P} EEP ( \sim 1 cmH_2 O) \hfill \\ LOHP = \underset{\raise0.3em\hbox{$\smash{\scriptscriptstyle-}$}}{L} ow Pa\underset{\raise0.3em\hbox{$\smash{\scriptscriptstyle-}$}}{O} _2 ( \sim 50mmHg) \hfill \\ \underset{\raise0.3em\hbox{$\smash{\scriptscriptstyle-}$}}{H} igh \underset{\raise0.3em\hbox{$\smash{\scriptscriptstyle-}$}}{P} EEP ( \sim 10 cmH_2 O) \hfill \\ HOLP = \underset{\raise0.3em\hbox{$\smash{\scriptscriptstyle-}$}}{H} igh Pa\underset{\raise0.3em\hbox{$\smash{\scriptscriptstyle-}$}}{O} _2 ( \sim 80mmHg) \hfill \\ \underset{\raise0.3em\hbox{$\smash{\scriptscriptstyle-}$}}{L} ow \underset{\raise0.3em\hbox{$\smash{\scriptscriptstyle-}$}}{P} EEP ( \sim 1 cmH_2 O) \hfill \\ HOHP = \underset{\raise0.3em\hbox{$\smash{\scriptscriptstyle-}$}}{H} igh Pa\underset{\raise0.3em\hbox{$\smash{\scriptscriptstyle-}$}}{O} _2 \hfill \\ ( \sim 80 mmHg)\underset{\raise0.3em\hbox{$\smash{\scriptscriptstyle-}$}}{H} igh \underset{\raise0.3em\hbox{$\smash{\scriptscriptstyle-}$}}{P} EEP \hfill \\ ( \sim 10 cmH_2 O) \hfill \\ \end{gathered} $$

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±1.3l/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+HOLP vs HOLP+HOHP,p<0.01) contributed to the reduction in Cl.Conclusion: In evaluating Cl 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.

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Authors and Affiliations

  1. Institute of Anesthesiology and Intensive Care, University of Milan, Department of Anaesthesia and Intensive Care, S. Gerardo Hospital, Via Donizetti 106, I-20052, Monza (MI), Italy

    M. Borelli, R. Fumagalli, M. Cereda & A. Pesenti

  2. Institute of Anesthesiology and Intensive Care, University of Milan, Department of Anaesthesia and Intensive Care, IRCCS Ospedale Maggiore, Via F. Sforza 35, I-20122, Milano (MI), Italy

    F. Bernasconi & L. Gattinoni

Authors
  1. M. Borelli
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  2. R. Fumagalli
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  3. F. Bernasconi
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  4. M. Cereda
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  5. L. Gattinoni
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  6. A. Pesenti
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Borelli, M., Fumagalli, R., Bernasconi, F. et al. Relief of hypoxemia contributes to a reduction in cardiac index related to the use of positive end-expiratory pressure. Intensive Care Med 22, 382–386 (1996). https://doi.org/10.1007/BF01712152

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  • DOI: https://doi.org/10.1007/BF01712152

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