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LV filling pressure during PEEP measured by nadir wedge pressure after airway disconnection

Carter, RS and Snyder, JV and Pinsky, MR (1985) LV filling pressure during PEEP measured by nadir wedge pressure after airway disconnection. American Journal of Physiology - Heart and Circulatory Physiology, 18 (4). ISSN 0363-6135

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Pulmonary arterial occlusion pressure (Ppao) may not accurately reflect left ventricular filling pressure (LVFP) during ventilation with positive end-expiratory pressure (PEEP) because increases in pleural pressure (Ppl) increase measured intrathoracic vascular and cardiac chamber pressures relative to atmospheric while decreasing LVFP by decreasing venous return. Steady-state values of Ppao off PEEP are not useful in understanding the hemodynamics on PEEP because of changes in blood volume distribution and ventricular afterload associated with the removal of PEEP. We hypothesized that changes in Ppao immediately after abrupt airway disconnection from PEEP selectively reflect removal of PEEP-associated Ppl changes prior to other physiological changes. In pentobarbital-anesthetized closed-chest dogs, we compared absolute left atrial pressure and left atrial pressure relative to Ppl (Pla(tm)) prior to abrupt disconnection from 15 cmH2O PEEP (on-PEEP), with Ppao at its nadir (nadir Ppao) following airway disconnection in three sequential conditions: control (normal), after propranolol-induced acute ventricular failure, and after oleic acid-induced lung injury. For all conditions at low LVFP (<9 Torr), nadir Ppao reflects Pla(tm) better than on-PEEP Ppao, while at higher LVFP (>9 Torr), on-PEEP Ppao better reflects Pla(tm) than nadir Ppao (P < 0.05). Accurate predictions of on-PEEP Pla(tm) can be made using both on-PEEP and nadir Ppao values in a multiple regression equation.


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Item Type: Article
Status: Published
CreatorsEmailPitt UsernameORCID
Carter, RS
Snyder, JV
Pinsky, MRpinsky@pitt.eduPINSKY0000-0001-6166-700X
Date: 1 January 1985
Date Type: Publication
Journal or Publication Title: American Journal of Physiology - Heart and Circulatory Physiology
Volume: 18
Number: 4
DOI or Unique Handle: 10.1152/ajpheart.1985.249.4.h770
Schools and Programs: School of Medicine > Critical Care Medicine
Refereed: Yes
ISSN: 0363-6135
Date Deposited: 24 Feb 2012 16:03
Last Modified: 22 Jun 2021 14:55


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