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Effect of positive end-expiratory pressure on right ventricular function in humans

Pinsky, MR and Desmet, JM and Vincent, JL (1992) Effect of positive end-expiratory pressure on right ventricular function in humans. American Review of Respiratory Disease, 146 (3). 681 - 687. ISSN 0003-0805

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Abstract

The effect of positive end-expiratory pressure (PEEP) on right ventricular (RV) function in humans is complex. Previous studies have been limited in their interpretation by not defining either pericardial pressure (Ppc) or RV volumes. Accordingly, we measured RV volumes and pressures and Ppc as PEEP was increased from zero to 15 cm H2O in 12 patients after thoracotomy, using a pulmonary arterial catheter equipped with a rapid responding thermistor that allowed measurement of RV ejection fraction (ef), while Ppc was measured via a pericardial balloon catheter. RV end-diastolic volume (EDV) was estimated as the ratio of stroke volume (SV) to RVef, whereas RV end-systolic volume (ESV) was estimated as RV EDV-SV. Right atrial pressure (Pra) was defined as end-diastolic pressure, and pulmonary arterial pressures (Ppa), both peak and mean, were used as end-systolic pressures. PEEP increased Ppc, Pra, and lung compliance (Cl). Cardiac output also decreased but not significantly. Neither mean nor peak systolic Ppa, nor RVef was significantly altered by PEEP. There was no relation between either RV filling pressure (Pra-Ppc) and EDV or the change in RV filling pressure and EDV, although EDV varied significantly as PEEP varied for individuals (p < 0.05). Similarly, there was no relation between Ppa and ESV when either mean or peak Ppa values relative to Ppc were used. The relations between EDV and both SV and RVef were weak (r = 0.54 and 0.55, respectively). RVef varied inversely with ESV (r = -0.77), although it showed no relation to transmural peak Ppa (r = 0.28). Both absolute and relative changes in EDV corresponded closely with respective ESV values (r = 0.94). For individuals, decreases in RVef, SV, and RV filling pressure were associated with increases in CI (p < 0.01). We conclude that EDV varies independently of changes in filling pressure, and that changes in ESV occur independently of changes in ejection pressure. These data can be explained by assuming that the RV shape changes can dissociate changes in RV EDV from changes in RV wall stress (preload). Thus, changes in RV EDV may or may not alter SV but should proportionately change ESV to a degree dependent on ejection pressure and contractility.


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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Pinsky, MRpinsky@pitt.eduPINSKY
Desmet, JM
Vincent, JL
Date: 1 January 1992
Date Type: Publication
Journal or Publication Title: American Review of Respiratory Disease
Volume: 146
Number: 3
Page Range: 681 - 687
DOI or Unique Handle: 10.1164/ajrccm/146.3.681
Schools and Programs: School of Medicine > Critical Care Medicine
Refereed: Yes
ISSN: 0003-0805
PubMed ID: 1519848
Date Deposited: 24 Feb 2012 15:27
Last Modified: 04 Feb 2019 15:57
URI: http://d-scholarship.pitt.edu/id/eprint/11095

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