Michard, F and Chemla, D and Richard, C and Wysocki, M and Pinsky, MR and Lecarpentier, Y and Teboul, JL
(1999)
Clinical use of respiratory changes in arterial pulse pressure to monitor the hemodynamic effects of PEEP.
American Journal of Respiratory and Critical Care Medicine, 159 (3).
935 - 939.
ISSN 1073-449X
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Abstract
In ventilated patients with acute lung injury (ALl) we investigated whether respiratory changes in arterial pulse pressure (ΔPP) could be related to the effects of PEEP and fluid loading (FL) on cardiac index (CI). Measurements were performed before and after application of a PEEP (10 cm H2O) in 14 patients. When the PEEP-induced decrease in CI was > 10% (six patients), measurements were also performed after FL. Maximal (PPmax) and minimal (PPmin) values of pulse pressure were determined over one respiratory cycle and ΔPP was calculated: ΔPP (%) 100 x {(PPmax PPmin)/([PPmax + PPmin]/2)}. PEEP decreased CI from 4.2 ± 1.1 to 3.8 ± 1.3 L/min/m2 (p < 0.01) and increased ΔPP from 9 ± 7 to 16 ± 13% (p < 0.01). The PEEP- induced changes in CI correlated with ΔPP on ZEEP (r - -0.91, p < 0.001) and with the PEEP-induced increase in ΔPP (r = 0.79, p < 0.001). FL increased CI from 3.5 ± 1.1 to 4.2 ± 0.9 L/min/m2 (p < 0.05) and decreased ΔPP from 27 ± 13 to 14 ± 9% (p < 0.05). The FL-induced changes in CI correlated with ΔPP before FL (r = 0.97, p < 0.01) and with the FL-induced decrease in ΔPP (r = -0.85, p < 0.05). In ventilated patients with ALl, ΔPP may be useful in predicting and assessing the hemodynamic effects of PEEP and FL.
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