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Clinical use of respiratory changes in arterial pulse pressure to monitor the hemodynamic effects of PEEP

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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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Michard, F
Chemla, D
Richard, C
Wysocki, M
Pinsky, MRpinsky@pitt.eduPINSKY
Lecarpentier, Y
Teboul, JL
Date: 1 January 1999
Date Type: Publication
Journal or Publication Title: American Journal of Respiratory and Critical Care Medicine
Volume: 159
Number: 3
Page Range: 935 - 939
DOI or Unique Handle: 10.1164/ajrccm.159.3.9805077
Schools and Programs: School of Medicine > Critical Care Medicine
Refereed: Yes
ISSN: 1073-449X
PubMed ID: 10051276
Date Deposited: 13 Mar 2012 14:36
Last Modified: 29 Apr 2019 13:55
URI: http://d-scholarship.pitt.edu/id/eprint/11316

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