The effects of positive end-expiratory pressure on cardiac function: a comparative echocardiography-conductance catheter study.

Berger, David; Wigger, Olivier; de Marchi, Stefano; Grübler, Martin R.; Bloch, Andreas; Kurmann, Reto; Stalder, Odile; Bachmann, Kaspar Felix; Bloechlinger, Stefan (2022). The effects of positive end-expiratory pressure on cardiac function: a comparative echocardiography-conductance catheter study. Clinical research in cardiology, 111(6), pp. 705-719. Springer-Verlag 10.1007/s00392-022-02014-1

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BACKGROUND

Echocardiographic parameters of diastolic function depend on cardiac loading conditions, which are altered by positive pressure ventilation. The direct effects of positive end-expiratory pressure (PEEP) on cardiac diastolic function are unknown.

METHODS

Twenty-five patients without apparent diastolic dysfunction undergoing coronary angiography were ventilated noninvasively at PEEPs of 0, 5, and 10 cmH2O (in randomized order). Echocardiographic diastolic assessment and pressure-volume-loop analysis from conductance catheters were compared. The time constant for pressure decay (τ) was modeled with exponential decay. End-diastolic and end-systolic pressure volume relationships (EDPVRs and ESPVRs, respectively) from temporary caval occlusion were analyzed with generalized linear mixed-effects and linear mixed models. Transmural pressures were calculated using esophageal balloons.

RESULTS

τ values for intracavitary cardiac pressure increased with the PEEP (n = 25; no PEEP, 44 ± 5 ms; 5 cmH2O PEEP, 46 ± 6 ms; 10 cmH2O PEEP, 45 ± 6 ms; p < 0.001). This increase disappeared when corrected for transmural pressure and diastole length. The transmural EDPVR was unaffected by PEEP. The ESPVR increased slightly with PEEP. Echocardiographic mitral inflow parameters and tissue Doppler values decreased with PEEP [peak E wave (n = 25): no PEEP, 0.76 ± 0.13 m/s; 5 cmH2O PEEP, 0.74 ± 0.14 m/s; 10 cmH2O PEEP, 0.68 ± 0.13 m/s; p = 0.016; peak A wave (n = 24): no PEEP, 0.74 ± 0.12 m/s; 5 cmH2O PEEP, 0.7 ± 0.11 m/s; 10 cmH2O PEEP, 0.67 ± 0.15 m/s; p = 0.014; E' septal (n = 24): no PEEP, 0.085 ± 0.016 m/s; 5 cmH2O PEEP, 0.08 ± 0.013 m/s; 10 cmH2O PEEP, 0.075 ± 0.012 m/s; p = 0.002].

CONCLUSIONS

PEEP does not affect active diastolic relaxation or passive ventricular filling properties. Dynamic echocardiographic filling parameters may reflect changing loading conditions rather than intrinsic diastolic function. PEEP may have slight positive inotropic effects.

CLINICAL TRIAL REGISTRATION

https://clinicaltrials.gov/ct2/show/NCT02267291 , registered 17. October 2014.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic of Intensive Care
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
04 Faculty of Medicine > Pre-clinic Human Medicine > Department of Clinical Research (DCR)

UniBE Contributor:

Berger, David, Wigger, Olivier, De Marchi, Stefano, Grübler, Martin, Bloch, Andreas, Kurmann, Reto, Stalder, Odile, Bachmann, Kaspar, Blöchlinger, Stefan

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1861-0684

Publisher:

Springer-Verlag

Funders:

[28] Gottfried und Julia Bangerter Rhyner Stiftung ; [116] Swiss Heart Foundation = Schweizerische Herzstiftung

Language:

English

Submitter:

Pubmed Import

Date Deposited:

07 Apr 2022 09:26

Last Modified:

20 Feb 2024 14:16

Publisher DOI:

10.1007/s00392-022-02014-1

PubMed ID:

35381904

Additional Information:

Open access funding provided by University of Bern.

Uncontrolled Keywords:

Diastolic function Echocardiography End-diastolic pressure End-systolic pressure Mechanical ventilation Positive end-expiratory pressure Volume relationship

BORIS DOI:

10.48350/169100

URI:

https://boris.unibe.ch/id/eprint/169100

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