The Effects of Different Levels of Positive End-Expiratory Pressure on Hemodynamic and Respiratory Indexes in Patients with Healthy and Damaged Lungs

Document Type : Original Article (s)

Authors

1 Associate Professor, Department of Anesthesiology and Critical Care, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

2 Assistant Professor, Department of Anesthesiology and Critical Care, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

3 Student of Medicine, School of Medicine AND Students Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: During mechanical ventilation, atelectasis may appear. Atelectasis seems to be caused by reduced lung volume and small airway collapse. The collapse of healthy anesthetized and acutely injured lungs of patients is well described and the main mechanical treatment of such collapse conditions is built upon positive end-expiratory pressure (PEEP). The aims of this study were to investigate the hemodynamic and respiratory effect of the adding PEEP in patients with healthy and damaged lungs during mechanical ventilation.Methods: In 24 patients with healthy and 28 patients with damaged lungs at constant ventilation, PEEP was decreased from 5 to 0 cmH2O and then increased to 15 in steps of 5 cmH2O every 10 minutes. We prospectively evaluated the effects of PEEP on the respiratory and hemodynamic indexes of this patients during ventilation and then, SPO2, peak inspiratory pressure, plateau airway pressure, tidal volume, static and dynamic compliance, heart rate and blood pressure (systolic, diastolic, and mean) were recorded.Findings: Increasing PEEP levels from 0 to 15 cmH2O improved oxygenation in both patient with healthy and damaged lungs; but increasing PEEP levels decreased heart rate and systolic, diastolic and mean arterial blood pressure, although this changes were not significant. Increasing PEEP increased respiratory indexes with statistically significant difference between two groups (P < 0.001).Conclusion: Because of increasing the respiratory indexes by increasing PEEP levels in both damaged and healthy lungs without significant hemodynamic effects, this maneuver can be propose to improve oxygenation and respiratory indexes during constant ventilation in both patients with healthy and damaged lungs.

Keywords

References

  1. Dreyfuss D, Saumon G. Ventilator-induced lung injury: lessons from experimental studies. Am J Respir Crit Care Med 1998; 157(1): 294-323.
  2. Parker JC, Hernandez LA, Peevy KJ. Mechanisms of ventilator-induced lung injury. Crit Care Med 1993; 21(1): 131-43.
  3. Duggan M, Kavanagh BP. Pulmonary atelectasis: a pathogenic perioperative entity. Anesthesiology 2005; 102(4): 838-54.
  4. Parlow JL, Ahn R, Milne B. Obesity is a risk factor for failure of "fast track" extubation following coronary artery bypass surgery. Can J Anaesth 2006; 53(3): 288-94.
  5. Lindberg P, Gunnarsson L, Tokics L, Secher E, Lundquist H, Brismar B, et al. Atelectasis and lung function in the postoperative period. Acta Anaesthesiol Scand 1992; 36(6): 546-53.
  6. Gattinoni L, Caironi P, Valenza F, Carlesso E. The role of CT-scan studies for the diagnosis and therapy of acute respiratory distress syndrome. Clin Chest Med 2006; 27(4): 559-70.
  7. Ware LB, Matthay MA. The acute respiratory distress syndrome. N Engl J Med 2000; 342(18): 1334-49.
  8. Tusman G, Bohm SH, Vazquez de Anda GF, do Campo JL, Lachmann B. 'Alveolar recruitment strategy' improves arterial oxygenation during general anaesthesia. Br J Anaesth 1999; 82(1): 8-13.
  9. Auler JO, Jr., Carmona MJ, Barbas CV, Saldiva PH, Malbouisson LM. The effects of positive end-expiratory pressure on respiratory system mechanics and hemodynamics in postoperative cardiac surgery patients. Braz J Med Biol Res 2000; 33(1): 31-42.
  10. Minkovich L, Djaiani G, Katznelson R, Day F, Fedorko L, Tan J, et al. Effects of alveolar recruitment on arterial oxygenation in patients after cardiac surgery: a prospective, randomized, controlled clinical trial. J Cardiothorac Vasc Anesth 2007; 21(3): 375-8.
  11. Claxton BA, Morgan P, McKeague H, Mulpur A, Berridge J. Alveolar recruitment strategy improves arterial oxygenation after cardiopulmonary bypass. Anaesthesia 2003; 58(2): 111-6.
  12. Maisch S, Reissmann H, Fuellekrug B, Weismann D, Rutkowski T, Tusman G, et al. Compliance and dead space fraction indicate an optimal level of positive end-expiratory pressure after recruitment in anesthetized patients. Anesth Analg 2008; 106(1): 175-81, table.
  13. Talmor D, Sarge T, Malhotra A, O'Donnell CR, Ritz R, Lisbon A, et al. Mechanical ventilation guided by esophageal pressure in acute lung injury. N Engl J Med 2008; 359(20): 2095-104.
  14. Krebs J, Pelosi P, Tsagogiorgas C, Alb M, Luecke T. Effects of positive end-expiratory pressure on respiratory function and hemodynamics in patients with acute respiratory failure with and without intra-abdominal hypertension: a pilot study. Crit Care 2009; 13(5): R160.
  15. Celebi S, Koner O, Menda F, Korkut K, Suzer K, Cakar N. The pulmonary and hemodynamic effects of two different recruitment maneuvers after cardiac surgery. Anesth Analg 2007; 104(2): 384-90.
  16. Desebbe O, Boucau C, Farhat F, Bastien O, Lehot JJ, Cannesson M. The ability of pleth variability index to predict the hemodynamic effects of positive end-expiratory pressure in mechanically ventilated patients under general anesthesia. Anesth Analg 2010; 110(3): 792-8.
  17. Brower RG, Lanken PN, MacIntyre N, Matthay MA, Morris A, Ancukiewicz M, et al. Higher versus lower positive end-expiratory pressures in patients with the acute respiratory distress syndrome. N Engl J Med 2004; 351(4): 327-36.
  18. Carvalho CR, Barbas CS, Medeiros DM, Magaldi RB, Lorenzi FG, Kairalla RA, et al. Temporal hemodynamic effects of permissive hypercapnia associated with ideal PEEP in ARDS. Am J Respir Crit Care Med 1997; 156(5): 1458-66.
  19. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress Syndrome Network. N Engl J Med 2000; 342(18): 1301-8.
  20. Tusman G, Bohm SH, Suarez-Sipmann F, Scandurra A, Hedenstierna G. Lung recruitment and positive end-expiratory pressure have different effects on CO2 elimination in healthy and sick lungs. Anesth Analg 2010; 111(4): 968-77.
  21. Chacko J, Rani U. Alveolar recruitment maneuvers in acute lung injury/acute respiratory distress syndrome. Indian J Crit Care Med 2009; 13(1): 1-6.
  22. Tusman G, Bohm SH, Tempra A, Melkun F, Garcia E, Turchetto E, et al. Effects of recruitment maneuver on atelectasis in anesthetized children. Anesthesiology 2003; 98(1): 14-22.
  23. Ashbaugh DG, Bigelow DB, Petty TL, Levine BE. Acute respiratory distress in adults. Lancet 1967; 2(7511): 319-23.
  24. Hall RI, Smith MS, Rocker G. The systemic inflammatory response to cardiopulmonary bypass: pathophysiological, therapeutic, and pharmacological considerations. Anesth Analg 1997; 85(4): 766-82.
  25. Craig DB. Postoperative recovery of pulmonary function. Anesth Analg 1981; 60(1): 46-52.
  26. Dorinsky PM, Whitcomb ME. The effect of PEEP on cardiac output. Chest 1983; 84(2): 210-6.
  27. Gainnier M, Michelet P, Thirion X, Arnal JM, Sainty JM, Papazian L. Prone position and positive end-expiratory pressure in acute respiratory distress syndrome. Crit Care Med 2003; 31(12): 2719-26.
Journal of Isfahan Medical School
Volume 31, Issue 239 - Serial Number 239
May and June 2013
Pages 767-776

Files

History

  • Receive Date: 14 August 2012
  • Revise Date: 30 April 2024
  • Accept Date: 06 April 2022

Share

How to cite

Statistics