Is There Any Association between PEEP and Upper Extremity DVT?

Abstract

Background. We hypothesized that positive end-exploratory pressure (PEEP) may promote venous stasis in the upper extremities and predispose to upper extremity deep vein thrombosis (UEDVT). Methods. We performed a retrospective case control study of medical intensive care unit patients who required mechanical ventilation (MV) for >72 hours and underwent duplex ultrasound of their upper veins for suspected DVT between January 2011 and December 2013. Results. UEDVT was found in 32 (28.5%) of 112 patients. Nineteen (67.8%) had a central venous catheter on the same side. The mean ± SD duration of MV was 13.2 ± 9.5 days. Average PEEP was 7.13 ± 2.97 cm H2O. Average PEEP was ≥10 cm H2O in 23 (20.5%) patients. Congestive heart failure (CHF) significantly increased the odds of UEDVT (OR 4.53, 95% CI 1.13–18.11; P = 0.03) whereas longer duration of MV (≥13 vs. <13 days) significantly reduced it (OR 0.29, 95% CI 0.11–0.8; P = 0.02). Morbid obesity showed a trend towards significance (OR 3.82, 95% CI 0.95–15.4; P = 0.06). Neither PEEP nor any of the other analyzed predictors was associated with UEDVT. Conclusions. There is no association between PEEP and UEDVT. CHF may predispose to UEDVT whereas the risk of UEDVT declines with longer duration of MV.

The Valsalva manoeuvre versus tourniquet for venipuncture

“…Similarly, an increase in thoracic pressures may lead to venous stasis in deep, peripheral veins of the arm, as shown by Al-saffar et al 17 Patients in our study showed an increase in vein diameters of the upper limb during Valsalva. In particular, an increase in vein diameter equal to 0.8 ± 0.7 mm (95% CI = 0.6, 0.9; p < 0.001) and 0.7 ± 0.5 mm (95% CI = 0.6, 0.8; p < 0.001) was observed for basilic and brachial veins, respectively, from the baseline.…”

Prone Positioning as a Potential Risk Factor for Deep Vein Thrombosis in COVID-19 Patients: A Hypothesis Generating Observation

“…Positive pressure mechanical ventilation with increased levels of PEEP as frequently applied in ARDS patients may further impair venous backflow particular from upper extremity veins [ 5 ]. A previous study investigated the impact of positive end-expiratory pressure on the development of upper extremity DVT without finding an association in supine positioned patients [ 20 ]. However, prone ventilation with face-down position was linked to mechanical compression and possible kinking of the internal jugular vein [ 21 ], which might contribute to DVT development in prone positioned patients.…”

Effects of positive airway pressure on basilic vein diameter and venous flow velocity in healthy volunteers

“…We chose to apply 10 cm H 2 O of airway pressure because of its feasibility with non-invasive devices (we used a CPAP helmet and circuit) and because it would be an adequate approximation of the average airway pressures applied in patients with respiratory failure. 24 The scientific literature already reports a higher incidence of upper vein deep thrombosis associated with venous lines in mechanically ventilated patients, 25 however it seems that positive pressure by itself does not increase the risk of thrombosis 26 in critically ill mechanically ventilated patients. In our experimental setting, we observed a 20.4% increase in the diameter of the basilica vein (+0.9 mm), which would be enough to offset a CVR estimation, possibly increasing the risk of upper arm deep vein thrombosis.…”