Cardiorespiratory Effects of High Positive End-expiratory Pressure

Kirby, Robert R.; Perry, Joel C.; Calderwood, Hugh W.; Ruiz, Bruce C.; Lederman, David S.

doi:10.1097/00000542-197511000-00009

Cited by 69 publications

(12 citation statements)

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“…In our study, Lung Injury Scores were mild to moderate (1.77 ± 0.71), as indicated by the Murray scores [23]. We believe that our results are partially affected by the transmission of PEEP applied to the airway to the intrathoracic 14 [21] concluded that their results were independent from noncompliant lungs and that the PEEP was transmitted to the intrathoracic vasculature. These results can be explained in part by the fact that Lung Injury Scores were mild to moderate, as we found out.…”

Section: Discussionsupporting

confidence: 47%

“…Positive end-expiratory pressure (PEEP) is an effective mean of improving hypoxemia [14,25]. PEEP increases FRC [8,19] and decreases pulmonary shunt without necessitating an increase in the inspired oxygen concentration (FrOz) into a potentially toxic range [14,18,25,26]. While improving arterial oxygenation, PEEP can reduce cardiac output and blood pressure [15].…”

Section: Introductionmentioning

confidence: 99%

“…PEEP impedes thoracic venous flow, increases central venous pressure, and might also increase ICP. These side effects of PEEP [4,14,26] could potentially produce critical reductions and elevations in CPP and ICP, respectively. The relationship of PEEP therapy on ICP and CPP has been of considerable interest to many investigators [3,7,9,11,30].…”

Section: Introductionmentioning

confidence: 99%

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Effects of Positive End-Expiratory Pressure on Intracranial Pressure and Cerebral Perfusion Pressure

Videtta

Villarejo

Cohen

et al. 2002

Intracranial Pressure and Brain Biochemical Monitoring

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SummaryThe effect of positive end-expiratory pressure (PEEP) on intracranial pressure (lCP) and cerebral perfusion pressure (CPP) has been reported by several investigators, without any consensus being reached. Acute neurological and neurosurgical patients suffer intracranial hypertension and acute lung injury with hypoxemia. Since PEEP may improve hypoxemia but elevate ICP and decrease CPP, it is important to determine the influence of varying levels of PEEP on ICP and CPP. The aim of the study was to investigate the changes in ICP and CPP associated with different levels of PEEP. Twenty patients requiring ICP monitoring and mechanical ventilation were enrolled. Patients had severe head injury (n = 10), spontaneous intracerebral haemorrhage (n = 5), and subarachnoid haemorrhage (n = 5). PEEP was raised from 5 (basal) to 15 cm H 20 in steps of 5 cm H20. After at least 10 minutes of each new PEEP setting, ICP and CPP were measured. PEEP at 10 and 15 cm H20 produced a significant (p < 0.05) increase in intracranial pressure 11.6 ± 5.6 and 14.6 ± 6.28 mm Hg, respectively; no significant (p = 0.819) change occurred in CPP.

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Section: Discussionsupporting

confidence: 47%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effects of Positive End-Expiratory Pressure on Intracranial Pressure and Cerebral Perfusion Pressure

Videtta

Villarejo

Cohen

et al. 2002

Intracranial Pressure and Brain Biochemical Monitoring

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“…With IMV, this improvement results not only from simply reducing the rate of positive pressure breaths but from maintaining the intrathoracic pump mechanism whereby negative pressure generated during inspiration enhances venous return regardless of the level of PEEP. 70,71 There are no comparisons with CMV in the literature that fail to demonstrate the superiority of IMV in improving cardiac performance. By maintaining improved cardiac output, IMV may reduce the need for fluid resuscitation and the use of vasopressors and decrease fluid accumulation in the lung seen with aggressive resuscitation.…”

Section: The Importance Of Spontaneous Breathingmentioning

confidence: 99%

Should Intermittent Mandatory Ventilation Be Abolished?

Kacmarek

Branson

2016

Respiratory Care

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Intermittent mandatory ventilation (IMV) was introduced nearly 50 years ago. Despite the initial fanfare and early adoption by many, the role of IMV continues to be questioned. The use of small tidal volumes complicates the application of IMV, and issues with work of breathing, weaning and lack of clear advantages have many calling for a moratorium on its use. Spontaneous breathing, however, has a number of salutatory effects on gas exchange, the distribution of ventilation, and hemodynamics. These issues will be explored in light of a growing body of evidence. Key words: Mechanical ventilation, intermittent mandatory ventilation, synchronized intermittent mandatory ventilation, asynchrony and work of breathing. [Respir Care 2016;61(6):854 -866.

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“…The renal effects of positive pressure ven tilation have been investigated on animals, but not on neonates [15,16,20], There is dif ficulty in making a distinction between the CPAP effects involved, such as hypoxia, hy percapnia, acidosis, which by themselves may damage the kidney [4,12,27], We, therefore, selected the cases where blood gas values, pulmonary function, and blood pressure were not a significant patho logical factor -the cases diagnosed as centrencephalic apnea.…”

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confidence: 99%

Effects of Continuous Positive Airway Pressure on Renal Function in Prematures

Tulassay¹,

Machay²,

Kiszel³

et al. 1983

Neonatology

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The effects of continuous positive airway pressure respiratory therapy – used in centrencephalic apnea in premature infants – has been investigated at a value of + 6 cm H₂O end-expiratory pressure. The results showed a significantly decreased glomerular filtration rate, decreased sodium and hydrogen ion excretion and urine output, without changes in systemic blood pressure, pulse rate, and blood gas values. At + 3 cm H₂O end-expiratory pressure no changes were observed.

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Cardiorespiratory Effects of High Positive End-expiratory Pressure

Cited by 69 publications

References 0 publications

Effects of Positive End-Expiratory Pressure on Intracranial Pressure and Cerebral Perfusion Pressure

Effects of Positive End-Expiratory Pressure on Intracranial Pressure and Cerebral Perfusion Pressure

Should Intermittent Mandatory Ventilation Be Abolished?

Effects of Continuous Positive Airway Pressure on Renal Function in Prematures

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