Effect of PEEP, blood volume, and inspiratory hold maneuvers on venous return

Berger, David; Moller, Per Werner; Weber, Alberto; Bloch, Andreas; Bloechlinger, Stefan; Hænggi, Matthias; Søndergaard, Søren; Jakob, Stephan M.; Magder, Sheldon; Takala, Jukka

doi:10.1152/ajpheart.00931.2015

Cited by 75 publications

(128 citation statements)

References 79 publications

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“…Eleven pigs were included in the study. As previously described (4), after premedication with intramuscular ketamine (20 mg/kg) and xylazine (2 mg/kg), induction and intubation followed with midazolam (0.5 mg/kg). Anesthesia was maintained with propofol (4 mg·kg Ϫ1 ·h Ϫ1 ) and fentanyl (5 g·kg Ϫ1 ·h Ϫ1 ), and the depth was controlled by repeatedly testing the response to nose pinch.…”

Section: Methodsmentioning

confidence: 99%

“…Flow was resumed after 30 s or earlier if signs of a reflex-mediated increase in arterial blood pressure (ABP) were seen. MSFP was taken as the mean value of RAP during three beats of equilibrium defined from ABP nadir (4). At least 3 min were allowed for heart rate and blood pressure to return to baseline.…”

Section: Volume States and Ecmo Pump Speedmentioning

confidence: 99%

“…To detect a change in MSFP and venous return driving pressure (VRdP) induced by changes in RAP, we assumed a SD of the difference of 0.7 mmHg based on previous data on the effects of PEEP (4). A sample size of n ϭ 9 would allow one to detect a significant change in these variables with a power of 80%.…”

Section: Statistical Analysis and Calculationsmentioning

confidence: 99%

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Right atrial pressure and venous return during cardiopulmonary bypass

Moller

Winkler

Hurni

et al. 2017

American Journal of Physiology-Heart and Circulatory Physiology

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The relevance of right atrial pressure (RAP) as the backpressure for venous return (Q) and mean systemic filling pressure as upstream pressure is controversial during dynamic changes of circulation. To examine the immediate response of Q (sum of caval vein flows) to changes in RAP and pump function, we used a closed-chest, central cannulation, heart bypass porcine preparation ( = 10) with venoarterial extracorporeal membrane oxygenation. Mean systemic filling pressure was determined by clamping extracorporeal membrane oxygenation tubing with open or closed arteriovenous shunt at euvolemia, volume expansion (9.75 ml/kg hydroxyethyl starch), and hypovolemia (bleeding 19.5 ml/kg after volume expansion). The responses of RAP and Q were studied using variable pump speed at constant airway pressure (P) and constant pump speed at variable P Within each volume state, the immediate changes in Q and RAP could be described with a single linear regression, regardless of whether RAP was altered by pump speed or P ( = 0.586-0.984). RAP was inversely proportional to pump speed from zero to maximum flow ( = 0.859-0.999). Changing P caused immediate, transient, directionally opposite changes in RAP and Q (RAP: ≤ 0.002 and Q: ≤ 0.001), where the initial response was proportional to the change in Q driving pressure. Changes in P generated volume shifts into and out of the right atrium, but their effect on upstream pressure was negligible. Our findings support the concept that RAP acts as backpressure to Q and that Guyton's model of circulatory equilibrium qualitatively predicts the dynamic response from changing RAP. Venous return responds immediately to changes in right atrial pressure. Concomitant volume shifts within the systemic circulation due to an imbalance between cardiac output and venous return have negligible effects on mean systemic filling pressure. Guyton's model of circulatory equilibrium can qualitatively predict the resulting changes in dynamic conditions with right atrial pressure as backpressure to venous return.

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Section: Methodsmentioning

confidence: 99%

Section: Volume States and Ecmo Pump Speedmentioning

confidence: 99%

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Right atrial pressure and venous return during cardiopulmonary bypass

Moller

Winkler

Hurni

et al. 2017

American Journal of Physiology-Heart and Circulatory Physiology

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“…On the other side, an increase in thoracic pressure due to MV [9] may have an effect on inflammation and edema in the abdominal compartment. In fact, the decrease in venous return related to high positive end-expiratory pressure (PEEP) ventilation [10] has been well described. In addition, a reduction on portal flow due to a vasoconstrictive reaction related directly to PEEP [11] has also been described.…”

Section: Introductionmentioning

confidence: 99%

Effect of mechanical ventilation versus spontaneous breathing on abdominal edema and inflammation in ARDS: an experimental porcine model

et al. 2020

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Background: Mechanical ventilation (MV), compared to spontaneous breathing (SB), has been found to increase abdominal edema and inflammation in experimental sepsis. Our hypothesis was that in primary acute respiratory distress syndrome (ARDS) MV would enhance inflammation and edema in the abdomen. Methods: Thirteen piglets were randomized into two groups (SB and MV) after the induction of ARDS by lung lavage and 1 h of injurious ventilation. 1. SB: continuous positive airway pressure 15 cmH 2 O, fraction of inspired oxygen (FIO 2 ) 0.5 and respiratory rate (RR) maintained at about 40 cycles min − 1 by titrating remifentanil infusion. 2. MV: volume control, tidal volume 6 ml kg − 1 , positive end-expiratory pressure 15 cmH 2 O, RR 40 cycles min − 1 , FIO 2 0.5. Main outcomes: abdominal edema, assessed by tissues histopathology and wet-dry weight; abdominal inflammation, assessed by cytokine concentration in tissues, blood and ascites, and tissue histopathology. Results: The groups did not show significant differences in hemodynamic or respiratory parameters. Moreover, edema and inflammation in the abdominal organs were similar. However, blood IL6 increased in the MV group in all vascular beds (p < 0.001). In addition, TNFα ratio in blood increased through the lungs in MV group (+ 26% ± 3) but decreased in the SB group (− 17% ± 3). Conclusions: There were no differences between the MV and SB group for abdominal edema or inflammation. However, the systemic increase in IL6 and the TNFα increase through the lungs suggest that MV, in this model, was harmful to the lungs.

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“…Modern concepts of invasive MV mainly involve different modes of positive pressure ventilation alongside with oxygen supply, which induce several changes to the patient's cardiovascular system (Pinsky 2005;Frazier 2008). The transition from negative pleural pressure throughout the spontaneous breath cycle to nonphysiological positive intrathoracic pressure under MV compromises venous blood return to the right atrium (Pinsky 2005;Berger et al 2016). Furthermore, hyperinflation of alveoli and compression of small pulmonary vessels increase pulmonary vascular resistance (PVR) and right ventricular afterload leading to elevated right atrial pressure, myocardial stretch, workload, and oxygen demand (Cherpanath et al 2016).…”

Section: Introductionmentioning

confidence: 99%

Mechanical ventilation strategies alter cardiovascular biomarkers in an infant rat model

et al. 2018

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Mechanical ventilation (MV) is routinely used in pediatric general anesthesia and critical care, but may adversely affect the cardiocirculatory system. Biomarkers are increasingly measured to assess cardiovascular status and improve clinical treatment decision‐making. As the impact of mechanical ventilation strategies on cardiovascular biomarkers in ventilated infants is largely unknown, we conducted this retrospective study in a healthy in vivo infant rat ventilation model using 14‐days old Wistar rats. We hypothesized that 2 h of mechanical ventilation with high and low positive end‐expiratory pressure (PEEP), hyperoxemia, hypoxemia, hypercapnia, and hypocapnia would significantly impact B‐type natriuretic peptide (BNP), vascular endothelial growth factor (VEGF), and endothelin‐1 (ET‐1). We found BNP to be driven by both high (9 cmH2O) and low (1 cmH2O) PEEP compared to ventilated control animals (P < 0.05). VEGF concentrations were associated with high PEEP, hyperoxemia, hypoxemia, and hypocapnia (P < 0.05), whereas ET‐1 levels were changed only in response to hypoxemia (P < 0.05). In conclusion, the mode of mechanical ventilation alters plasma biomarker concentrations. Moreover, BNP and VEGF might serve as surrogate parameters for ventilation induced cardiovascular compromise and lung tissue damage. Furthermore, our data support the hypothesis, that sudden onset of hyperoxemia may trigger a quick VEGF release as a possible cellular survival reflex.

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Effect of PEEP, blood volume, and inspiratory hold maneuvers on venous return

Cited by 75 publications

References 79 publications

Right atrial pressure and venous return during cardiopulmonary bypass

Right atrial pressure and venous return during cardiopulmonary bypass

Effect of mechanical ventilation versus spontaneous breathing on abdominal edema and inflammation in ARDS: an experimental porcine model

Mechanical ventilation strategies alter cardiovascular biomarkers in an infant rat model

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