High positive end expiratory pressure levels affect hemodynamics in elderly patients with hypertension admitted to the intensive care unit: a prospective cohort study

Zhou, Li; Cai, Guolong; Xu, Zhihui; Weng, Qinyong; Ye, Qinyong; Chen, Cunrong

doi:10.1186/s12890-019-0965-9

Cited by 15 publications

(12 citation statements)

References 31 publications

(31 reference statements)

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“…Both CVP and positive end-expiratory pressure were shown to be independently associated with worsening of renal function [ 28 ]. Meanwhile, several studies demonstrated that the increase of positive end-expiratory pressure could led an increase in CVP [ 29 , 30 ]. Taken together, high positive end-expiratory pressure might involve with AKI, at least partly, by increasing CVP.…”

Section: Discussionmentioning

confidence: 99%

Central venous pressure and acute kidney injury in critically ill patients with multiple comorbidities: a large retrospective cohort study

et al. 2022

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Background Given the traditional acceptance of higher central venous pressure (CVP) levels, clinicians ignore the incidence of acute kidney injury (AKI). The objective of this study was to assess whether elevated CVP is associated with increased AKI in critically ill patients with multiple comorbidities. Methods This was a retrospective observational cohort study using data collected from the Medical Information Mart for Intensive Care (MIMIC)-III open-source clinical database (version 1.4). Critically ill adult patients with CVP and serum creatinine measurement records were included. Linear and multivariable logistic regression were performed to determine the association between elevated CVP and AKI. Results A total of 11,135 patients were enrolled in our study. Critically ill patients in higher quartiles of mean CVP presented greater KDIGO AKI severity stages at 2 and 7 days. Linear regression showed that the CVP quartile was positively correlated with the incidence of AKI within 2 (R2 = 0.991, P = 0.004) and 7 days (R2 = 0.990, P = 0.005). Furthermore, patients in the highest quartile of mean CVP exhibited an increased risk of AKI at 7 days than those in the lowest quartile of mean CVP with an odds ratio of 2.80 (95% confidence interval: 2.32–3.37) after adjusting for demographics, treatments and comorbidities. The adjusted odds of AKI were 1.10 (95% confidence interval: 1.08–1.12) per 1 mmHg increase in mean CVP. Conclusions Elevated CVP is associated with an increased risk of AKI in critically ill patients with multiple comorbidities. The optimal CVP should be personalized and maintained at a low level to avoid AKI in critical care settings.

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Section: Discussionmentioning

confidence: 99%

Central venous pressure and acute kidney injury in critically ill patients with multiple comorbidities: a large retrospective cohort study

et al. 2022

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“…Blood pressure was stepwise decreased when PEEP was stepwise increased which also re ects the impact increased PEEP has on blood pressure, as seen in Table 2. In a human population it is a known, studied and a stated fact that PEEP has an effect on the cardiac output [15][16][17][18][19][20]. The MPC from the airway was fairly similar when using PEEP 5, 10, 15, 20 or 25 cm H 2 O regardless of changes in blood pressure.…”

Section: Discussionmentioning

confidence: 99%

Different particle flow from exhaled air after gradual increase of PEEP during mechanical ventilation

Broberg¹,

Pierre

Fakhro

et al. 2022

Preprint

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Objectives: Detecting particle flow from the airways by none invasively online analysing technique might serve as an additional tool to monitor mechanical ventilation. In the present study we used a customised Pexa (Particles in Exhaled Air), which is an optical particle counter for airway monitoring of particle flow in exhaled air. Positive end expiratory pressure (PEEP) is often used as a tool during recruitment manoeuvre and the aim of this study was to investigate the impact of different levels of PEEP on particle flow in exhaled in an experimental setting.Methods: Five animals received a gradual increase of 5 PEEP to a maximum of 25 PEEP during VCV. Measurements were done before every increase in PEEP in fully anaesthetised domestic pigs. The particle count along with vital parameters and ventilator settings were collected continuously. The particle sizes measured was between 0.41 µm and 4.55 µm.Results: All animals had a significant increase in particle count going from all increased levels of PEEP and back down to baseline PEEP of 5 cmH2O. Here shown with PEEP 15 that had a mean particle count of 401 ± 122 particles compared to after release of PEEP back to 5 with a mean particle count of 5968 ± 1784 (p<0.001). A significant decrease was seen in blood pressure in the higher levels of PEEP compared to PEEP 5 cmH2O.Conclusions: In the present study significant increase in particle count was seen when releasing PEEP back to baseline compared to all levels of PEEP. This finding may indicate that this technique can give diagnostic possibilities for monitoring lung function during mechanical ventilation.

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“…Because patients with heart failure receiving VA-ECMO often have abnormal lung function. Although the Extracorporeal Life support organization (ELSO) suggested higher PEEP levels may be more suitable if increased alveolar strain and alveolar over-distension are considered [3], higher PEEP may affect left and right ventricular load in VA-ECMO and then reduce cardiac output [4][5]. Thus, by frequent cardiac echography monitoring, we thought that PEEP levels less than 12cmH2O were recommended.…”

Section: Discussionmentioning

confidence: 99%

Therapeutic Management of VA-ECMO Support for Cardiogenic Shock: Case Report.

Yang

Yan

et al. 2021

Preprint

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Introduction: Cardiogenic shock is considered a serious stage of heart disease, and there is no better way to treat this. Veno-arterial Extracorporeal membrane oxygenation (VA-ECMO) is a well-established technology that can be used as potential life-saving measures in patients who present with cardiac arrest or severe hemodynamic instability by improving organ perfusion and oxygenation. However, it is usually complex and needs individualized decisions in a multidisciplinary approach to manage patients receiving Extracorporeal membrane oxygenation, as defined clinical condition’s protocols are still lacking. Case presentation: one patient was a 44-year-old man with out-of-hospital ventricular fibrillation was transferred to our hospital after initial cardiopulmonary resuscitation. In the emergency department, he presented with ST-segment elevation extensive anterior wall myocardial infarction and cardiogenic shock with paroxysmal ventricular tachycardia. After transfer to intensive care unit, VA-ECMO was implanted due to worsening cardiogenic shock and recovered slowly thereafter. Another patient was a 58-year-old woman presented refractory hypotension. As a bridge-therapy, VA-ECMO support was implanted and then the patient was taken to the cardiac catheterization laboratory where she experienced Percutaneous coronary intervention and implanted a drug-eluting stent in the right coronary artery. Due to acute kidney injury, continuous renal replacement therapy was given to facilitate the control of fluid access balance, the removal of inflammatory media.Conclusion: VA-ECMO is not only used as a temporary treatment strategy for cardiogenic shock, but also as a bridge-therapy. It is important to focus on the improve the success rate of VA-ECMO treatment and avoid complications.

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High positive end expiratory pressure levels affect hemodynamics in elderly patients with hypertension admitted to the intensive care unit: a prospective cohort study

Cited by 15 publications

References 31 publications

Central venous pressure and acute kidney injury in critically ill patients with multiple comorbidities: a large retrospective cohort study

Central venous pressure and acute kidney injury in critically ill patients with multiple comorbidities: a large retrospective cohort study

Different particle flow from exhaled air after gradual increase of PEEP during mechanical ventilation

Therapeutic Management of VA-ECMO Support for Cardiogenic Shock: Case Report.

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