Positive end-expiratory pressure aggravates left ventricular diastolic relaxation further in patients with pre-existing relaxation abnormality

Chin, Ji Hyun; Lee, Eun‐Ho; Kim, W.J.; Choi, Donghoon; Hahm, Kyung‐Don; Sim, Ji Hoon; Choi, In‐Cheol

doi:10.1093/bja/aet061

Cited by 19 publications

(21 citation statements)

References 33 publications

(14 reference statements)

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“…We used "E" values for defining diastolic dysfunction in our study, as it is mostly independent of both preload and heart rate. It is well known that inotrope therapy may affect myocardial functions (34)(35)(36)(37)(38). More than 40% of the patients in their study were already on inotropes at the time of echocardiography compared to only 14% (eight of 56) in our study.…”

Section: Discussioncontrasting

confidence: 55%

Prevalence and Outcome of Diastolic Dysfunction in Children With Fluid Refractory Septic Shock—A Prospective Observational Study*

Sankar

Das

Jain

et al. 2014

Pediatric Critical Care Medicine

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Section: Discussioncontrasting

confidence: 55%

Prevalence and Outcome of Diastolic Dysfunction in Children With Fluid Refractory Septic Shock—A Prospective Observational Study*

Sankar

Das

Jain

et al. 2014

Pediatric Critical Care Medicine

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“…PEEP may worsen myocardial perfusion. Recent study by Chin et al demonstrated that incremental PEEP from 0 cm H 2 O to 5 and 10 cm H 2 O worsened diastolic dysfunction in patients with preexisting diastolic dysfunction that might take the risk to myocardial infarction [12]. …”

Section: Pathophysiology Of Peepmentioning

confidence: 99%

PEEP Role in ICU and Operating Room: From Pathophysiology to Clinical Practice

Vargas

Sutherasan

Gregoretti

et al. 2014

The Scientific World Journal

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Positive end expiratory pressure (PEEP) may prevent cyclic opening and collapsing alveoli in acute respiratory distress syndrome (ARDS) patients, but it may play a role also in general anesthesia. This review is organized in two sections. The first one reports the pathophysiological effect of PEEP on thoracic pressure and hemodynamic and cerebral perfusion pressure. The second section summarizes the knowledge and evidence of the use of PEEP in general anesthesia and intensive care. More specifically, for intensive care this review refers to ARDS and traumatic brain injured patients.

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“…The end‐diastolic dimensions of the LV decrease during positive pressure ventilation, and multiple factors may contribute to this. Positive pressure ventilation reduces right ventricular preload and this will, shortly after, reduce left ventricular filling pressure.…”

Section: Echocardiography During Positive Pressure Ventilationmentioning

confidence: 99%

“…If the pulmonary artery pressure is increased concomitantly, this effect on left ventricular filling will be exacerbated. The echocardiographic result is a decrease in both early diastolic transmitral flow (pulsed Doppler E‐wave) and of early relaxation velocities of the mitral valve annuli, e′ . In addition, interventricular interdependence may be of influence.…”

Section: Echocardiography During Positive Pressure Ventilationmentioning

confidence: 99%

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When appearances deceive: Echocardiographic changes due to common chest pathology

et al. 2018

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Most indications for performing echocardiography focus on the evaluation of properties intrinsic to the heart. However, numerous extra‐cardiac conditions indirectly convey changes to the echocardiographic appearance through alterations in the governing physiology. Pulmonary embolism increases pulmonary arterial pressure if a sufficient cross‐sectional area of the pulmonary vascular bed is occluded. This may result in dilatation of the right ventricle and, in severe cases, concomitant early diastolic septal collapse into the left ventricle. Acute respiratory failure has been shown to yield a similar echocardiographic appearance in experimental conditions due to the resultant pulmonary vasoconstriction. Echocardiography in the presence of pulmonary disease can reveal underlying cardiac pathologies such as pulmonary hypertension that contribute to the clinical severity of respiratory distress. Positive pressure ventilation affects preload, afterload, and compliance of both ventricles. The echocardiographic net result cannot be uniformly anticipated, but provides information on the deciding physiology or pathophysiology. Mediastinal pathology including tumors, herniation of abdominal content, and pleural effusion can often be visualized directly with echocardiography. Mediastinal pathologies adjacent to the heart may compress the myocardium directly, thus facilitating echocardiographic and clinical signs of tamponade in the absence of pericardial effusion. In conclusion, many pathologies of extra‐cardiac origin influence the echocardiographic appearance of the heart. These changes do not reflect properties of the myocardium but may well be mistaken for it. Hence, these conditions are essential knowledge to all physicians performing echocardiography across the spectrum from advanced cardiological diagnostics to rapid point‐of‐care focused cardiac ultrasonography.

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Positive end-expiratory pressure aggravates left ventricular diastolic relaxation further in patients with pre-existing relaxation abnormality

Abstract: Increasing PEEP led to a progressive decline in LV relaxation in patients with pre-existing LV relaxation abnormality.

Cited by 19 publications

References 33 publications

Prevalence and Outcome of Diastolic Dysfunction in Children With Fluid Refractory Septic Shock—A Prospective Observational Study*

Prevalence and Outcome of Diastolic Dysfunction in Children With Fluid Refractory Septic Shock—A Prospective Observational Study*

PEEP Role in ICU and Operating Room: From Pathophysiology to Clinical Practice

When appearances deceive: Echocardiographic changes due to common chest pathology

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