PPV May Be a Starting Point to Achieve Circulatory Protective Mechanical Ventilation

Abstract

Pulse pressure variation (PPV) is a mandatory index for hemodynamic monitoring during mechanical ventilation. The changes in pleural pressure (Ppl) and transpulmonary pressure (PL) caused by mechanical ventilation are the basis for PPV and lead to the effect of blood flow. If the state of hypovolemia exists, the effect of the increased Ppl during mechanical ventilation on the right ventricular preload will mainly affect the cardiac output, resulting in a positive PPV. However, PL is more influenced by the change in alveolar pressure, which produces an increase in right heart overload, resulting in high PPV. In particular, if spontaneous breathing is strong, the transvascular pressure will be extremely high, which may lead to the promotion of alveolar flooding and increased RV flow. Asynchronous breathing and mediastinal swing may damage the pulmonary circulation and right heart function. Therefore, according to the principle of PPV, a high PPV can be incorporated into the whole respiratory treatment process to monitor the mechanical ventilation cycle damage/protection regardless of the controlled ventilation or spontaneous breathing. Through the monitoring of PPV, the circulation-protective ventilation can be guided at bedside in real time by PPV.

Effects of aggressive and conservative strategies for mechanical ventilation liberation

“…To limit these harms it may be beneficial to expedite weaning from strict lung protective ventilation parameters to allow for lower sedation requirements. However, it is also possible that allowing patients to breathe spontaneously before they have adequately recovered from their critical illness may result in worsened injury or further impact patient hemodynamics [15][16][17]. While spontaneous breathing may be beneficial in less sick patients with improved ventilation/perfusion matching and more physiologic breathing [18], this may not be the case for sicker patients with potentially injurious pressure and volume subsequently leading to worsened lung injurywhat has been described as patient self-induced lung injury (P-SILI) [19][20][21][22][23].…”