Hostname: page-component-76fb5796d-25wd4 Total loading time: 0 Render date: 2024-04-30T06:29:12.358Z Has data issue: false hasContentIssue false
  • English
  • Français

The influence of PEEP and tidal volume on central blood volume

Published online by Cambridge University Press:  20 June 2006

J. C. Kubitz ,
G. I. Kemming ,
G. Schultheiß ,
J. Starke ,
A. Podtschaske ,
A. E. Goetz  and
D. A. Reuter
J. C. Kubitz
Affiliation:
Ludwig Maximilians University Munich, Großhadern University Hospital, Department of Anaesthesiology, Munich, Germany Ludwig Maximilians University Munich, Institute for Surgical Research, Munich, Germany University of Hamburg, Hamburg-Eppendorf University-Medical Center, Department of Anaesthesiology, Hamburg, Germany
G. I. Kemming
Affiliation:
Ludwig Maximilians University Munich, Großhadern University Hospital, Department of Anaesthesiology, Munich, Germany Ludwig Maximilians University Munich, Institute for Surgical Research, Munich, Germany
G. Schultheiß
Affiliation:
Ludwig Maximilians University Munich, Institute for Surgical Research, Munich, Germany
J. Starke
Affiliation:
Ludwig Maximilians University Munich, Institute for Surgical Research, Munich, Germany
A. Podtschaske
Affiliation:
Ludwig Maximilians University Munich, Institute for Surgical Research, Munich, Germany
A. E. Goetz
Affiliation:
University of Hamburg, Hamburg-Eppendorf University-Medical Center, Department of Anaesthesiology, Hamburg, Germany
D. A. Reuter
Affiliation:
Ludwig Maximilians University Munich, Institute for Surgical Research, Munich, Germany University of Hamburg, Hamburg-Eppendorf University-Medical Center, Department of Anaesthesiology, Hamburg, Germany
Get access

Abstract

Summary

Background and objective: Measurement of central blood volumes (CBV), such as global end-diastolic volume (GEDV) and right ventricular end-diastolic volume (RVEDV) are considered appropriate estimates of intravascular volume status. However, to apply those parameters for preload assessment in mechanically ventilated patients, the influence of tidal volume (TV) and positive endexpiratory airway pressure (PEEP) on those parameters must be known. Methods: In 13 mechanically ventilated piglets, the effect of low (10 mL kg−1) and high (20 mL kg−1) TVs on CBV was investigated in absence and presence of PEEP (0 and 15 cmH2O). GEDV, RVEDV, right heart (RHEDV) and left heart end-diastolic volume (LHEDV) were measured by thermodilution. Blood flow on the descending thoracic aorta measured with an ultrasonic flow-probe served to determine stroke volume (SV). Measurements were performed during baseline conditions, after volume loading with previously extracted haemodilution blood (20 mL kg−1) and following haemorrhage (30 mL kg−1). Results: Application of PEEP decreased GEDV and SV significantly (P < 0.05). Augmenting TV did not reduce GEDV systematically, but significantly reduced SV (P < 0.05). Changes in ventilator settings only influenced RVEDV following volume loading (P < 0.05). RHEDV and LHEDV decreased following application of PEEP, but only RHEDV decreased after augmenting TV at baseline and following volume loading. Correlation of SV with parameters of CBV was r = 0.487 (P < 0.01) for GEDV, r = 0.553 (P < 0.01) for RVEDV, r = 0.596 (P < 0.01) for RHEDV and r = 0.303 (P < 0.01) for LHEDV. Conclusion: Application of PEEP decreases CBV and SV. Augmenting TV reduces SV but not CBV. There is a moderate correlation between parameters of CBV and cardiac performance.

Keywords

VENTRICULAR FUNCTIONBLOOD VOLUMECONTINUOUS POSITIVE AIRWAY PRESSURECARDIAC VOLUME, END-DIASTOLIC VOLUMETIDAL VOLUME
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 23 , Issue 11 , November 2006 , pp. 954 - 961
Copyright
2006 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Michard F, Boussat S, Chemla D. Relation between respiratory changes in arterial pulse pressure and fluid responsiveness in septic patients with acute circulatory failure. Am J Respir Crit Care Med 2000; 162: 134–138.Google Scholar
Reuter DA, Felbinger TW, Schmidt Cet al. Stroke volume variations for assessment of cardiac responsiveness to volume loading in mechanically ventilated patients after cardiac surgery. Intensive Care Med 2002; 28: 392–398.Google Scholar
Wagner JG, Leatherman JW. Right ventricular end-diastolic volume as predictor of the hemodynamic response to a fluid challenge. Chest 1998; 113: 1048–1054.Google Scholar
Rex S, Brose S, Metzelder Set al. Prediction of fluid responsiveness in patients during cardiac surgery. Br J Anaesth 2004; 93: 782–788.Google Scholar
Reuse C, Vincent JL, Pinsky MR. Measurements of right ventricular volumes during fluid challenge. Chest 1990; 98: 1450–1454.Google Scholar
Bendjelid K, Romand JA. Fluid responsiveness in mechanically ventilated patients: a review of indices used in intensive care. Intensive Care Med 2003; 29: 352–360.Google Scholar
Della Rocca G, Costa GM, Coccia C, Pompei L, Di Marco P, Pietropaoli P. Preload Index: pulmonary artery occlusion pressure versus intrathoracic blood volume monitoring during lung transplantation. Anesth Analg 2002; 95: 835–843.Google Scholar
Luecke T, Roth H, Herrmann Pet al. Assessment of cadiac preload and left ventricular function under increasing levels of positive end-expiratory pressure. Intensive Care Med 2004; 30: 119–126.Google Scholar
Reuter DA, Felbinger TW, Moerstedt K, Kilger E, Weis F, Goetz AE. Intrathoracic blood volume index by thermo-dilution for preload monitoring after cardiac surgery. J Cardiothorac Vasc Anesth 2002; 16: 191–195.Google Scholar
Diebel LN, Wilson RF, Tagett MG, Kline RA. End-diastolic volume – a better indicator of preload in the critically ill. Arch Surg 1992; 127: 817–821.Google Scholar
Cheatham ML, Nelson LD, Chang MC, Safesak K. Right ventricular end-diastolic volume index as a predictor of preload status in patients with positive end-diastolic pressure. Crit Care Med 1998; 26: 1801–1806.Google Scholar
Michard F, Sami A, Zarka V, Bahloul M, Richard C, Teboul JL. Global end-diastolic volume as an indicator of cardiac preload in patients with septic shock. Chest 2003; 124: 1900–1908.Google Scholar
Sakka SG, Rühl CC, Pfeiffer UJet al. Assessment of cardiac preload and extravascular lung water by single transpulmonary thermodilution. Intensive Care Med 2000; 26: 180–187.Google Scholar
Scharf S, Brown R. Influence of the right ventricle on canine left ventricular function with PEEP. J Appl Physiol 1982; 52: 254–259.Google Scholar
Santamore WP, Bove AA, Heckman JL. Right and left ventricular pressure-volume response to positive end-expiratory pressure. Am J Physiol 1984; 246: H114–H119.Google Scholar
Tittley JG, Fremes SE, Weisel RDet al. Hemodynamic and myocardial metabolic consequences of PEEP. Chest 1985; 88: 4496–4502.Google Scholar
Biondi JW, Schulman DS, Soufer Ret al. The effect of incremental positive end-expiratory pressure on right ventricular hemodynamics and ejection fraction. Anesth Analg 1988; 67: 144–151.Google Scholar
Huemer G, Kolev N, Kurz A, Zimpfer M. Influence of positive end-expiratory pressure on right and left ventricular performance assessed by doppler two-dimensional echocardiography. Chest 1994; 106: 67–73.Google Scholar
Jardin F, Delorme D, Hardy A, Auvert B, Beauchet A, Bourdarias JP. Reevaluation of hemodynamic consequences of positive pressure ventilation: emphasis on cyclic right ventricular afterloading by mechanical lung inflation. Anesthesiology 1990; 72: 966–970.Google Scholar
Vieillard-Baron A, Loubieres Y, Schmitt JM, Page B, Dubourg O, Jardin F. Cyclic changes in right ventricular output impedance during mechanical ventilation. J Appl Physiol 1999; 87: 1644–1650.Google Scholar
Hoeft A, Schorn B, Weyland Aet al. Bedside assessment of intravascular volume status in patients undergoing coronary bypass surgery. Anesthesiology 1994; 81: 76–86.Google Scholar
Lichtwark-Aschoff M, Zeravik K, Pfeiffer UJ. Intrathoracic blood volume accurately reflects circulatory volume status in critically ill patients with mechanical ventilation. Intensive Care Med 1992; 18: 142–147.Google Scholar
Wiesenack C, Prasser C, Keyl C, Rödig G. Assessment of intrathoracic blood volume as an indicator of cardiac preload: single transpulmonary thermodilution technique versus assessment of pressure preload parameters derived from a pulmonary artery catheter. J Cardiothorac Vasc Anesth 2001; 15: 584–588.Google Scholar
Diebel LN, Myers T, Dulchavsky S. Effects of increasing airway pressure and PEEP on the assessment of cardiac preload. J Trauma 1997; 42: 585–590.Google Scholar