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Effects of positive end-expiratory pressure on gastric mucosal perfusion in acute respiratory distress syndrome
INTRODUCTION: Positive end-expiratory pressure (PEEP) improves oxygenation and can prevent ventilator-induced lung injury in patients with acute respiratory distress syndrome (ARDS). Nevertheless, PEEP can also induce detrimental effects by its influence on the cardiovascular system. The purpose of...
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Formato: | Texto |
Lenguaje: | English |
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BioMed Central
2004
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1065018/ https://www.ncbi.nlm.nih.gov/pubmed/15469573 http://dx.doi.org/10.1186/cc2905 |
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author | Bruhn, Alejandro Hernandez, Glenn Bugedo, Guillermo Castillo, Luis |
author_facet | Bruhn, Alejandro Hernandez, Glenn Bugedo, Guillermo Castillo, Luis |
author_sort | Bruhn, Alejandro |
collection | PubMed |
description | INTRODUCTION: Positive end-expiratory pressure (PEEP) improves oxygenation and can prevent ventilator-induced lung injury in patients with acute respiratory distress syndrome (ARDS). Nevertheless, PEEP can also induce detrimental effects by its influence on the cardiovascular system. The purpose of this study was to assess the effects of PEEP on gastric mucosal perfusion while applying a protective ventilatory strategy in patients with ARDS. METHODS: Eight patients were included. A pressure–volume curve was traced and ideal PEEP, defined as lower inflection point + 2 cmH(2)O, was determined. Gastric tonometry was measured continuously (Tonocap). After baseline measurements, 10, 15 and 20 cmH(2)O PEEP and ideal PEEP were applied for 30 min each. By the end of each period, hemodynamic, CO(2 )gap (gastric minus arterial partial pressures), and ventilatory measurements were performed. RESULTS: PEEP had no effect on CO(2 )gap (median [range], baseline: 19 [2–30] mmHg; PEEP 10: 19 [0–40] mmHg; PEEP 15: 18 [0–39] mmHg; PEEP 20: 17 [4–39] mmHg; ideal PEEP: 19 [9–39] mmHg; P = 0.18). Cardiac index also remained unchanged (baseline: 4.6 [2.5–6.3] l min(-1 )m(-2); PEEP 10: 4.5 [2.5–6.9] l min(-1 )m(-2); PEEP 15: 4.3 [2–6.8] l min(-1 )m(-2); PEEP 20: 4.7 [2.4–6.2] l min(-1 )m(-2); ideal PEEP: 5.1 [2.1–6.3] l min(-1 )m(-2); P = 0.08). One patient did not complete the protocol because of hypotension. CONCLUSION: PEEP of 10–20 cmH(2)O does not affect gastric mucosal perfusion and is hemodynamically well tolerated in most patients with ARDS, including those receiving adrenergic drugs. |
format | Text |
id | pubmed-1065018 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2004 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-10650182005-03-16 Effects of positive end-expiratory pressure on gastric mucosal perfusion in acute respiratory distress syndrome Bruhn, Alejandro Hernandez, Glenn Bugedo, Guillermo Castillo, Luis Crit Care Research INTRODUCTION: Positive end-expiratory pressure (PEEP) improves oxygenation and can prevent ventilator-induced lung injury in patients with acute respiratory distress syndrome (ARDS). Nevertheless, PEEP can also induce detrimental effects by its influence on the cardiovascular system. The purpose of this study was to assess the effects of PEEP on gastric mucosal perfusion while applying a protective ventilatory strategy in patients with ARDS. METHODS: Eight patients were included. A pressure–volume curve was traced and ideal PEEP, defined as lower inflection point + 2 cmH(2)O, was determined. Gastric tonometry was measured continuously (Tonocap). After baseline measurements, 10, 15 and 20 cmH(2)O PEEP and ideal PEEP were applied for 30 min each. By the end of each period, hemodynamic, CO(2 )gap (gastric minus arterial partial pressures), and ventilatory measurements were performed. RESULTS: PEEP had no effect on CO(2 )gap (median [range], baseline: 19 [2–30] mmHg; PEEP 10: 19 [0–40] mmHg; PEEP 15: 18 [0–39] mmHg; PEEP 20: 17 [4–39] mmHg; ideal PEEP: 19 [9–39] mmHg; P = 0.18). Cardiac index also remained unchanged (baseline: 4.6 [2.5–6.3] l min(-1 )m(-2); PEEP 10: 4.5 [2.5–6.9] l min(-1 )m(-2); PEEP 15: 4.3 [2–6.8] l min(-1 )m(-2); PEEP 20: 4.7 [2.4–6.2] l min(-1 )m(-2); ideal PEEP: 5.1 [2.1–6.3] l min(-1 )m(-2); P = 0.08). One patient did not complete the protocol because of hypotension. CONCLUSION: PEEP of 10–20 cmH(2)O does not affect gastric mucosal perfusion and is hemodynamically well tolerated in most patients with ARDS, including those receiving adrenergic drugs. BioMed Central 2004-07-15 /pmc/articles/PMC1065018/ /pubmed/15469573 http://dx.doi.org/10.1186/cc2905 Text en Copyright © 2004 Bruhn et al.; licensee BioMed Central Ltd. http://creativecommons.org/licences/by/2.0 This is an Open Access article: verbartim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with article's original URL. (http://creativecommons.org/licences/by/2.0) |
spellingShingle | Research Bruhn, Alejandro Hernandez, Glenn Bugedo, Guillermo Castillo, Luis Effects of positive end-expiratory pressure on gastric mucosal perfusion in acute respiratory distress syndrome |
title | Effects of positive end-expiratory pressure on gastric mucosal perfusion in acute respiratory distress syndrome |
title_full | Effects of positive end-expiratory pressure on gastric mucosal perfusion in acute respiratory distress syndrome |
title_fullStr | Effects of positive end-expiratory pressure on gastric mucosal perfusion in acute respiratory distress syndrome |
title_full_unstemmed | Effects of positive end-expiratory pressure on gastric mucosal perfusion in acute respiratory distress syndrome |
title_short | Effects of positive end-expiratory pressure on gastric mucosal perfusion in acute respiratory distress syndrome |
title_sort | effects of positive end-expiratory pressure on gastric mucosal perfusion in acute respiratory distress syndrome |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1065018/ https://www.ncbi.nlm.nih.gov/pubmed/15469573 http://dx.doi.org/10.1186/cc2905 |
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