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

BACKGROUND: To study the effects of different positive end expiratory pressure (PEEP) on blood pressure and heart function in elderly patients with hypertension. METHODS: Forty elderly patients above 65 years of age treated with mechanical ventilation were divided into two groups: a control group of non-hypertensive subjects (n = 18) and a hypertension group (n = 22) patients with essential hypertension. Changes in blood pressure, central venous pressure (CVP), central venous oxygen saturation (ScvO(2)), heart rate, and airway pressure were determined in response to different selected PEEP levels of 0, 2, 4, 6, 8, 10 and 12 cm H(2)O under SIMV(PC) + PSV mode throughout the study. RESULTS: In both groups, the increase in PEEP led to an increase in CVP and airway pressure. When PEEP was above 4 cm H(2)O in the hypertension group, a decrease in blood pressure and ScvO(2), and an increase of heart rate were observed. These results indicated that cardiac output significantly decreased. CONCLUSION: High levels of PEEP can significantly influence changes in blood pressure and heart function in elderly patients with hypertension. TRIAL REGISTRATION: This trial was retrospectively registered, The Chinese trial registration number is ChiCTR-ROC-17012873. The date of registration is 10-2-2017.