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Erschienen in: Intensive Care Medicine 1/2004

01.01.2004 | Experimental

Assessment of cardiac preload and left ventricular function under increasing levels of positive end-expiratory pressure

verfasst von: Thomas Luecke, Harry Roth, Peter Herrmann, Alf Joachim, Gerald Weisser, Paolo Pelosi, Michael Quintel

Erschienen in: Intensive Care Medicine | Ausgabe 1/2004

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Abstract

Objective

(1) To assess the impact of high intrathoracic pressure on left ventricular volume and function. (2) To test the hypothesis that right ventricular end-diastolic volume (RVEDV) and intrathoracic blood volume (ITBV) represent cardiac preload and are superior to central venous pressure (CVP) or pulmonary capillary wedge pressure (PCWP). The validity of these parameters was tested by means of correlation with left ventricular end-diastolic volume (LVEDV), the true cardiac preload.

Design

Prospective animal study.

Subjects

Fifteen adult sheep.

Interventions

All animals were studied before and after saline washout-induced lung injury, undergoing volume-controlled ventilation with increasing levels of PEEP (0, 7, 14 and 21 cmH2O, respectively).

Measurements and main results

Left ventricular ejection fraction (LVEF), stroke volume (LVSV) and LVEDV were measured using computed tomography. ITBV and RVEDV were obtained by the thermal dye dilution technique. At PEEP 21 cmH2O, LVSV significantly decreased compared to baseline, PEEP 0 and PEEP 7 cmH2O. LVEDV was maintained except for the highest level of PEEP, while LVEF remained unchanged. RVEDV and RVEF also remained unchanged. The overall correlation of RVEDV and ITBV with LVEDV was satisfactory (r=0.56 and r=0.62, respectively) and clearly superior to cardiac filling pressures.

Conclusion

In the present study, (1) ventilation with increasing levels of PEEP did not alter RV function, while LV function was impaired at the highest level of PEEP; (2) unlike cardiac filling pressures, ITBV and RVEDV both provide valid estimates of cardiac preload even at high intrathoracic pressures.
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Metadaten
Titel
Assessment of cardiac preload and left ventricular function under increasing levels of positive end-expiratory pressure
verfasst von
Thomas Luecke
Harry Roth
Peter Herrmann
Alf Joachim
Gerald Weisser
Paolo Pelosi
Michael Quintel
Publikationsdatum
01.01.2004
Verlag
Springer Berlin Heidelberg
Erschienen in
Intensive Care Medicine / Ausgabe 1/2004
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-003-1993-7

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