Respiratory failure & ventilation
Increasing Levels of Positive End-expiratory Pressure Cause Stepwise Biventricular Stroke Work Reduction in a Porcine Model
Authors' conclusion
A stepwise increase in PEEP caused stepwise reduction in biventricular stroke work. However, there are important interventricular differences in response to increased PEEP levels. PEEP increased right ventricular afterload leading to uncoupling and right ventricular ejection fraction decline.
Study context
- Population
- Healthy female pigs of ≈60 kg
- Participants
- 6 pigs
- Comparison
- Stepwise increase of positive end-expiratory pressure (PEEP) from 0 to 5, 7, 9, 11, 13, 15, 17 and 20 cm H2O
- Outcome
- Biventricular stroke work (pressure-volume loops)
Methodological detailsprospective, observational, porcine model
- Prospective
- Observational
- Porcine model
Main finding
As reported in the abstract
Ventricular stroke work
- Left ventricular stroke work, increasing PEEP: 5,740 ± 973 vs. 2,303 ± 1,154 mmHg · ml
- P < 0.001
- Right ventricular stroke work, increasing PEEP: 2,064 ± 769 vs. 468 ± 133 mmHg · ml
- P < 0.001
Further findings
Left ventricular ejection fraction, afterload and coupling
- Preserved with increasing PEEP
Right ventriculo-arterial coupling
- Uncoupling with increasing PEEP: 0.74 ± 0.30 vs. 0.19 ± 0.13
- P = 0.01
- PEEP increased right ventricular afterload
Right ventricular ejection fraction
- Reduction with increasing PEEP: 64 ± 8% vs. 37 ± 7%
- P < 0.001
Original publication
Increasing Levels of Positive End-expiratory Pressure Cause Stepwise Biventricular Stroke Work Reduction in a Porcine Model. Anesthesiology. Published 31 October 2023. doi:10.
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