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Open Access

Influence of positive end-expiratory pressure (PEEP) on left ventricular regional wall motion in patients with acute respiratory distress syndrome (ARDS)

  • E Huettemann1,
  • M Steinecke1,
  • C Schelenz1,
  • S Thomas1 and
  • K Reinhart1
Critical Care20026(Suppl 1):P14

https://doi.org/10.1186/cc1596

Published: 1 March 2002

Keywords

Wall MotionAcute Respiratory Distress SyndromeRegional Wall MotionPeep LevelTransoesophageal Echocardiography

Regional left ventricular wall motion abnormalities have been described at a positive end-expiratory pressure (PEEP) level of 20 cm H2O [1]. However, no PEEP level has yet been defined, above which RWMA may occur.

Objective

To assess global and regional LV performance in response to PEEP by transoesophageal echocardiography (TOE) in patients with ARDS.

Setting

Surgical ICU in a university hospital.

Patients

Eight critically ill patients with normal systolic LV function requiring mechanical ventilation (tidal volume 6-8 ml/kg, PEEP 12 ± 2 cmH2O) due to ARDS.

Measurements

Regional and global LV performance were assessed at PEEP levels of 5, 10, 15, 20 and 25 cmH2O by means of TOE by the centerline method on the transgastric short-axis view.

Results

PEEP =15 cmH2O produced a significant reduction in systolic septal wall motion (hypokinesia) and a significant augmentation of lateral systolic wall motion (hyperkinesia). Global LV performance - measured as fractional area change - was not significantly affected.

Conclusion and discussion

PEEP levels =15 cmH2O may be associated with an inhomogeneity of regional wall motion. Most likely, this phenomenon is related to a nonuniform transmission of the increased intrathoracic pressure on the left ventricular wall because of its different relation to the pleural space.

Authors’ Affiliations

(1)
Department of Anaesthesiology, Intensive Care, Friedrich-Schiller-University, Jena, Germany

References

  1. Fellahi JL, Valtier B, Beauchet A, et al.: Does positive end-expiratory pressure ventilation improve left ventricular function? A comparative study by transesophageal echocardiography in cardiac and noncardiac patients. Chest 1998, 114: 556-562.View ArticlePubMedGoogle Scholar

Copyright

© Biomed central limited 2001

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