Positive end-expiratory pressure decreases mesenteric blood flow despite normalization of cardiac output

R. Love, E. Choe, H. Lippton, L. Flint, S. Steinberg, K. Davis, George Kramer, C. E. Lucas, G. M. Watkins

Research output: Contribution to journalArticle

48 Citations (Scopus)

Abstract

Positive end-expiratory pressure (PEEP) is a commonly used adjunct to mechanical ventilation and is known to have deleterious effects on cardiac output (CO). Its effects on regional blood flow are not well known. We evaluated the effect of PEEP on the mesenteric microcirculation and CO. Sprague-Dawley rats were treated with mechanical ventilation and either no PEEP (Control) or increasing levels of PEEP (PEEP). Using in vivo video- microscopy, mesenteric A1 arteriolar optical Doppler velocities and A1 and A3 (the first- and third-order arterioles branching off the feeding mesenteric arcade) intraluminal diameters were measured (n = 6/group). In a separate set of experimental animals, CO was determined by thermodilution technique (n = 5/group). Additionally, after the PEEP group attained a PEEP level of 20-cm H2O PEEP, two boluses of 2 mL 0.9 normal saline (NS) were given intravenously. The Control groups had the same determinations performed over the same time course as the PEEP group but were not exposed to any PEEP. Mesenteric blood flow (MBF) was calculated from vessel diameter and red blood cell velocity. The MBF and CO fell progressively as PEEP was increased from 10- to 15- to 20-cm H2O pressure. MBF was reduced 75% (p < 0.05) and the CO was reduced 31% (p < 0.05) from baseline at 20-cm H2O pressure PEEP. After 4 mL normal saline, the MBF was still 45% below baseline (p < 0.05) while the CO had returned to baseline. In conclusion, both MBF and CO are decreased significantly with increasing PEEP. Fluid resuscitation will reverse the adverse effects of PEEP on CO, but there is only partial correction of the negative effects on MBF.

Original languageEnglish (US)
Pages (from-to)195-199
Number of pages5
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume39
Issue number2
DOIs
StatePublished - 1995
Externally publishedYes

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Positive-Pressure Respiration
Cardiac Output
Artificial Respiration
Pressure
Thermodilution
Video Microscopy
Regional Blood Flow
Arterioles
Microcirculation
Resuscitation
Sprague Dawley Rats

ASJC Scopus subject areas

  • Surgery

Cite this

Positive end-expiratory pressure decreases mesenteric blood flow despite normalization of cardiac output. / Love, R.; Choe, E.; Lippton, H.; Flint, L.; Steinberg, S.; Davis, K.; Kramer, George; Lucas, C. E.; Watkins, G. M.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 39, No. 2, 1995, p. 195-199.

Research output: Contribution to journalArticle

Love, R. ; Choe, E. ; Lippton, H. ; Flint, L. ; Steinberg, S. ; Davis, K. ; Kramer, George ; Lucas, C. E. ; Watkins, G. M. / Positive end-expiratory pressure decreases mesenteric blood flow despite normalization of cardiac output. In: Journal of Trauma - Injury, Infection and Critical Care. 1995 ; Vol. 39, No. 2. pp. 195-199.
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abstract = "Positive end-expiratory pressure (PEEP) is a commonly used adjunct to mechanical ventilation and is known to have deleterious effects on cardiac output (CO). Its effects on regional blood flow are not well known. We evaluated the effect of PEEP on the mesenteric microcirculation and CO. Sprague-Dawley rats were treated with mechanical ventilation and either no PEEP (Control) or increasing levels of PEEP (PEEP). Using in vivo video- microscopy, mesenteric A1 arteriolar optical Doppler velocities and A1 and A3 (the first- and third-order arterioles branching off the feeding mesenteric arcade) intraluminal diameters were measured (n = 6/group). In a separate set of experimental animals, CO was determined by thermodilution technique (n = 5/group). Additionally, after the PEEP group attained a PEEP level of 20-cm H2O PEEP, two boluses of 2 mL 0.9 normal saline (NS) were given intravenously. The Control groups had the same determinations performed over the same time course as the PEEP group but were not exposed to any PEEP. Mesenteric blood flow (MBF) was calculated from vessel diameter and red blood cell velocity. The MBF and CO fell progressively as PEEP was increased from 10- to 15- to 20-cm H2O pressure. MBF was reduced 75{\%} (p < 0.05) and the CO was reduced 31{\%} (p < 0.05) from baseline at 20-cm H2O pressure PEEP. After 4 mL normal saline, the MBF was still 45{\%} below baseline (p < 0.05) while the CO had returned to baseline. In conclusion, both MBF and CO are decreased significantly with increasing PEEP. Fluid resuscitation will reverse the adverse effects of PEEP on CO, but there is only partial correction of the negative effects on MBF.",
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