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Impact of acute hypercapnia and augmented positive end-expiratory pressure on right ventricle function in severe acute respiratory distress syndrome
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Impact of acute hypercapnia and augmented positive end-expiratory pressure on right ventricle function in severe acute respiratory distress syndrome
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Journal Article
Impact of acute hypercapnia and augmented positive end-expiratory pressure on right ventricle function in severe acute respiratory distress syndrome
2009
Overview
Purpose
To evaluate the effects of acute hypercapnia induced by positive end-expiratory pressure (PEEP) variations at constant plateau pressure (
P
plat
) in patients with severe acute respiratory distress syndrome (ARDS) on right ventricular (RV) function.
Methods
Prospective observational study in two academic intensive care units enrolling 11 adults with severe ARDS (PaO
2
/FiO
2
<150 mmHg at PEEP >5 cmH
2
O). We compared three ventilatory strategies, each used for 1 h, with
P
plat
at 22 (20–25) cmH
2
O: low PEEP (5.4 cmH
2
O) or high PEEP (11.0 cmH
2
O) with compensation of the tidal volume reduction by either a high respiratory rate (high PEEP/high rate) or instrumental dead space decrease (high PEEP/low rate). We assessed RV function (transesophageal echocardiography), alveolar dead space (expired CO
2
), and alveolar recruitment (pressure–volume curves).
Results
Compared to low PEEP, PaO
2
/FiO
2
ratio and alveolar recruitment were increased with high PEEP. Alveolar dead space remained unchanged. Both high-PEEP strategies induced higher PaCO
2
levels [71 (60–94) and 75 (53–84), vs. 52 (43–68) mmHg] and lower pH values [7.17 (7.12–7.23) and 7.20 (7.16–7.25) vs. 7.30 (7.24–7.35)], as well as RV dilatation, LV deformation and a significant decrease in cardiac index. The decrease in stroke index tended to be negatively correlated to the increase in alveolar recruitment with high PEEP.
Conclusions
Acidosis and hypercapnia induced by tidal volume reduction and increase in PEEP at constant
P
plat
were associated with impaired RV function and hemodynamics despite positive effects on oxygenation and alveolar recruitment (
ClinicalTrials.gov
#NCT00236262).
Publisher
Springer-Verlag,Springer,Springer Nature B.V,Springer Verlag
Subject
/ Acidosis, Respiratory - etiology
/ Aged
/ Alveoli
/ Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
/ Biological and medical sciences
/ Echocardiography, Transesophageal
/ Emergency and intensive respiratory care
/ Female
/ Heart
/ Humans
/ Male
/ Medicine
/ Original
/ Pneumology/Respiratory System
/ Positive-Pressure Respiration - adverse effects
/ Positive-Pressure Respiration - methods
/ Respiratory distress syndrome
/ Respiratory Distress Syndrome, Adult - complications
/ Respiratory Distress Syndrome, Adult - metabolism
/ Respiratory Distress Syndrome, Adult - physiopathology
/ Respiratory Distress Syndrome, Adult - therapy
