The effects of positive end-expiratory pressure on cardiac function: a comparative echocardiography-conductance catheter study

David Berger; Olivier Wigger; Stefano de Marchi; Martin R Grübler; Andreas Bloch; Reto Kurmann; Odile Stalder; Kaspar Felix Bachmann; Stefan Bloechlinger

doi:10.1007/s00392-022-02014-1

The effects of positive end-expiratory pressure on cardiac function: a comparative echocardiography-conductance catheter study

Clin Res Cardiol. 2022 Jun;111(6):705-719. doi: 10.1007/s00392-022-02014-1. Epub 2022 Apr 6.

Authors

David Berger^#¹, Olivier Wigger^#^{2

3}, Stefano de Marchi², Martin R Grübler², Andreas Bloch^{4

5}, Reto Kurmann^{2

6}, Odile Stalder⁷, Kaspar Felix Bachmann^{4

5

8}, Stefan Bloechlinger^{4

2

3}

Affiliations

¹ Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland. David.berger@insel.ch.
² Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
³ Klinik Für Kardiologie, Kantonsspital Winterthur, Winterthur, Switzerland.
⁴ Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland.
⁵ Zentrum Für Intensivmedizin, Kantonsspital Luzern, Luzern, Switzerland.
⁶ Klinik Für Kardiologie, Kantonsspital Luzern, Luzern, Switzerland.
⁷ CTU Bern, University of Bern, Bern, Switzerland.
⁸ Department of Anesthesiology and Pain Medicine, Inselspital, Bern University Hospital,, University of Bern, Bern, Switzerland.

^# Contributed equally.

Abstract

Background: Echocardiographic parameters of diastolic function depend on cardiac loading conditions, which are altered by positive pressure ventilation. The direct effects of positive end-expiratory pressure (PEEP) on cardiac diastolic function are unknown.

Methods: Twenty-five patients without apparent diastolic dysfunction undergoing coronary angiography were ventilated noninvasively at PEEPs of 0, 5, and 10 cmH₂O (in randomized order). Echocardiographic diastolic assessment and pressure-volume-loop analysis from conductance catheters were compared. The time constant for pressure decay (τ) was modeled with exponential decay. End-diastolic and end-systolic pressure volume relationships (EDPVRs and ESPVRs, respectively) from temporary caval occlusion were analyzed with generalized linear mixed-effects and linear mixed models. Transmural pressures were calculated using esophageal balloons.

Results: τ values for intracavitary cardiac pressure increased with the PEEP (n = 25; no PEEP, 44 ± 5 ms; 5 cmH₂O PEEP, 46 ± 6 ms; 10 cmH₂O PEEP, 45 ± 6 ms; p < 0.001). This increase disappeared when corrected for transmural pressure and diastole length. The transmural EDPVR was unaffected by PEEP. The ESPVR increased slightly with PEEP. Echocardiographic mitral inflow parameters and tissue Doppler values decreased with PEEP [peak E wave (n = 25): no PEEP, 0.76 ± 0.13 m/s; 5 cmH₂O PEEP, 0.74 ± 0.14 m/s; 10 cmH₂O PEEP, 0.68 ± 0.13 m/s; p = 0.016; peak A wave (n = 24): no PEEP, 0.74 ± 0.12 m/s; 5 cmH₂O PEEP, 0.7 ± 0.11 m/s; 10 cmH₂O PEEP, 0.67 ± 0.15 m/s; p = 0.014; E' septal (n = 24): no PEEP, 0.085 ± 0.016 m/s; 5 cmH₂O PEEP, 0.08 ± 0.013 m/s; 10 cmH₂O PEEP, 0.075 ± 0.012 m/s; p = 0.002].

Conclusions: PEEP does not affect active diastolic relaxation or passive ventricular filling properties. Dynamic echocardiographic filling parameters may reflect changing loading conditions rather than intrinsic diastolic function. PEEP may have slight positive inotropic effects.

Clinical trial registration: https://clinicaltrials.gov/ct2/show/NCT02267291 , registered 17. October 2014.

Keywords: Diastolic function; Echocardiography; End-diastolic pressure; End-systolic pressure; Mechanical ventilation; Positive end-expiratory pressure; Volume relationship.

Publication types

Randomized Controlled Trial

MeSH terms

Catheters
Diastole
Echocardiography
Heart Ventricles*
Humans
Positive-Pressure Respiration*

Associated data

ClinicalTrials.gov/NCT02267291