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The influence of PEEP and tidal volume on central blood volume

Published online by Cambridge University Press:  20 June 2006

J. C. Kubitz ,
G. I. Kemming ,
G. Schultheiß ,
J. Starke ,
A. Podtschaske ,
A. E. Goetz  and
D. A. Reuter
J. C. Kubitz
Affiliation:
Ludwig Maximilians University Munich, Großhadern University Hospital, Department of Anaesthesiology, Munich, Germany Ludwig Maximilians University Munich, Institute for Surgical Research, Munich, Germany University of Hamburg, Hamburg-Eppendorf University-Medical Center, Department of Anaesthesiology, Hamburg, Germany
G. I. Kemming
Affiliation:
Ludwig Maximilians University Munich, Großhadern University Hospital, Department of Anaesthesiology, Munich, Germany Ludwig Maximilians University Munich, Institute for Surgical Research, Munich, Germany
G. Schultheiß
Affiliation:
Ludwig Maximilians University Munich, Institute for Surgical Research, Munich, Germany
J. Starke
Affiliation:
Ludwig Maximilians University Munich, Institute for Surgical Research, Munich, Germany
A. Podtschaske
Affiliation:
Ludwig Maximilians University Munich, Institute for Surgical Research, Munich, Germany
A. E. Goetz
Affiliation:
University of Hamburg, Hamburg-Eppendorf University-Medical Center, Department of Anaesthesiology, Hamburg, Germany
D. A. Reuter
Affiliation:
Ludwig Maximilians University Munich, Institute for Surgical Research, Munich, Germany University of Hamburg, Hamburg-Eppendorf University-Medical Center, Department of Anaesthesiology, Hamburg, Germany
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Abstract

Summary

Background and objective: Measurement of central blood volumes (CBV), such as global end-diastolic volume (GEDV) and right ventricular end-diastolic volume (RVEDV) are considered appropriate estimates of intravascular volume status. However, to apply those parameters for preload assessment in mechanically ventilated patients, the influence of tidal volume (TV) and positive endexpiratory airway pressure (PEEP) on those parameters must be known. Methods: In 13 mechanically ventilated piglets, the effect of low (10 mL kg−1) and high (20 mL kg−1) TVs on CBV was investigated in absence and presence of PEEP (0 and 15 cmH2O). GEDV, RVEDV, right heart (RHEDV) and left heart end-diastolic volume (LHEDV) were measured by thermodilution. Blood flow on the descending thoracic aorta measured with an ultrasonic flow-probe served to determine stroke volume (SV). Measurements were performed during baseline conditions, after volume loading with previously extracted haemodilution blood (20 mL kg−1) and following haemorrhage (30 mL kg−1). Results: Application of PEEP decreased GEDV and SV significantly (P < 0.05). Augmenting TV did not reduce GEDV systematically, but significantly reduced SV (P < 0.05). Changes in ventilator settings only influenced RVEDV following volume loading (P < 0.05). RHEDV and LHEDV decreased following application of PEEP, but only RHEDV decreased after augmenting TV at baseline and following volume loading. Correlation of SV with parameters of CBV was r = 0.487 (P < 0.01) for GEDV, r = 0.553 (P < 0.01) for RVEDV, r = 0.596 (P < 0.01) for RHEDV and r = 0.303 (P < 0.01) for LHEDV. Conclusion: Application of PEEP decreases CBV and SV. Augmenting TV reduces SV but not CBV. There is a moderate correlation between parameters of CBV and cardiac performance.

Keywords

VENTRICULAR FUNCTIONBLOOD VOLUMECONTINUOUS POSITIVE AIRWAY PRESSURECARDIAC VOLUME, END-DIASTOLIC VOLUMETIDAL VOLUME
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 23 , Issue 11 , November 2006 , pp. 954 - 961
Copyright
2006 European Society of Anaesthesiology

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