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The effect of PEEP on the right ventricle.A transeosophageal echocardiography and tissue Doppler study
Authors: Margaritis A, Patsouras D, Tsigaridas N, Rammos A, Bolosi M, Ygropoulou O, Tzimas P, Papadopoulos G.
Number of views: 356
The aim of this study was to determine how low and moderate levels of PEEP affect right ventricular structure and function.
The study involved 14 patients under mechanical ventilation (pressure controlled). To perform the study, we used transesophageal echocardiography (M-mode, two-dimensional,tissue Doppler) and 10 parameters were recorded. Measurements were performed initially with PEEP 0 cmΗ2Ο, then 10 minutes after applying PEEP 5cmΗ2Ο and 10 minutes after applying PEEP 10cmΗ2Ο.
After applying PEEP 5 cmH2O, there was no statistically significant change observed in any parameter. In contrast, after the application of PEEP 10cmH2O, significant changes in most parameters were recorded: St changed from 10,86±3,8 cm/sec (mean±SD) at ΡΕΕΡ 0 cmH2O to 8,7±2,9 at PEEP 10 cmH2O, TAPSE changed from 2,876±0,643cm to 2,385±0,556cm, IVA from 2,2692±0,93m/sec2 to 2,8536±1,628m/sec2, ΕΤ from 259,27±17,47 msec to 229,34±31,22msec,EDA from 21,372±5,01cm2 to 18,87±4,15cm2, left ventricular eccentricity index at end-diastole from 0,9±0,07 to 0,99±0,08. After applying PEEP 10cmH2O, a trend towards an increase in MPI index of right ventricle and a decline in ESA of the right ventricle were recorded. With respect to other parameters no statistically significant differences were recorded.
After applying ΡΕΕΡ=5cmH2O there is no significant change noted in the overall structure and function of right heart. After applying ΡΕΕΡ=10cmH2O changes were recorded in the structure and function of right ventricle caused mainly by the reduction of preload and less by the augmentation of afterload.