Myocardial Function during Ventilation with Lower versus Higher Positive End-Expiratory Pressure in Patients without ARDS

Anna Geke Algera^{1

2}, Charalampos Pierrakos^{1

3}, Michela Botta^{1

2}, Claudio Zimatore^{1

2

4}, Luigi Pisani^{1

5}, Pieter-Roel Tuinman⁶, Lieuwe D J Bos^{1

2}, Wim K Lagrand¹, Marcello Gama de Abreu⁷, Paolo Pelosi⁸, Ary Serpa Neto^{9

10

11

12}, Marcus J Schultz^{1

2

5

13}, Thomas G V Cherpanath¹, Frederique Paulus^{1

14}

Affiliations

¹ Department of Intensive Care, Amsterdam University Medical Centers Location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
² Laboratory of Experimental Intensive Care and Anesthesiology (LEICA), Amsterdam University Medical Centers Location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
³ Department of Intensive Care, Brugmann University Hospital, Université Libre de Bruxelles, 1020 Brussel, Belgium.
⁴ Section of Anesthesia and Intensive Care, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, 70124 Bari, Italy.
⁵ Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok 10400, Thailand.
⁶ Department of Intensive Care & Research VUmc Intensive Care (REVIVE), Amsterdam University Medical Centers Location Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands.
⁷ Department of Anesthesiology and Intensive Care, University Hospital Carl Gustav Carus, 01307 Dresden, Germany.
⁸ Department of Surgical Sciences and Integrated Diagnostics, IRCCS San Martino Policlinico Hospital, University of Genoa, 16132 Genoa, Italy.
⁹ Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia.
¹⁰ Department of Critical Care Medicine, Melbourne Medical School, Austin Hospital, University of Melbourne, Heidelberg, VIC 3084, Australia.
¹¹ Data Analytics Research and Evaluation (DARE) Centre, Austin Hospital, Heidelberg, VIC 3084, Australia.
¹² Department of Intensive Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo 05652-900, Brazil.
¹³ Nuffield Department of Medicine, Oxford University, Oxford OX3 7BN, UK.
¹⁴ Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, 1095 DZ Amsterdam, The Netherlands.

PMID: 35566435
PMCID: PMC9104897
DOI: 10.3390/jcm11092309

Myocardial Function during Ventilation with Lower versus Higher Positive End-Expiratory Pressure in Patients without ARDS

Anna Geke Algera et al. J Clin Med. 2022.

. 2022 Apr 21;11(9):2309.

doi: 10.3390/jcm11092309.

Authors

Affiliations

¹ Department of Intensive Care, Amsterdam University Medical Centers Location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
² Laboratory of Experimental Intensive Care and Anesthesiology (LEICA), Amsterdam University Medical Centers Location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
³ Department of Intensive Care, Brugmann University Hospital, Université Libre de Bruxelles, 1020 Brussel, Belgium.
⁴ Section of Anesthesia and Intensive Care, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, 70124 Bari, Italy.
⁵ Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok 10400, Thailand.
⁶ Department of Intensive Care & Research VUmc Intensive Care (REVIVE), Amsterdam University Medical Centers Location Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands.
⁷ Department of Anesthesiology and Intensive Care, University Hospital Carl Gustav Carus, 01307 Dresden, Germany.
⁸ Department of Surgical Sciences and Integrated Diagnostics, IRCCS San Martino Policlinico Hospital, University of Genoa, 16132 Genoa, Italy.
⁹ Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia.
¹⁰ Department of Critical Care Medicine, Melbourne Medical School, Austin Hospital, University of Melbourne, Heidelberg, VIC 3084, Australia.
¹¹ Data Analytics Research and Evaluation (DARE) Centre, Austin Hospital, Heidelberg, VIC 3084, Australia.
¹² Department of Intensive Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo 05652-900, Brazil.
¹³ Nuffield Department of Medicine, Oxford University, Oxford OX3 7BN, UK.
¹⁴ Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, 1095 DZ Amsterdam, The Netherlands.

PMID: 35566435
PMCID: PMC9104897
DOI: 10.3390/jcm11092309

Abstract

The aim of this study was to investigate whether lower PEEP (positive end-expiratory pressure) had beneficial effects on myocardial function among intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) compared to higher PEEP. In this pre-planned substudy of a randomized controlled trial (RELAx), comparing lower to higher PEEP, 44 patients underwent transthoracic echocardiography. The exclusion criteria were known poor left ventricular function and severe shock requiring high dosages of norepinephrine. To create contrast, we also excluded patients who received PEEP between 2 cmH2O and 7 cmH2O in the two randomization arms of the study. The primary outcome was the right ventricular myocardial performance index (MPI), a measure of systolic and diastolic function. The secondary outcomes included systolic and diastolic function parameters. A total of 20 patients were ventilated with lower PEEP (mean ± SD, 0 ± 1 cmH2O), and 24 patients, with higher PEEP (8 ± 1 cmH2O) (mean difference, -8 cmH2O; 95% CI: -8.1 to -7.9 cmH2O; p = 0.01). The tidal volume size was low in both groups (median (IQR), 7.2 (6.3 to 8.1) versus 7.0 (5.3 to 9.1) ml/kg PBW; p = 0.97). The median right ventricular MPI was 0.32 (IQR, 0.26 to 0.39) in the lower-PEEP group versus 0.38 (0.32 to 0.41) in the higher-PEEP group; the median difference was -0.03; 95% CI: -0.11 to 0.03; p = 0.33. The other systolic and diastolic parameters were similar. In patients without ARDS ventilated with a low tidal volume, a lower PEEP had no beneficial effects on the right ventricular MPI.

Keywords: ARDS; ICU; MPI; PEEP; mechanical ventilation; myocardial function.

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Conflict of interest statement

Gama de Abreu reports the receipt of grants and personal fees from ZOLL and Drager Medical and personal fees from GE Healthcare and Ambu. Serpa Neto reports the receipt of lecture fees from Drager. Schultz reports receiving speakers’ fees and travel and lodging for a 2018 workshop organized by Hamilton. The other authors declare no competing interests.

Figures

**Figure 1**
Flow of patients. Abbreviations: PEEP, positive end-expiratory pressure.

See this image and copyright information in PMC

References

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Myocardial Function during Ventilation with Lower versus Higher Positive End-Expiratory Pressure in Patients without ARDS

Affiliations

Myocardial Function during Ventilation with Lower versus Higher Positive End-Expiratory Pressure in Patients without ARDS

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References