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2026, Number 1

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Med Crit 2026; 40 (1)

Behavior of pulmonary artery acceleration time with increases in PEEP in patients undergoing mechanical ventilation

Hernández BFP, López RKH, Vidals SM, Zamora GSE, Alva AN, Gasca AJC

Language: Spanish
References: 26
Page: 25-29
PDF size: 307.58 Kb.


ABSTRACT

This study analyzes the impact of positive end-expiratory pressure (PEEP) on cardiopulmonary hemodynamics in patients undergoing invasive mechanical ventilation, with a particular focus on pulmonary artery acceleration time (PAAT) as a noninvasive echocardiographic parameter. This study evaluated the impact of increases in PEEP on PAAT and hemodynamic parameters in patients undergoing invasive mechanical ventilation. Thirty-five patients were included, with a mean age of 48.6 ± 14 years, 53.3% male, and a mean body mass index of 29.2 ± 7.5 kg/m2. The severity assessment on admission showed a mean APACHE II score of 16.1 ± 3.5 and a SOFA score of 9.2 ± 3.1. Acute respiratory distress syndrome (ARDS) was diagnosed at admission in 34.3% of cases, with a mean PaO2/FiO2 ratio of 190.7 ± 45. During the PEEP escalation maneuver (5, 10, and 15 cmH2O), there was a trend toward a decrease in the TAAP (118.4 ± 13.6, 115.9 ± 13.5, and 112.8 ± 19.7 ms, respectively), as well as a progressive decrease in the S wave (15, 14.6, and 13.9 cm/s). The TAPSE showed relative stability, while the PSAP and TAPSE/PSAP remained unchanged. Static compliance (SCr) decreased from 39.7 ± 6.8 to 37.8 ± 8.7 mL/cmH2O as PEEP increased. Bivariate analysis did not identify statistically significant differences between variables at different PEEP levels; however, a consistent trend toward right ventricular hemodynamic deterioration was documented, reflected in reduced PAAT and systolic contractility (S wave).


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