medigraphic.com

2026, Number 1

<< Back Next >>

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).


REFERENCES

  1. Slutsky AS, Ranieri VM. Ventilator-induced lung injury. N Engl J Med. 2013;369(22):2126-2136.

  2. Gattinoni L, Carlesso E, Cressoni M. Evolution of PEEP: "how should we set it?" Intensive Care Med. 2010;36(10):1615-1622.

  3. Gattinoni L, Carlesso E, Cressoni M. The "baby lung" became an adult. Intensive Care Med. 2011;37(3):380-382.

  4. Branson RD. Modes of mechanical ventilation: conventional respiratory care techniques for the acute care hospital and home. Respir Care. 2009;54(1):120-137.

  5. Marini JJ, Culver BH, Butler J. Mechanical effect of lung distention with positive pressure on cardiac function. Am Rev Respir Dis. 1981;124(4):382-386.

  6. Nanas S, Magder S. Adaptations of the peripheral circulation to PEEP. Am Rev Respir Dis. 1992;146(3):688-693.

  7. Pinsky MR. Cardiovascular issues in respiratory care. Chest. 2005;128(5 Suppl 2):592S-597S.

  8. Protti A, Andreis DT, Monti M, et al. Lung stress and strain during mechanical ventilation: any difference between statics and dynamics? Crit Care Med. 2013;41(4):1046-1055.

  9. Rudski LG, Lai WW, Afilalo J, et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr. 2010;23(7):685-713; quiz 786-788.

  10. Tei C, Dujardin KS, Hodge DO, et al. Doppler echocardiographic index for assessment of global right ventricular function. J Am Soc Echocardiogr. 1996;9(6):838-847.

  11. Jardin F, Vieillard-Baron A. Right ventricular function and positive pressure ventilation in clinical practice: from hemodynamic subsets to respirator settings. Intensive Care Med. 2003;29(9):1426-1434.

  12. World Medical Association. Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310(20):2191-2194. doi: 10.1001/jama.2013.281053.

  13. Secretaría de Salud. Reglamento de la Ley General de Salud en Materia de Investigación para la Salud. Diario Oficial de la Federación. 2007.

  14. Secretaría de Salud. NORMA Oficial Mexicana NOM-012-SSA3-2012, que establece los criterios para la ejecución de proyectos de investigación para la salud en seres humanos. Diario Oficial de la Federación. 2013 [consultado 27 Jun 2022]. Disponible en: https://dof.gob.mx/nota_detalle.php?codigo=5284148&fecha=04/01/2013#gsc.tab=0

  15. Dreyfuss D, Saumon G. Ventilator-induced lung injury: lessons from experimental studies. Am J Respir Crit Care Med. 1998;157(1):294-323.

  16. Webb HH, Tierney DF. Experimental pulmonary edema due to intermittent positive pressure ventilation with high inflation pressures. Protection by positive end-expiratory pressure. Am Rev Respir Dis. 1974;110(5):556-565.

  17. West JB. Regional differences in gas exchange in the lung due to gravitational effect. J Appl Physiol. 1962;17:893-898.

  18. Rahn H, Otis AB, Hieger HA, Mink IF. The pressure-volume diagram of the thorax and lung. Am J Physiol. 1946;147:161-178.

  19. Pinsky MR. Heart-lung interactions during mechanical ventilation. Curr Opin Crit Care. 2012;18(3):256-260.

  20. Repessé X, Charron C, Vieillard-Baron A. Right ventricular failure in acute respiratory distress syndrome: mechanisms and management. Curr Opin Crit Care. 2016;22(3):230-235.

  21. Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the ASE and EACVI. J Am Soc Echocardiogr. 2015;28(1):1-39.e14.

  22. Forfia PR, Fisher MR, Mathai SC, et al. Tricuspid annular displacement predicts survival in pulmonary hypertension. Am J Respir Crit Care Med. 2006;174(9):1034-1041.

  23. Dabestani A, Mahan G, Gardin JM, et al. Evaluation of pulmonary artery pressure and resistance by pulsed Doppler echocardiography. Am J Cardiol. 1987;59(6):662-668.

  24. Tossavainen E, Soderberg S, Grönlund C, Gonzalez M, Henein MY, Lindqvist P. Pulmonary artery acceleration time in identifying pulmonary hypertension patients with raised pulmonary vascular resistance. Eur Heart J Cardiovasc Imaging. 2013;14(9):890-897.

  25. Bowcock EM, Gerhardy B, Huang S, Orde S. Right ventricular outflow tract Doppler flow analysis and pulmonary arterial coupling by transthoracic echocardiography in sepsis: a retrospective exploratory study. Crit Care. 2022;26(1):303.

  26. Vieillard-Baron A, Prigent A, Repessé X, Goudelin M, Prat G, Evrard B, Charron C, Vignon P, Geri G. Right ventricular failure in septic shock: characterization, incidence and impact on fluid responsiveness. Crit Care. 2020;24(1):630.




2020     |     www.medigraphic.com