Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Clinical review: Positive end-expiratory pressure and cardiac output. | Available online http content 9 6 607 Review Clinical review Positive end-expiratory pressure and cardiac output Thomas Luecke1 and Paolo Pelosi2 Section Head Critical Care Department of Anesthesiology and Critical Care Medicine University Hospital of Mannheim Germany 2Associate Professor in Anaesthesia and Intensive Care Dipartimento di Scienze Cliniche e Biologiche Università degli Studi dell Insubria Varese Italy Corresponding author Thomas Luecke Published online 18 October 2005 This article is online at http content 9 6 607 2005 BioMed Central Ltd Critical Care 2005 9 607-621 DOI cc3877 Abstract In patients with acute lung injury high levels of positive end-expiratory pressure PEEP may be necessary to maintain or restore oxygenation despite the fact that aggressive mechanical ventilation can markedly affect cardiac function in a complex and often unpredictable fashion. As heart rate usually does not change with PEEP the entire fall in cardiac output is a consequence of a reduction in left ventricular stroke volume SV . PEEP-induced changes in cardiac output are analyzed therefore in terms of changes in SV and its determinants preload afterload contractility and ventricular compliance . Mechanical ventilation with PEEP like any other active or passive ventilatory maneuver primarily affects cardiac function by changing lung volume and intrathoracic pressure. In order to describe the direct cardiocirculatory consequences of respiratory failure necessitating mechanical ventilation and PEEP this review will focus on the effects of changes in lung volume factors controlling venous return the diastolic interactions between the ventricles and the effects of intrathoracic pressure on cardiac function specifically left ventricular function. Finally the hemodynamic consequences of PEEP in patients with heart failure chronic obstructive pulmonary disease and acute respiratory distress syndrome are .
