The hemodynamic influence of positive end expiratory pressures titrated by different methods on patients with acute respiratory distress syndrome
HUANG Li-ping
FU Hui
WANG Qiao-sheng
TANG Shi-lin
PENG Liang-shan
Abstract：Objective To investigate the hemodynamic influence of positive end expiratory pressures (PEEPs) titrated by different methods on patients with acute respiratory distress syndrome (ARDS).Methods A prospective self-control observational study was conducted.Moderate to severe ARDS patients in the early stage were enrolled from June 2014 to June 2016, who received recruitment maneuver and followed by a decremented PEEP trail, so as the optimal PEEPs were titrated using optimal oxygenation, best static pulmonary compliance and the lowest dead space fraction methods.The parameters of respiratory mechanics, blood gas analysis and hemodynamic were observed.Results Totally 19 patients were enrolled according to the criteria (13 male), with age of 49±11years old, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score of 20.8±6.41.Among them, 12 patients were moderate ARDS and 9 were severe ARDS.The optimal PEEP titrated by optimal oxygenation (16.7±3.7 cmH2O) was significantly higher than the baseline (5.0±0.0 cmH2O), and the PEEPs titrated by best static pulmonary compliance (10.9±2.9 cmH2O) and lowest dead space fraction (11.5±3.8 cmH2O) (P<0.05).The optimal PEEP titrated by best oxygenation resulted in significant higher PaO2/FiO2 (313.7±88.5 mmHg) than the baseline (151.7±49.2 mmHg), and those using PEEPs titrated by best static pulmonary compliance (268.6±92.6 mmHg) and lowest dead space fraction (261.7±71.4 mmHg) (P<0.05);also significant lower pulmonary compliance (Cst) (49.7±12.25 mL/cmH2O) and higher dead space fraction (Vd/Vt) (58.9±15.87%) than those using best static pulmonary compliance method (63.3±9.88 mL/cmH2O and 53.3±11.63%) and lowest dead space fraction method (62.5±14.73 mL/cmH2O and 50.1±9.41%) (P<0.05).Compared with using best static pulmonary compliance method and lowest dead space fraction method, using best oxygenation method could result in significant increased CVP (18.6±5.9 vs.14.8±3.8 and 15.1±3.7 cmH2O, P<0.05), decreased cardiac output (CO) (3.81±1.32 vs.4.28±0.99 and 4.32±1.44 L/min, P<0.05) and delivery oxygen (DO2) (472.1±133.78 vs.501.8±99.89 and 509.4±103.47 mL/min, P<0.05).There was no significant difference in heart rate (HR) (95.3±9.5 vs.91.9±8.6 and 90.7±12.7 bpm), mean artery pressure (MAP) (64.9±14.4 vs.73.4±12.6 and 73.3±7.8 mmHg) or central venous saturation (ScvO2) (67.74±10.26 vs.70.53±11.54 and 68.87±15.64%) among the 3 methods (all P>0.05).Conclusion The optimal PEEP titrated by best oxygenation method is the highest one, but significantly reduces the CO and DO2.The optimal PEEPs titrated by best static pulmonary compliance and the lowest dead space fraction are lower but do not influence the CO and DO2 in ARDS patients.
Keywords：acute respiratory distress syndromepositive end expiratory pressurepulmonary compliancedead spacecardiac output
Publication Date：2017-01-01
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：6( 2141-2146 )