Interactions between hemodynamic and hormonal modifications during PEEP-induced antidiuresis and antinatriuresis.
The interactions between hemodynamic and hormonal modifications during antidiuresis and antinatriuresis induced by positive end-expiratory pressure (PEEP) were studied in six patients under 15 cm H2O PEEP before PEEP and after the addition of lower body positive pressure (LBPP) to PEEP (PEEP+LBPP). We measured or calculated the following: cardiac index, systemic arterial, right atrial, pulmonary arterial, and pulmonary artery occlusive pressures; indexed renal blood flow (iodohippurate 131 sodium clearance); total blood volume (chromium 51 radiolabeled RBCs); glomerular filtration rate; urinary output; fractional excretion of sodium (FE Na+); plasma concentrations of antidiuretic hormone (ADH), plasma renin activity (PRA), norepinephrine and epinephrine; urinary concentration of PGE2 (PGE2u). Although LBPP application corrected PEEP deleterious effects on systemic and renal hemodynamics, sustained fall in Vu and in FE Na+ were observed. Antidiuresis was not due to ADH release. Sympathetic activation and high PRA appeared the main determinants of renal function alterations in PEEP ventilation.
Farge
D
D
Department of Anesthesiology and Intensive Care, University Hospital, Paris, France.
De la Coussaye
J E
JE
Beloucif
S
S
Fratacci
M D
MD
Payen
D M
DM
D000328:Adult; D004231:Diuresis; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D008297:Male; D009318:Natriuresis; D011175:Positive-Pressure Respiration; D012964:Sodium / Q000652:urine; D014667:Vasopressins / Q000097:blood
D014667:Vasopressins; D012964:Sodium