Intraocular pressure during mechanical ventilation with different levels of positive end-expiratory pressure.
OBJECTIVE
To determine the effect of positive end-expiratory pressure (PEEP) on intraocular pressure.


METHODS
Prospective, controlled, longitudinal, dual center study. In one group, patients served as their own control. In the second group, isolated determinations of intraocular pressure were made in mechanically ventilated patients receiving PEEP.


METHODS
Adult intensive care units of two university hospitals.


METHODS
Intraocular pressures were measured serially in eight patients during the recovery phase of different clinical conditions and in 22 patients receiving mechanical ventilation with PEEP > or = 10 cm H2O for > 24 hrs.


METHODS
Group A) In eight patients, a PEEP dose-response curve was established (PEEP 0, 5, 10, 15, and 0 cm H2O every 15 mins). Intraocular pressures were measured at the end of each period. Group B) In 22 patients, measurement of intraocular pressures were done while the patients received mechanical ventilation with PEEP > or = 10 cm H2O for at least > 24 hrs.


RESULTS
In both groups, there was a positive correlation between the PEEP level and the central venous pressure (p < .05 in group A, and p < .03 in group B). No relationships between intraocular pressure and PEEP or central venous pressure were observed. However, there was a correlation between intraocular pressure and length of PEEP therapy (p < .03). We found ocular hypertension in only one patient (right eye intraocular pressure = 26 mm Hg; left eye intraocular pressure = 24 mm Hg).


CONCLUSIONS
Short-term therapy with PEEP of < or = 15 cm H2O does not present a clinically important significant risk for intraocular pressure increase in a population with normal basal ocular tonometry. During prolonged mechanical ventilation with PEEP, increments in intraocular pressure may occur, but these increments appear to not be of a clinically relevant magnitude.
Department of Medicine, West Virginia University Health Sciences Center, Morgantown 26506.
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D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000403:Airway Resistance; D001784:Blood Gas Analysis; D002496:Central Venous Pressure; D005260:Female; D006801:Humans; D007429:Intraocular Pressure; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009798:Ocular Hypertension / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D011175:Positive-Pressure Respiration / Q000009:adverse effects / Q000379:methods; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors