The influence of PEEP and tidal volume on central blood volume.
OBJECTIVE
Measurement of central blood volumes (CBV), such as global end-diastolic volume (GEDV) and right ventricular end-diastolic volume (RVEDV) are considered appropriate estimates of intravascular volume status. However, to apply those parameters for preload assessment in mechanically ventilated patients, the influence of tidal volume (TV) and positive endexpiratory airway pressure (PEEP) on those parameters must be known.


METHODS
In 13 mechanically ventilated piglets, the effect of low (10 mL kg(-1)) and high (20 mL kg(-1)) TVs on CBV was investigated in absence and presence of PEEP (0 and 15 cm H(2)O). GEDV, RVEDV, right heart (RHEDV) and left heart end-diastolic volume (LHEDV) were measured by thermodilution. Blood flow on the descending thoracic aorta measured with an ultrasonic flow-probe served to determine stroke volume (SV). Measurements were performed during baseline conditions, after volume loading with previously extracted haemodilution blood (20 mL kg(-1)) and following haemorrhage (30 mL kg(-1)).


RESULTS
Application of PEEP decreased GEDV and SV significantly (P < 0.05). Augmenting TV did not reduce GEDV systematically, but significantly reduced SV (P < 0.05). Changes in ventilator settings only influenced RVEDV following volume loading (P < 0.05). RHEDV and LHEDV decreased following application of PEEP, but only RHEDV decreased after augmenting TV at baseline and following volume loading. Correlation of SV with parameters of CBV was r = 0.487 (P < 0.01) for GEDV, r = 0.553 (P < 0.01) for RVEDV, r = 0.596 (P < 0.01) for RHEDV and r = 0.303 (P < 0.01) for LHEDV.


CONCLUSIONS
Application of PEEP decreases CBV and SV. Augmenting TV reduces SV but not CBV. There is a moderate correlation between parameters of CBV and cardiac performance.
Kubitz
J C
JC
Ludwig Maximilians University Munich, Grosshadern University Hospital, Department of Anaesthesiology, Munich, Germany. jkubitz@gmx.de
Kemming
G I
GI
Schultheiss
G
G
Starke
J
J
Podtschaske
A
A
Goetz
A E
AE
Reuter
D A
DA
D000818:Animals; D001810:Blood Volume / Q000502:physiology*; D023421:Models, Animal; D008991:Monitoring, Physiologic / Q000379:methods; D011175:Positive-Pressure Respiration / Q000379:methods; D012121:Respiration, Artificial / Q000379:methods*; D013223:Statistics as Topic; D034421:Sus scrofa; D013815:Thermodilution / Q000379:methods; D013990:Tidal Volume / Q000502:physiology*