title: Hemodynamic effects of positive end-expiratory pressure during abdominal hyperpression: a preliminary study in healthy volunteers.
abstract: OBJECTIVE
  An increase in abdominal pressure induces an increase in left ventricular afterload under clinical conditions. We tested the hypothesis that positive end-expiratory pressure (PEEP) could reverse the hemodynamic consequences of abdominal hyperpression by opposing the increase in left ventricular afterload.
  
  
  METHODS
  Eight healthy volunteers were investigated during 3 experimental conditions: (1) baseline, (2) increase in abdominal pressure by means of medical antishock trousers (MAST) inflation, and (3) addition of PEEP +10 cm H(2)O. Heart loading conditions and left ventricular systolic and diastolic function were assessed by transthoracic echocardiography.
  
  
  RESULTS
  The application of PEEP significantly reduced the prior increase in end-systolic wall stress: 45 ± 11 vs 55 ± 14 kdyn/cm(2), P < .05. Medical antishock trousers inflation significantly altered the deceleration time of mitral E wave: 199 ± 23 vs 156 ± 38 milliseconds, P < .05. Left ventricular preload and global systolic performance were unaffected by MAST and PEEP applications.
  
  
  CONCLUSIONS
  The increase in left ventricular afterload induced by MAST inflation can be efficiently reduced by the use of a moderate PEEP. Potential clinical applications in the abdominal compartment syndrome or in the setting of laparoscopic surgery should be developed.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, CHU de Caen, Caen, France. fellahi-jl@chu-caen.fr
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Fellahi
authors.forename: Vincent
authors.initials: V
authors.lastname: Caille
authors.forename: Cyril
authors.initials: C
authors.lastname: Charron
authors.forename: Georges
authors.initials: G
authors.lastname: Daccache
authors.forename: Antoine
authors.initials: A
authors.lastname: Vieillard-Baron
mesh_terms: D000005:Abdomen / Q000502:physiology*; D000328:Adult; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011175:Positive-Pressure Respiration; D011312:Pressure