Echocardiographic Measures of Diastolic Function Are Preload Dependent during Triggered Positive Pressure Ventilation: A Controlled Crossover Study in Healthy Subjects

Background. The use of echocardiography in intensive care settings impacts decision making. A prerequisite for the use of echocardiography is relative resistance to changes in volume status and levels of positive pressure ventilation (PPV). Studies on indices of diastolic function report conflicting...

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Main Authors: Peter Juhl-Olsen, Christian Alcaraz Frederiksen, Johan Fridolf Hermansen, Carl-Johan Jakobsen, Erik Sloth
Format: Article
Language:English
Published: Hindawi Limited 2012-01-01
Series:Critical Care Research and Practice
Online Access:http://dx.doi.org/10.1155/2012/703196
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spelling doaj-28679b0df3f64d1ea7cc0a6839a40dc02020-11-24T23:15:31ZengHindawi LimitedCritical Care Research and Practice2090-13052090-13132012-01-01201210.1155/2012/703196703196Echocardiographic Measures of Diastolic Function Are Preload Dependent during Triggered Positive Pressure Ventilation: A Controlled Crossover Study in Healthy SubjectsPeter Juhl-Olsen0Christian Alcaraz Frederiksen1Johan Fridolf Hermansen2Carl-Johan Jakobsen3Erik Sloth4Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Skejby, Brendstrupgaardsvej 100, 8200 Aarhus N, DenmarkDepartment of Anaesthesiology and Intensive Care, Aarhus University Hospital, Skejby, Brendstrupgaardsvej 100, 8200 Aarhus N, DenmarkDepartment of Anaesthesiology and Intensive Care, Aarhus University Hospital, Skejby, Brendstrupgaardsvej 100, 8200 Aarhus N, DenmarkDepartment of Anaesthesiology and Intensive Care, Aarhus University Hospital, Skejby, Brendstrupgaardsvej 100, 8200 Aarhus N, DenmarkDepartment of Anaesthesiology and Intensive Care, Aarhus University Hospital, Skejby, Brendstrupgaardsvej 100, 8200 Aarhus N, DenmarkBackground. The use of echocardiography in intensive care settings impacts decision making. A prerequisite for the use of echocardiography is relative resistance to changes in volume status and levels of positive pressure ventilation (PPV). Studies on indices of diastolic function report conflicting results with regard to dependence on volume status. Evidence is scarce on PPV. Methods. Ten healthy subjects were exposed to 6 levels of positive end-expiratory pressure (PEEP) and pressure support (PS) following a baseline reading. All ventilator settings were performed at three positions: horizontal, reverse-Trendelenburg, and Trendelenburg. Echocardiography was performed throughout. Results. During spontaneous breathing, early diastolic transmitral velocity () changed with positioning (), whereas early diastolic velocity of the mitral annulus () was independent (). With PPV, and proved preload dependent (). Increases in PEEP, PS, or a combination influenced and in reverse-Trendelenburg- and horizontal positions, but not in the Trendelenburg position. Discussion. The change towards preload dependency of with PPV suggests that PPV increases myocardial preload sensitivity. The susceptibility of and to preload changes during PPV discourages their use in settings of volume shifts or during changes in ventilator settings. Conclusion. Positioning and PPV affect and .http://dx.doi.org/10.1155/2012/703196
collection DOAJ
language English
format Article
sources DOAJ
author Peter Juhl-Olsen
Christian Alcaraz Frederiksen
Johan Fridolf Hermansen
Carl-Johan Jakobsen
Erik Sloth
spellingShingle Peter Juhl-Olsen
Christian Alcaraz Frederiksen
Johan Fridolf Hermansen
Carl-Johan Jakobsen
Erik Sloth
Echocardiographic Measures of Diastolic Function Are Preload Dependent during Triggered Positive Pressure Ventilation: A Controlled Crossover Study in Healthy Subjects
Critical Care Research and Practice
author_facet Peter Juhl-Olsen
Christian Alcaraz Frederiksen
Johan Fridolf Hermansen
Carl-Johan Jakobsen
Erik Sloth
author_sort Peter Juhl-Olsen
title Echocardiographic Measures of Diastolic Function Are Preload Dependent during Triggered Positive Pressure Ventilation: A Controlled Crossover Study in Healthy Subjects
title_short Echocardiographic Measures of Diastolic Function Are Preload Dependent during Triggered Positive Pressure Ventilation: A Controlled Crossover Study in Healthy Subjects
title_full Echocardiographic Measures of Diastolic Function Are Preload Dependent during Triggered Positive Pressure Ventilation: A Controlled Crossover Study in Healthy Subjects
title_fullStr Echocardiographic Measures of Diastolic Function Are Preload Dependent during Triggered Positive Pressure Ventilation: A Controlled Crossover Study in Healthy Subjects
title_full_unstemmed Echocardiographic Measures of Diastolic Function Are Preload Dependent during Triggered Positive Pressure Ventilation: A Controlled Crossover Study in Healthy Subjects
title_sort echocardiographic measures of diastolic function are preload dependent during triggered positive pressure ventilation: a controlled crossover study in healthy subjects
publisher Hindawi Limited
series Critical Care Research and Practice
issn 2090-1305
2090-1313
publishDate 2012-01-01
description Background. The use of echocardiography in intensive care settings impacts decision making. A prerequisite for the use of echocardiography is relative resistance to changes in volume status and levels of positive pressure ventilation (PPV). Studies on indices of diastolic function report conflicting results with regard to dependence on volume status. Evidence is scarce on PPV. Methods. Ten healthy subjects were exposed to 6 levels of positive end-expiratory pressure (PEEP) and pressure support (PS) following a baseline reading. All ventilator settings were performed at three positions: horizontal, reverse-Trendelenburg, and Trendelenburg. Echocardiography was performed throughout. Results. During spontaneous breathing, early diastolic transmitral velocity () changed with positioning (), whereas early diastolic velocity of the mitral annulus () was independent (). With PPV, and proved preload dependent (). Increases in PEEP, PS, or a combination influenced and in reverse-Trendelenburg- and horizontal positions, but not in the Trendelenburg position. Discussion. The change towards preload dependency of with PPV suggests that PPV increases myocardial preload sensitivity. The susceptibility of and to preload changes during PPV discourages their use in settings of volume shifts or during changes in ventilator settings. Conclusion. Positioning and PPV affect and .
url http://dx.doi.org/10.1155/2012/703196
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