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Title: Myocardial Function during Ventilation with Lower versus Higher Positive End-Expiratory Pressure in Patients without ARDS.
Austin Authors: Algera, Anna Geke;Pierrakos, Charalampos;Botta, Michela;Zimatore, Claudio;Pisani, Luigi;Tuinman, Pieter-Roel;Bos, Lieuwe D J;Lagrand, Wim K;Gama de Abreu, Marcello;Pelosi, Paolo;Serpa Neto, Ary ;Schultz, Marcus J;Cherpanath, Thomas G V;Paulus, Frederique
Affiliation: Data Analytics Research and Evaluation (DARE) Centre
Intensive Care
Medicine (University of Melbourne)
Department of Intensive Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo 05652-900, Brazil
Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
Department of Intensive Care, Amsterdam University Medical Centers Location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
Department of Intensive Care, Brugmann University Hospital, Université Libre de Bruxelles, 1020 Brussel, Belgium
Nuffield Department of Medicine, Oxford University, Oxford OX3 7BN, UK
Section of Anesthesia and Intensive Care, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, 70124 Bari, Italy
Laboratory of Experimental Intensive Care and Anesthesiology (LEICA), Amsterdam University Medical Centers Location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
Department of Intensive Care & Research VUmc Intensive Care (REVIVE), Amsterdam University Medical Centers Location Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok 10400, Thailand
Department of Anesthesiology and Intensive Care, University Hospital Carl Gustav Carus, 01307 Dresden, Germany
Department of Surgical Sciences and Integrated Diagnostics, IRCCS San Martino Policlinico Hospital, University of Genoa, 16132 Genoa, Italy
Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, 1095 DZ Amsterdam, The Netherlands
Issue Date: 21-Apr-2022
Date: 2022
Publication information: Journal of Clinical Medicine 2022; 11(9): 2309
Abstract: The aim of this study was to investigate whether lower PEEP (positive end-expiratory pressure) had beneficial effects on myocardial function among intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) compared to higher PEEP. In this pre-planned substudy of a randomized controlled trial (RELAx), comparing lower to higher PEEP, 44 patients underwent transthoracic echocardiography. The exclusion criteria were known poor left ventricular function and severe shock requiring high dosages of norepinephrine. To create contrast, we also excluded patients who received PEEP between 2 cmH2O and 7 cmH2O in the two randomization arms of the study. The primary outcome was the right ventricular myocardial performance index (MPI), a measure of systolic and diastolic function. The secondary outcomes included systolic and diastolic function parameters. A total of 20 patients were ventilated with lower PEEP (mean ± SD, 0 ± 1 cmH2O), and 24 patients, with higher PEEP (8 ± 1 cmH2O) (mean difference, -8 cmH2O; 95% CI: -8.1 to -7.9 cmH2O; p = 0.01). The tidal volume size was low in both groups (median (IQR), 7.2 (6.3 to 8.1) versus 7.0 (5.3 to 9.1) ml/kg PBW; p = 0.97). The median right ventricular MPI was 0.32 (IQR, 0.26 to 0.39) in the lower-PEEP group versus 0.38 (0.32 to 0.41) in the higher-PEEP group; the median difference was -0.03; 95% CI: -0.11 to 0.03; p = 0.33. The other systolic and diastolic parameters were similar. In patients without ARDS ventilated with a low tidal volume, a lower PEEP had no beneficial effects on the right ventricular MPI.
DOI: 10.3390/jcm11092309
ORCID: 0000-0003-2675-4604
Journal: Journal of Clinical Medicine
PubMed URL: 35566435
PubMed URL:
ISSN: 2077-0383
Type: Journal Article
Subjects: ARDS
mechanical ventilation
myocardial function
Appears in Collections:Journal articles

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