The effect of positive end-expiratory pressure on cardiac output and oxygen delivery during cardiopulmonary resuscitation
Abstract Background Positive end-expiratory pressure (PEEP) is used to optimize oxygenation by preventing alveolar collapse. However, PEEP can potentially decrease cardiac output through cardiopulmonary interactions. The effect of PEEP on cardiac output during cardiopulmonary resuscitation (CPR) is...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2020-07-01
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| Series: | Intensive Care Medicine Experimental |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s40635-020-00330-2 |
| _version_ | 1819149930892099584 |
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| author | Yosef Levenbrown Md Jobayer Hossain James P. Keith Katlyn Burr Anne Hesek Thomas Shaffer |
| author_facet | Yosef Levenbrown Md Jobayer Hossain James P. Keith Katlyn Burr Anne Hesek Thomas Shaffer |
| author_sort | Yosef Levenbrown |
| collection | DOAJ |
| description | Abstract Background Positive end-expiratory pressure (PEEP) is used to optimize oxygenation by preventing alveolar collapse. However, PEEP can potentially decrease cardiac output through cardiopulmonary interactions. The effect of PEEP on cardiac output during cardiopulmonary resuscitation (CPR) is not known. Methods This was a preclinical randomized, controlled, animal study conducted in an animal research facility on 25 Landrace-Yorkshire pigs. After inducing cardiac arrest, CPR was performed with LUCAS 3. During CPR, pigs were ventilated at a PEEP of 0, 5, 10, 15, 20 cmH2O (randomly determined via lottery) for 9 min. Cardiac output, obtained via ultrasound dilution, and PaO2 were measured, and oxygen delivery calculated for each PEEP. Results A mixed-effects repeated-measures analysis of variance was used to compare the baseline value adjusted mean cardiac output, PaO2, and oxygen delivery between PEEP groups. Least significant difference test was used to conduct pairwise comparisons between PEEP groups. To determine optimum PEEP, Gaussian mixture model was applied to the adjusted means of cardiac output and oxygen delivery. Increasing PEEP to 10 and higher resulted in significant declines in cardiac output. A PEEP of 15 and higher resulted in significant declines in oxygen delivery. As PEEP was increased from 0 to 20, PaO2 increased significantly. Gaussian mixture model identified the 0–5 PEEP group as providing optimal cardiac output and oxygen delivery, with PEEP of 5 providing the highest oxygen delivery. Conclusions A PEEP of 0–5 resulted in the optimal oxygen delivery and cardiac output during CPR, with PEEP of 5 resulting in higher oxygen delivery, and a slightly lower, statistically insignificant cardiac output than PEEP of 0. |
| first_indexed | 2024-12-22T14:09:26Z |
| format | Article |
| id | doaj.art-a4ba729f56024a8a8c1fca32c3d9ca4e |
| institution | Directory Open Access Journal |
| issn | 2197-425X |
| language | English |
| last_indexed | 2024-12-22T14:09:26Z |
| publishDate | 2020-07-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Intensive Care Medicine Experimental |
| spelling | doaj.art-a4ba729f56024a8a8c1fca32c3d9ca4e2022-12-21T18:23:13ZengSpringerOpenIntensive Care Medicine Experimental2197-425X2020-07-018111110.1186/s40635-020-00330-2The effect of positive end-expiratory pressure on cardiac output and oxygen delivery during cardiopulmonary resuscitationYosef Levenbrown0Md Jobayer Hossain1James P. Keith2Katlyn Burr3Anne Hesek4Thomas Shaffer5Division of Pediatric Critical Care, Nemours/Alfred I. duPont Hospital for ChildrenNemours Biomedical ResearchDepartment of Respiratory Care, Nemours/Alfred I. duPont Hospital for ChildrenDepartment of Respiratory Care, Nemours/Alfred I. duPont Hospital for ChildrenNemours Biomedical ResearchNemours Biomedical Research/Research Lung CenterAbstract Background Positive end-expiratory pressure (PEEP) is used to optimize oxygenation by preventing alveolar collapse. However, PEEP can potentially decrease cardiac output through cardiopulmonary interactions. The effect of PEEP on cardiac output during cardiopulmonary resuscitation (CPR) is not known. Methods This was a preclinical randomized, controlled, animal study conducted in an animal research facility on 25 Landrace-Yorkshire pigs. After inducing cardiac arrest, CPR was performed with LUCAS 3. During CPR, pigs were ventilated at a PEEP of 0, 5, 10, 15, 20 cmH2O (randomly determined via lottery) for 9 min. Cardiac output, obtained via ultrasound dilution, and PaO2 were measured, and oxygen delivery calculated for each PEEP. Results A mixed-effects repeated-measures analysis of variance was used to compare the baseline value adjusted mean cardiac output, PaO2, and oxygen delivery between PEEP groups. Least significant difference test was used to conduct pairwise comparisons between PEEP groups. To determine optimum PEEP, Gaussian mixture model was applied to the adjusted means of cardiac output and oxygen delivery. Increasing PEEP to 10 and higher resulted in significant declines in cardiac output. A PEEP of 15 and higher resulted in significant declines in oxygen delivery. As PEEP was increased from 0 to 20, PaO2 increased significantly. Gaussian mixture model identified the 0–5 PEEP group as providing optimal cardiac output and oxygen delivery, with PEEP of 5 providing the highest oxygen delivery. Conclusions A PEEP of 0–5 resulted in the optimal oxygen delivery and cardiac output during CPR, with PEEP of 5 resulting in higher oxygen delivery, and a slightly lower, statistically insignificant cardiac output than PEEP of 0.http://link.springer.com/article/10.1186/s40635-020-00330-2Cardiopulmonary resuscitationPEEPCardiac outputVentilationResuscitation |
| spellingShingle | Yosef Levenbrown Md Jobayer Hossain James P. Keith Katlyn Burr Anne Hesek Thomas Shaffer The effect of positive end-expiratory pressure on cardiac output and oxygen delivery during cardiopulmonary resuscitation Intensive Care Medicine Experimental Cardiopulmonary resuscitation PEEP Cardiac output Ventilation Resuscitation |
| title | The effect of positive end-expiratory pressure on cardiac output and oxygen delivery during cardiopulmonary resuscitation |
| title_full | The effect of positive end-expiratory pressure on cardiac output and oxygen delivery during cardiopulmonary resuscitation |
| title_fullStr | The effect of positive end-expiratory pressure on cardiac output and oxygen delivery during cardiopulmonary resuscitation |
| title_full_unstemmed | The effect of positive end-expiratory pressure on cardiac output and oxygen delivery during cardiopulmonary resuscitation |
| title_short | The effect of positive end-expiratory pressure on cardiac output and oxygen delivery during cardiopulmonary resuscitation |
| title_sort | effect of positive end expiratory pressure on cardiac output and oxygen delivery during cardiopulmonary resuscitation |
| topic | Cardiopulmonary resuscitation PEEP Cardiac output Ventilation Resuscitation |
| url | http://link.springer.com/article/10.1186/s40635-020-00330-2 |
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