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The Annals of Thoracic Surgery, Vol 33, 585-592, Copyright © 1982 by The Society of Thoracic Surgeons
P Van Trigt, TL Spray, MK Pasque, RB Peyton, GL Pellom, CM Christian, L Fagraeus and AS Wechsler
To quantitate the alterations in left ventricular (LV) dimensions and
performance at successive levels of positive end-expiratory pressure
(PEEP), 16 patients undergoing coronary artery bypass grafting (CABG)
underwent instrumentation with ultrasonic dimension transducers to measure
the minor-axis diameter of the left ventricle. Matched micromanometers were
placed to measure intracavitary LV pressure and intrathoracic pressure. LV
pressure and dimension data were recorded and computer analyzed during
continuous positive-pressure ventilation at 0, 5, 10, and 15 cm H2O of PEEP
4 to 8 hours postoperatively. Preload was determined by the end-diastolic
minor-axis diameter, cardiac output was measured by thermodilution, and
indices of LV contractility assessed included the maximal velocity of
minor-axis shortening and the slope of the end-systolic pressure-diameter
relationship. PEEP produced a progressive increase in intrathoracic
pressure associated with a fall in cardiac output; this was associated with
a decrease in LV end-diastolic diameter and no significant change in the
maximal velocity of minor-axis shortening or the slope of the end-systolic
pressure-diameter relationship. Our results indicate that PEEP of 10 cm H2O
or greater will produce a significant fall in cardiac output in patients
following CABG, due to a decrease in preload rather than impaired LV
contractility.
ARTICLES
The effect of PEEP on left ventricular diastolic dimensions and systolic performance following myocardial revascularization
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