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Ann Thorac Surg 1985;40:464-468
© 1985 The Society of Thoracic Surgeons

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Articles

Cardiovascular Effects of Positive End-Expiratory Pressure (PEEP) after Pneumonectomy in Dogs

From the Departments of Surgery and Pediatrics, University of North Carolina, Chapel Hill, NC.

^* Address reprint requests to Dr. Lores, 108 Burnett-Womack Building 229H, University of North Carolina, Chapel Hill, NC 27514

Little is known regarding the hemodynamic effect of positive end-expiratory pressure (PEEP) following pneumonectomy. To investigate this, 9 mongrel dogs underwent PEEP before and after lung resection. With the chest closed, the dog anesthetized, and partial pressure of carbon dioxide constant, PEEP was added in increments of 2 mm Hg until the animal's condition became hemodynamically unstable. At each level of PEEP, aortic, pulmonary, left atrial, and central venous pressures were monitored while aortic flow (cardiac output) was determined with an electromagnetic probe and airway pressure was measured with a Millar catheter in the respiratory tubing. Pneumonectomy was then performed, PEEP was again sequentially added, and the same measurements were recorded. Both before and after pneumonectomy, a strong positive linear correlation exists between the level of PEEP and pulmonary vascular resistance (PVR) (r > 0.74; p < 0.05). Also, there is a high negative linear correlation between the level of PEEP and cardiac output (r > –0.76; p < 0.05). At 0 mm Hg of PEEP, the PVR is higher after pneumonectomy than before (p < 0.02). The incremental elevation in PVR persists after pneumonectomy at each level of PEEP, and in 5 of the 9 dogs the slope of the linear regression line relating PVR to PEEP was steeper following resection (p < 0.05), thereby demonstrating an exaggerated effect of PEEP on PVR. In addition, all animals had a lower cardiac output at each comparable level of PEEP following pneumonectomy (p < 0.05). These data show that PEEP decreases cardiac output and increases PVR both before and after pneumonectomy in the anesthetized dog with normal lungs. These exaggerated effects of PEEP following pneumonectomy need to be considered when using PEEP in a patient following pneumonectomy.

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