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Ann Thorac Surg 1975;19:552-560
© 1975 The Society of Thoracic Surgeons


Articles

Comparative Hemodynamic Consequences of Inflation Hold, PEEP, and Interrupted PEEP: An Experimental Study in Normal Dogs

Kenneth F. MacDonnell, M.D.*, Armand A. Lefemine, M.D., Hyung S. Moon, M.D., Daniel J. Donovan, A.B., Richard P. Johnston

Pulmonary and Respiratory Units and the Department of Cardio-Thoracic Surgery, St. Elizabeth's Hospital of Boston, Brighton, and the Departments of Medicine and Surgery, Tufts University School of Medicine, Boston, Mass

Accepted for publication November 26, 1974.

* Address reprint requests to Dr. MacDonnell, Pulmonary Unit, St. Elizabeth's Hospital, 736 Cambridge St., Brighton, Mass. 02135


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Cardiac output and airway, intrathoracic, arterial, pulmonary artery, left atrial, and central venous pressures were studied in 8 mongrel dogs. They were anesthetized and ventilated with (1) inflation hold of various duration, (2) continuous positive end-expiratory pressure (PEEP), and (3) interrupted PEEP (three breaths on positive end-expiratory pressure and one breath off).

The results indicate a minimal decrease in cardiac output (of approximately 5%) with inflation hold. Diminished cardiac output was noted with increasing levels of continuous PEEP. The severity of the decrease in cardiac output was proportional to the airway pressure. The higher levels (20 cm H2O) of PEEP were associated with profound decreases. Utilization of a technique of interrupted PEEP substantially reduced the adverse hemodynamic effects in the dog.


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Supported by National Institutes of Health General Research Support Grant no. 5587.


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  1. Ashbaugh DG, Petty TL, Bigelow DB, Harris TM. Continuous positive pressure breathing (CPPB) in adult respiratory distress syndrome J Thorac Cardiovasc Surg 1969;57:31.[Medline]
  2. Colgan F, Marocco P. Cardiac respiratory effects of constant and intermittent positive pressure breathing Anesthesiology 1972;36:444.[Medline]
  3. Cournand A, Motley H, Werko L, Richards D. Physiological studies of the effects of intermittent positive pressure breathing on cardiac output in man Am J Physiol 1948;152:162.[Medline]
  4. Hubay CA, Brecher GA, Clement FL. Etiological factors affecting pulmonary artery flow with controlled respiration Surgery 1955;38:215.[Medline]
  5. Mead, J., and Whittenberger, J. L. Lung Inflation and Hemodynamics. In W. O. Fenn and H. Rahn (Eds), Handbook of Physiology: Section 3, Respiration, 1964. Vol I, p477.
  6. Milnor WR. Physiology in medicine N Engl J Med 1972;287:27.[Medline]
  7. Morgan B, Martin N, Honbein T, Crawford E, Guntheroth W. Hemodynamic effects of intermittent positive pressure respirators Anesthesiology 1966;27:584.[Medline]
  8. Powers Jr. SR, Mannal R, Neclerio M, English M, Marr C, Leather R, Ueda H, Williams G, Custead W, Dutton R. Physiologic consequences of positive end-expiratory pressure (PEEP) ventilation Ann Surg 1973;178:265.[Medline]
  9. West JB. Distribution of Blood Flow and Ventilation Measurements Measured with Radioactive GasesIn: Simon M, editor. Frontiers in Pulmonary Radiology. New York: Grune & Stratton; 1969. pp. 174.




This Article
Right arrow Abstract Freely available
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Right arrow Add to Personal Folders
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Right arrow Articles by MacDonnell, K. F.
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PubMed
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Right arrow Articles by MacDonnell, K. F.
Right arrow Articles by Johnston, R. P.