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. 1982 Feb;195(2):121–130. doi: 10.1097/00000658-198202000-00001

Cardiovascular effects of ventilation with positive expiratory airway pressure.

P K Smith, G S Tyson Jr, J W Hammon Jr, C O Olsen, R A Hopkins, G W Maier, D C Sabiston Jr, J S Rankin
PMCID: PMC1352430  PMID: 7034659

Abstract

The broad clinical application of positive and expiratory pressure (PEEP) in the treatment of a variety of respiratory disorders has led to the observation that positive airway pressure can result in cardiac dysfunction. Recent attempts to integrate and extend the results of past research have led to diverse explanations of the overall cardiopulmonary effects of PEEP. This review summarizes previous work in the field and attempts to explain the basis of the divergent conclusions of previous investigators. Data are presented from several experimental models, as well as studies in postoperative patients to formulate an overall analysis of the influence of airway pressure on the central circulation. It appears that the effects of PEEP are primarily mechanical and are mediated through a combination of right ventricular preload limitation and outflow obstruction. Both effects are additive in limiting left ventricular preload and can be ameliorated by volume loading in the absence of significant right ventricular or pulmonary vascular disease. Neural, humoral and ventricular interactive forces appear to be insignificant under most circumstances. The clinical implications of these advances in the current understanding of PEEP are reviewed.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

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