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The effect of positive‐end‐expiratory pressure on stroke volume variation: An experimental study in dogs
Author(s) -
Nakashima Tsuyoshi,
Kawazoe Yu,
Iseri Toshie,
Miyamoto Kyohei,
Fujimoto Yuka,
Kato Seiya
Publication year - 2020
Publication title -
clinical and experimental pharmacology and physiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.752
H-Index - 103
eISSN - 1440-1681
pISSN - 0305-1870
DOI - 10.1111/1440-1681.13262
Subject(s) - preload , positive end expiratory pressure , stroke volume , medicine , central venous pressure , anesthesia , cardiac output , ventilation (architecture) , hemodynamics , pulmonary wedge pressure , cardiology , blood pressure , beagle , mechanical ventilation , heart rate , mechanical engineering , engineering
Stroke volume variation (SVV) may be affected by ventilation settings. However, it is unclear whether positive‐end‐expiratory pressure (PEEP) affects SVV independently of the effect of driving pressure. We aimed to investigate the effect of driving pressure and PEEP on SVV under various preload conditions using beagle dogs as the animal model. We prepared three preload model, baseline, mild and moderate haemorrhage model. Mild and moderate haemorrhage models were created in nine anaesthetized, mechanically ventilated dogs by sequentially removing 10 mL/kg, and then an additional 10 mL/kg of blood, respectively. We measured cardiac output, stroke volume (SV), SVV, heart rate, central venous pressure, pulmonary capillary wedge pressure and the mean arterial pressure under varying ventilation settings. Peak inspiratory pressure (PIP) was incrementally increased by 4 cmH 2 O, from 9 cmH 2 O to 21 cmH 2 O, under PEEP values of 4, 8, and 12 cmH 2 O. The driving pressure did not significantly decrease SV under each preload condition and PEEP; however, significantly increased SVV. In contrast, the increased PEEP decreased SV and increased SVV under each preload condition and driving pressure, but these associations were not statistically significant. According to multiple regression analysis, an increase in PEEP and decrease in preload significantly decreased SV ( P < .05). In addition, an increase in the driving pressure and decrease in preload significantly increased SVV ( P < .05). Driving pressure had more influence than PEEP on SVV.