Hemodynamic response to positive end-expiratory pressure following right atrium-pulmonary artery bypass (Fontan procedure)

Donald Williams, P. D. Kiernan, M. P. Metke, H. M. Marsh, G. K. Danielson

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Abstract

Thirteen patients were studied in the early postoperative period to determine the hemodynamic response to increasing levels of positive end-expiratory pressure (PEEP) following right atrium pulmonary artery bypass (Fontan procedure). Hemodynamic data and arterial oxygen and carbon dioxide tensions were measured without PEEP and with PEEP = 3, 6, 9, and 12 cm H2O. Cardiac index decreased progressively with increasing levels of PEEP compared to PEEP = 0 (cardiac index = 2.7 ± 1.2 L/min/m2), and the decrease was significant at PEEP = 9 (cardiac index = 2.2 ± 0.8 L/min/m2, p < 0.05) and 12 cm H2O (cardiac index = 2.0 ± 0.7 L/min/m2, p < 0.05). Both arterial oxygen tension and pulmonary vascular resistance index increased significantly at all levels of PEEP studied compared to PEEP = 0. Significant positive trends were demonstrated for arterial oxygen tension and pulmonary vascular resistance index and a significant negative trend was shown for cardiac index with increasing PEEP. Heart rate, right atrial pressure, left atrial pressure, mean arterial blood pressure, and arterial carbon dioxide tension did not change significantly nor consistently with increasing PEEP. From these data it appears that PEEP is an effective means of raising arterial oxygen tension after right atrium-pulmonary artery bypass. A progressive fall in cardiac index occurs with increasing PEEP, and the fall becomes significant at PEEP > 6 cm H2O. The fall in cardiac index appears to be mediated by a significant rise in pulmonary vascular resistance index.

Original languageEnglish
Pages (from-to)856-861
Number of pages6
JournalJournal of Thoracic and Cardiovascular Surgery
Volume87
Issue number6
StatePublished - Aug 30 1984
Externally publishedYes

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ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

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