Wassim H Fares1, Shannon S Carson. 1. Yale University, School of Medicine, Department of Internal Medicine, Section of Pulmonary, Critical Care & Sleep Medicine, New Haven, CT 06510. Electronic address: wassim.fares@yale.edu.
Abstract
PURPOSE: The purpose of the study is to evaluate the association between positive end-expiratory pressure (PEEP) and cardiac index in patients with acute respiratory distress syndrome (ARDS). METHODS: This is a secondary cross-sectional analysis of the multicenter randomized controlled Fluid and Catheter Treatment Trial enrolling adult patients within 48 hours of ARDS onset. Patients randomized to the pulmonary artery catheter arm, who had PEEP and cardiac index measurements performed within a short period of each other during the first 3 days of the FACTT study enrollment, were included in this study. Because FACTT had a 2 × 2 factorial design, half of the patients were in a "liberal fluids" study arm, and the other half were in a "conservative fluids" study arm. RESULTS:The final study population (833 measurements or observations, in 367 patients) was comparable with the original overall FACTT study population. The mean PEEP level used was 8.2 ± 3.4 cm H2O, and the mean cardiac index was 4.2 ± 1.2 L/min per square meter. There was no association between PEEP and cardiac index in patients with ARDS, even when adjusted for Acute Physiology and Chronic Health Evaluation score, age, fluid study arm in FACTT, and sepsis. CONCLUSION: In patients with ARDS who are managed with liberal or conservative fluid management protocols, PEEP is not associated with lower cardiac index.
RCT Entities:
PURPOSE: The purpose of the study is to evaluate the association between positive end-expiratory pressure (PEEP) and cardiac index in patients with acute respiratory distress syndrome (ARDS). METHODS: This is a secondary cross-sectional analysis of the multicenter randomized controlled Fluid and Catheter Treatment Trial enrolling adult patients within 48 hours of ARDS onset. Patients randomized to the pulmonary artery catheter arm, who had PEEP and cardiac index measurements performed within a short period of each other during the first 3 days of the FACTT study enrollment, were included in this study. Because FACTT had a 2 × 2 factorial design, half of the patients were in a "liberal fluids" study arm, and the other half were in a "conservative fluids" study arm. RESULTS: The final study population (833 measurements or observations, in 367 patients) was comparable with the original overall FACTT study population. The mean PEEP level used was 8.2 ± 3.4 cm H2O, and the mean cardiac index was 4.2 ± 1.2 L/min per square meter. There was no association between PEEP and cardiac index in patients with ARDS, even when adjusted for Acute Physiology and Chronic Health Evaluation score, age, fluid study arm in FACTT, and sepsis. CONCLUSION: In patients with ARDS who are managed with liberal or conservative fluid management protocols, PEEP is not associated with lower cardiac index.
Authors: Herbert P Wiedemann; Arthur P Wheeler; Gordon R Bernard; B Taylor Thompson; Douglas Hayden; Ben deBoisblanc; Alfred F Connors; R Duncan Hite; Andrea L Harabin Journal: N Engl J Med Date: 2006-05-21 Impact factor: 91.245
Authors: Gordon D Rubenfeld; Ellen Caldwell; Eve Peabody; Jim Weaver; Diane P Martin; Margaret Neff; Eric J Stern; Leonard D Hudson Journal: N Engl J Med Date: 2005-10-20 Impact factor: 91.245
Authors: Maureen O Meade; Deborah J Cook; Gordon H Guyatt; Arthur S Slutsky; Yaseen M Arabi; D James Cooper; Andrew R Davies; Lori E Hand; Qi Zhou; Lehana Thabane; Peggy Austin; Stephen Lapinsky; Alan Baxter; James Russell; Yoanna Skrobik; Juan J Ronco; Thomas E Stewart Journal: JAMA Date: 2008-02-13 Impact factor: 56.272
Authors: Daniel Talmor; Todd Sarge; Atul Malhotra; Carl R O'Donnell; Ray Ritz; Alan Lisbon; Victor Novack; Stephen H Loring Journal: N Engl J Med Date: 2008-11-11 Impact factor: 91.245