Thomas G V Cherpanath1, Fabienne D Simonis, Berto J Bouma, Rianne H de Bruin-Bon, Rogier M Determann, Nicole P Juffermans, Marcelo Gama de Abreu, Paolo Pelosi, Ary Serpa Neto, Johan A B Groeneveld, Marcus J Schultz, Wim K Lagrand. 1. From the Departments of Intensive Care Medicine (T.G.V.C., F.D.S., N.P.J., W.K.L.) Cardiology (B.J.B., R.H.d.B.-B.) the Laboratory of Experimental Intensive Care and Anesthesiology (M.J.S.); Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands the Department of Intensive Care, Onze Lieve Vrouwe Gasthuis Hospital, Amsterdam, The Netherlands (R.M.D) the Department of Anesthesiology and Intensive Care, University Hospital Carl Gustav Carus, Dresden, Germany (M.G.d.A.) the Department of Surgical Sciences and Integrated Diagnostics, Scientific Institute for Research, Hospitalization and Health Care, San Martino IST, University of Genoa, Genoa, Italy (P.P.) the Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil (A.S.N.) the Department of Intensive Care Medicine, Erasmus Medical Center, Rotterdam, The Netherlands (J.A.B.G.).
Abstract
BACKGROUND: Mechanical ventilation with low tidal volumes has the potential to mitigate ventilation-induced lung injury, yet the clinical effect of tidal volume size on myocardial function has not been clarified. This cross-sectional study investigated whether low tidal volume ventilation has beneficial effects on myocardial systolic and diastolic function compared to intermediate tidal volume ventilation. METHODS: Forty-two mechanically ventilated patients without acute respiratory distress syndrome (ARDS) underwent transthoracic echocardiography after more than 24 h of mechanical ventilation according to the Protective Ventilation in Patients without ARDS (PReVENT) trial comparing a low versus intermediate tidal volume strategy. The primary outcome was left ventricular and right ventricular myocardial performance index as measure for combined systolic and diastolic function, with lower values indicating better myocardial function and a right ventricular myocardial performance index greater than 0.54 regarded as the abnormality threshold. Secondary outcomes included specific systolic and diastolic parameters. RESULTS: One patient was excluded due to insufficient acoustic windows, leaving 21 patients receiving low tidal volumes with a tidal volume size (mean ± SD) of 6.5 ± 1.8 ml/kg predicted body weight, while 20 patients were subjected to intermediate tidal volumes receiving a tidal volume size of 9.5 ± 1.6 ml/kg predicted body weight (mean difference, -3.0 ml/kg; 95% CI, -4.1 to -2.0; P < 0.001). Right ventricular dysfunction was reduced in the low tidal volume group compared to the intermediate tidal volume group (myocardial performance index, 0.41 ± 0.13 vs. 0.64 ± 0.15; mean difference, -0.23; 95% CI, -0.32 to -0.14; P < 0.001) as was left ventricular dysfunction (myocardial performance index, 0.50 ± 0.17 vs. 0.63 ± 0.19; mean difference, -0.13; 95% CI, -0.24 to -0.01; P = 0.030). Similarly, most systolic parameters were superior in the low tidal volume group compared to the intermediate tidal volume group, yet diastolic parameters did not differ between both groups. CONCLUSIONS: In patients without ARDS, intermediate tidal volume ventilation decreased left ventricular and right ventricular systolic function compared to low tidal volume ventilation, although without an effect on diastolic function.
BACKGROUND: Mechanical ventilation with low tidal volumes has the potential to mitigate ventilation-induced lung injury, yet the clinical effect of tidal volume size on myocardial function has not been clarified. This cross-sectional study investigated whether low tidal volume ventilation has beneficial effects on myocardial systolic and diastolic function compared to intermediate tidal volume ventilation. METHODS: Forty-two mechanically ventilated patients without acute respiratory distress syndrome (ARDS) underwent transthoracic echocardiography after more than 24 h of mechanical ventilation according to the Protective Ventilation in Patients without ARDS (PReVENT) trial comparing a low versus intermediate tidal volume strategy. The primary outcome was left ventricular and right ventricular myocardial performance index as measure for combined systolic and diastolic function, with lower values indicating better myocardial function and a right ventricular myocardial performance index greater than 0.54 regarded as the abnormality threshold. Secondary outcomes included specific systolic and diastolic parameters. RESULTS: One patient was excluded due to insufficient acoustic windows, leaving 21 patients receiving low tidal volumes with a tidal volume size (mean ± SD) of 6.5 ± 1.8 ml/kg predicted body weight, while 20 patients were subjected to intermediate tidal volumes receiving a tidal volume size of 9.5 ± 1.6 ml/kg predicted body weight (mean difference, -3.0 ml/kg; 95% CI, -4.1 to -2.0; P < 0.001). Right ventricular dysfunction was reduced in the low tidal volume group compared to the intermediate tidal volume group (myocardial performance index, 0.41 ± 0.13 vs. 0.64 ± 0.15; mean difference, -0.23; 95% CI, -0.32 to -0.14; P < 0.001) as was left ventricular dysfunction (myocardial performance index, 0.50 ± 0.17 vs. 0.63 ± 0.19; mean difference, -0.13; 95% CI, -0.24 to -0.01; P = 0.030). Similarly, most systolic parameters were superior in the low tidal volume group compared to the intermediate tidal volume group, yet diastolic parameters did not differ between both groups. CONCLUSIONS: In patients without ARDS, intermediate tidal volume ventilation decreased left ventricular and right ventricular systolic function compared to low tidal volume ventilation, although without an effect on diastolic function.
Authors: Charalampos Pierrakos; Anna Geke Algera; Fabienne Simonis; Thomas G V Cherpanath; Wim K Lagrand; Frederique Paulus; Lieuwe D J Bos; Marcus J Schultz Journal: Front Cardiovasc Med Date: 2022-05-31
Authors: Anna Geke Algera; Charalampos Pierrakos; Michela Botta; Claudio Zimatore; Luigi Pisani; Pieter-Roel Tuinman; Lieuwe D J Bos; Wim K Lagrand; Marcello Gama de Abreu; Paolo Pelosi; Ary Serpa Neto; Marcus J Schultz; Thomas G V Cherpanath; Frederique Paulus Journal: J Clin Med Date: 2022-04-21 Impact factor: 4.964