PEEP and CPAP following open-heart surgery in infants and children.

The cardiorespiratory effects of 5 cm H2O end-expiratory pressure were studied in 22 infants and children an hour after open-heart surgery during mechanical ventilation with positive end-expiratory pressure (PEEP) and prior to endotracheal extubation approximately 15 hours later during spontaneous breathing (CPAP). Thermodilution cardiac output determinations and respiratory airflow, volume and pressure recordings were made to assess the effects of airway pressure changes on the respiratory waveform and oxygen delivery. Neither PEEP nor CPAP had a significant effect on cardiac output, intrapulmonary shunting, oxygen consumption, or oxygen utilization. Patients who had had pulmonary hypertension preoperatively did not behave differently from those without pulmonary hypertension when removed from ventilatory supprot. Expiratory airflow was significantly prolonged when positive end-expiratory pressure existed during both controlled and spontaneous respiration. During CPAP, this "expiratory braking" was associated with an increase in tidal volume and decreases in respiratory rate and minute volume. Because of the lack of improvement in cardiopulmonary function in this group of patients, and the possibility of untoward effects from sustained end-expiratory pressure, PEEP and CPAP might properly be reserved as temporary supportive techniques should respiratory function be compromised.