An unusual cardiovascular response to PEEP

[The effect of PEEP ventilation on hemodynamics and regional blood flow (author's transl)]

The beneficial effects of PEEP on lung function may be counteracted by its hemodynamic sequelae induced by a reduction of venous return due to the elevated intrathoracic pressure, and by an increased right ventricular afterload secondary to the rise of pulmonary vascular resistance. PEEP redistributes cardiac output in favor of brain, heart, adrenals and intestines, whereas the perfusion of stomach, pancreas and thyroid is diminished out of proportion to the fall of cardiac output. Total renal blood flow is relatively little affected; however, redistribution of intrarenal blood flow will result in a marked salt-water-retention. Reduction of hepatic artery flow, at higher levels of PEEP, may jeopardize liver tissue oxygenation. - Under clinical conditions, individual differences regarding preexisting cardiopulmonary and peripheral-vascular diseases may modify the PEEP-induced hemodynamic alterations in a wide range.