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RESEARCH ARTICLE
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Influence of positive end-expiratory pressure on arterial blood pressure in mechanically ventilated trauma patients in the field: a retrospective cohort study


1 Department of Anesthesiology and Perioperative Intensive Care Medicine, University of Cologne, Cologne, Germany
2 Department of Trauma Surgery and Sports Medicine, Innsbruck Medical University, Innsbruck, Austria
3 Department of Anesthesiology and Intensive Care Medicine, Hospitallers Brothers Hospital, Paracelsus Medical University, Salzburg, Austria
4 Institute for Anesthesiology and Critical Care Medicine, Trauma Hospital Salzburg, Salzburg, Austria
5 Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Klinikum Friedrichshafen, Friedrichshafen, Germany
6 Department of Anesthesiology, Emergency and Critical Care Medicine, County Hospital Wiener Neustadt, Wiener Neustadt, Austria

Correspondence Address:
Holger Herff,
Department of Anesthesiology and Perioperative Intensive Care Medicine, University of Cologne, Cologne
Germany
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2045-9912.344979

Ventilation with positive end-expiratory pressure (PEEP) may result in decreased venous return to the heart and therefore decrease cardiac output. We evaluated the influence of PEEP ventilation on arterial blood pressure in the field in 296 posttraumatic intubated patients being treated by a helicopter emergency medical service in a retrospective cohort study. Initial systolic blood pressure on the scene, upon hospital admission and their mean difference were compared between patients being ventilated with no/low PEEP (0–0.3 kPa) and moderate PEEP (0.3–1 kPa). In a subgroup analysis of initially hemodynamic unstable patients (systolic blood pressure < 80 mmHg), systolic blood pressure was compared between patients being ventilated with no/low or moderate PEEP Further, the mean difference between initial systolic blood pressure and upon hospital admission was correlated with the chosen PEEP. Systolic arterial blood pressure of patients being ventilated with no/low PEEP improved from 105 ± 36 mmHg to 112 ± 38 mmHg, and that of patients being ventilated with moderate PEEP improved from 105 ± 38 mmHg to 119 ± 27 mmHg. In initially unstable patients being ventilated with no/low PEEP systolic blood pressure improved from initially 55 ± 36 mmHg to 78 ± 30 mmHg upon hospital admission, and in those being ventilated with moderate PEEP, the systolic blood pressure improved from 43 ± 38 mmHg to 91 ± 27 mmHg. There was no significant correlation between the chosen PEEP and the mean difference of systolic blood pressure (Pearson’s correlation, r = 0.07, P = 0.17). Ventilation with moderate PEEP has no adverse effect on arterial systolic blood pressure in this cohort of trauma patients requiring mechanical ventilation. Initially unstable patients being ventilated with moderate PEEP tend to be hemodynamically more stable.


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    -  Krappinger D
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