Nakashima Tsuyoshi, Kawazoe Yu, Iseri Toshie, Miyamoto Kyohei, Fujimoto Yuka, Kato Seiya
Department of Emergency and Critical Care Medicine, Wakayama Medical University, Wakayama City, Japan.
Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
Clin Exp Pharmacol Physiol. 2020 Jun;47(6):1014-1019. doi: 10.1111/1440-1681.13262. Epub 2020 Feb 25.
Stroke volume variation (SVV) may be affected by ventilation settings. However, it is unclear whether positive-end-expiratory pressure (PEEP) affects SVV independently of the effect of driving pressure. We aimed to investigate the effect of driving pressure and PEEP on SVV under various preload conditions using beagle dogs as the animal model. We prepared three preload model, baseline, mild and moderate haemorrhage model. Mild and moderate haemorrhage models were created in nine anaesthetized, mechanically ventilated dogs by sequentially removing 10 mL/kg, and then an additional 10 mL/kg of blood, respectively. We measured cardiac output, stroke volume (SV), SVV, heart rate, central venous pressure, pulmonary capillary wedge pressure and the mean arterial pressure under varying ventilation settings. Peak inspiratory pressure (PIP) was incrementally increased by 4 cmH O, from 9 cmH O to 21 cmH O, under PEEP values of 4, 8, and 12 cmH O. The driving pressure did not significantly decrease SV under each preload condition and PEEP; however, significantly increased SVV. In contrast, the increased PEEP decreased SV and increased SVV under each preload condition and driving pressure, but these associations were not statistically significant. According to multiple regression analysis, an increase in PEEP and decrease in preload significantly decreased SV (P < .05). In addition, an increase in the driving pressure and decrease in preload significantly increased SVV (P < .05). Driving pressure had more influence than PEEP on SVV.
每搏量变异度（SVV）可能受通气设置的影响。然而，呼气末正压（PEEP）是否独立于驱动压的作用而影响SVV尚不清楚。我们旨在以比格犬为动物模型，研究在各种前负荷条件下驱动压和PEEP对SVV的影响。我们制备了三种前负荷模型，即基线模型、轻度出血模型和中度出血模型。分别通过依次抽取10 mL/kg，然后再抽取10 mL/kg血液，在9只麻醉、机械通气的犬中建立轻度和中度出血模型。我们在不同通气设置下测量心输出量、每搏量（SV）、SVV、心率、中心静脉压、肺毛细血管楔压和平均动脉压。在4、8和12 cmH₂O的PEEP值下，吸气峰压（PIP）从9 cmH₂O逐步增加4 cmH₂O至21 cmH₂O。在每种前负荷条件和PEEP下，驱动压并未显著降低SV；然而，显著增加了SVV。相比之下，在每种前负荷条件和驱动压下，PEEP增加使SV降低且SVV增加，但这些关联无统计学意义。根据多元回归分析，PEEP增加和前负荷降低显著降低SV（P < 0.05）。此外，驱动压增加和前负荷降低显著增加SVV（P < 0.05）。驱动压对SVV的影响大于PEEP。
