Critical Care Medicine  |   May 2020
Myocardial Function during Low versus Intermediate Tidal Volume Ventilation in Patients without Acute Respiratory Distress Syndrome
Author Notes
  • From the Departments of Intensive Care Medicine (T.G.V.C., F.D.S., N.P.J., W.K.L.) and Cardiology (B.J.B., R.H.d.B.-B.); and 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.).
  • This article is accompanied by an editorial on p. 944.
    This article is accompanied by an editorial on p. 944.×
  • Submitted for publication February 8, 2019. Accepted for publication January 2, 2020. Published online first on February 11, 2020.
    Submitted for publication February 8, 2019. Accepted for publication January 2, 2020. Published online first on February 11, 2020.×
  • Address correspondence to Dr. Cherpanath: Department of Intensive Care Medicine, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. t.g.cherpanath@amsterdamumc.nl. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Critical Care Medicine / Clinical Science / Cardiovascular Anesthesia / Critical Care / Respiratory System
Critical Care Medicine   |   May 2020
Myocardial Function during Low versus Intermediate Tidal Volume Ventilation in Patients without Acute Respiratory Distress Syndrome
Anesthesiology 5 2020, Vol.132, 1102-1113. doi:https://doi.org/10.1097/ALN.0000000000003175
Anesthesiology 5 2020, Vol.132, 1102-1113. doi:https://doi.org/10.1097/ALN.0000000000003175
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.

Editor’s Perspective:

What We Already Know about This Topic:

  • Lower tidal volume mechanical ventilation is associated with reduced ventilation induced lung injury

What This Article Tells Us That Is New:

  • What is not known is if lower versus intermediate tidal volume mechanical ventilation is also associated with improved systolic and diastolic left ventricular and right ventricular myocardial function

  • This study of 42 mechanically ventilated patients who did not have acute respiratory distress syndrome found that lower tidal volume mechanical ventilation was associated with increased right and left ventricular systolic function but not improved diastolic function