Thread by @manalalasnag, 𝙏𝙃𝙀 𝙈𝙐𝘾𝙃 𝙁𝙊𝙍𝙂𝙊𝙏𝙏𝙀𝙉 𝙍𝙑1/5Dif Approaches to Optimizing PEEPPEEP and RV FunctionClifford Greyson [...]

Manal Alasnag

manalalasnag

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𝙏𝙃𝙀 𝙈𝙐𝘾𝙃 𝙁𝙊𝙍𝙂𝙊𝙏𝙏𝙀𝙉 𝙍𝙑

1/5
Dif Approaches to Optimizing PEEP

PEEP and RV Function
Clifford Greyson @SCCM #CCC50

#PedsICU #PedsCICU #PedsCards

2/5

Frank-Starling law is more reflective of LV physiology

RV normally unstressed at end diastole

RV maladapts to volume overload overtime

Distorted RV balloons impedes LV

RV perfusion occurs during ventricular systole

Vicious cycle

of RV dysfunction

2/5Frank-Starling law is more reflective of LV physiology RV normally unstressed at end diastole RV maladapts to volume overload overtime Distorted RV balloons impedes LV RV perfusion occurs during ventricular systole Vicious cycle of RV dysfunction

2/5Frank-Starling law is more reflective of LV physiology RV normally unstressed at end diastole RV maladapts to volume overload overtime Distorted RV balloons impedes LV RV perfusion occurs during ventricular systole Vicious cycle of RV dysfunction

2/5Frank-Starling law is more reflective of LV physiology RV normally unstressed at end diastole RV maladapts to volume overload overtime Distorted RV balloons impedes LV RV perfusion occurs during ventricular systole Vicious cycle of RV dysfunction

2/5Frank-Starling law is more reflective of LV physiology RV normally unstressed at end diastole RV maladapts to volume overload overtime Distorted RV balloons impedes LV RV perfusion occurs during ventricular systole Vicious cycle of RV dysfunction

3/5

RV afterload affected by

PVR

Pul vascular compliance

LAP

all compromised with excessive PEEP

3/5RV afterload affected byPVRPul vascular compliance LAPall compromised with excessive PEEP

3/5RV afterload affected byPVRPul vascular compliance LAPall compromised with excessive PEEP

3/5RV afterload affected byPVRPul vascular compliance LAPall compromised with excessive PEEP

3/5RV afterload affected byPVRPul vascular compliance LAPall compromised with excessive PEEP

4/5

“moderate” PEEP can recruit alveoli, reduce hypoxia and improve Pul vasoconstriction

how CAN we tell

clinical improvement:
systemic pressure

ECHO: CO increase

4/5“moderate” PEEP can recruit alveoli, reduce hypoxia and improve Pul vasoconstriction how CAN we tell clinical improvement:systemic pressure ECHO: CO increase

4/5“moderate” PEEP can recruit alveoli, reduce hypoxia and improve Pul vasoconstriction how CAN we tell clinical improvement:systemic pressure ECHO: CO increase

4/5“moderate” PEEP can recruit alveoli, reduce hypoxia and improve Pul vasoconstriction how CAN we tell clinical improvement:systemic pressure ECHO: CO increase

5/5

#COVID19 in AICU has demonstrated that the RV is a major player

figuring out what works is just not
so easy

mortality for hospitalised patients on organ support and survival to hospital discharge

https://sccmcovid19.org
#SCCMDiscovery

5/5 #COVID19 in AICU has demonstrated that the RV is a major player figuring out what works is just not so easy mortality for hospitalised patients on organ support and survival to hospital discharge https://sccmcovid19.org #SCCMDiscovery

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