Positive end-expiratory pressure potentiates the severity of canine right ventricular ischemia-reperfusion injury

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Positive end-expiratory pressure (PEEP) increases right ventricular (RV) afterload and oxygen demands. However, whether increased RV oxygen demands with high levels of PEEP can potentiate the severity of RV ischemic damage is unknown. In 20 anesthetized, closed-chest dogs randomly assigned to 0 cmH2O PEEP (ZEEP; n = 10) or 15 cmH2O PEEP (PEEP; n = 10), RV blood flow (radioactive microspheres) and segmental shortening (ultrasonic crystals) were determined during 90 min ischemia and 120 min reperfusion while mean aortic pressure was maintained above 90 mmHg. The in vivo RV area at risk (gentian violet) and area of necrosis (triphenyltetrazolium chloride) were assessed. After application of 15 cmH2O PEEP, pulmonary vascular resistance increased by 75% (P less than 0.05). During ischemia, the RV rate-pressure product remained greater with PEEP (2,403 +/- 174 mmHg.beat.min-1) than with ZEEP (1,909 +/- 94 mmHg.beat.min-1; P less than 0.05), indicating higher oxygen demands with PEEP. The area at risk from ischemia relative to RV free wall tended to be greater with PEEP (68.5 +/- 2.4%) than with ZEEP (60.0 +/- 3.9%; P = 0.08), and collateral blood flow in this risk zone was significantly lower during ischemia with PEEP (9.0 +/- 1.7 ml.min-1 x 100 g-1) than with ZEEP (18.3 +/- 3.6 ml.min-1 x 100 g-1; P less than 0.05). Accordingly, PEEP extended RV necrosis in the area at risk from 21.8 +/- 5.3% (ZEEP) to 58.1 +/- 8.4% (PEEP; P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)