The associated use of permissive @entity2944 (PHY) and high @entity9239 levels (PEEP(IDEAL)) has been recently indicated as part of a lung-protective-approach ( @entity4991 ) in @entity649 ( @entity649 ). However, the net hemodynamic effect produced by this association is not known. We analyzed the temporal hemodynamic effects of this combined strategy in 48 @entity1 (mean age 34 +/- 13 yr) with @entity649 , focusing on its immediate (after 1 h), early (first 36 h), and late (2nd-7th d) consequences. Twenty-five @entity1 were submitted to @entity4991 --with the combined use of permissive @entity2944 (PHY), VT < 6 ml/kg, distending pressures above PEEP < 20 cm @entity2507 , and PEEP 2 cm @entity2507 above the lower inflection point on the static inspiratory P-V curve (P(FLEX))- and 23 control @entity1 were submitted to conventional mechanical ventilation. @entity4991 was initiated at once, resulting in an immediate increase in heart rate (p = 0.0002), cardiac output (p = 0.0002), @entity26 delivery (DO2l, p = 0.0003), and mixed venous @entity4095 (p = 0.0006), with a maintained systemic @entity26 consumption (p = 0.52). The mean pulmonary arterial pressure markedly increased (mean increment 8.8 mm Hg; p < 0.0001), but the pulmonary vascular resistance did not change (p = 0.32). Cardiac filling pressures increased (p < 0.001) and the systemic vascular resistance fell (p = 0.003). All these alterations were progressively attenuated in the course of the first 36 h, despite persisting @entity2944 . Plasma @entity880 suffered a progressive decrement along the early period in @entity4991 but not in control @entity1 (p < 0.0001). No hemodynamic consequences of @entity4991 were noticed in the late period and renal function was preserved. A multivariate analysis suggested that these acute hyperdynamic effects were related to @entity12906 , with no depressant effects ascribed to high PEEP levels. In contrast, high plateau pressures were associated with @entity65 . Thus, as long as sufficiently low distending pressures are concomitantly applied, the sudden installation of PHY plus PEEP(IDEAL) induces a transitory hyperdynamic state and @entity120 without harmful consequences to this young @entity649 population.

Temporal hemodynamic effects of permissive XXXX associated with ideal PEEP in @entity649 .

@entity1 :: ('9606', 'Species') :: ['patients'] @entity4991 :: ('CHEBI:52288', 'Chemical') :: ['LPA'] @entity2944 :: ('MESH:D006935', 'Disease') :: ['hypercapnia'] @entity12906 :: ('MESH:D000142', 'Disease') :: ['respiratory acidosis'] @entity649 :: ('MESH:D012128', 'Disease') :: ['ARDS', 'acute respiratory distress syndrome'] @entity26 :: ('MESH:D010100', 'Chemical') :: ['oxygen'] @entity120 :: ('MESH:D006976', 'Disease') :: ['pulmonary hypertension'] @entity2507 :: ('CHEBI:33813', 'Chemical') :: ['H2O'] @entity880 :: ('MESH:D019344', 'Chemical') :: ['lactate'] @entity65 :: ('MESH:D002318', 'Disease') :: ['cardiovascular depression'] @entity9239 :: ('CHEBI:60683', 'Chemical') :: ['PEEP'] @entity4095 :: ('MESH:C093415', 'Chemical') :: ['Po2']
@entity2944 :: (MESH:D006935,Disease) :: ['hypercapnia']
