Cardiopulmonary parameters during high PEEP in children

Crit Care Med. 1980 Jul;8(7):372-6. doi: 10.1097/00003246-198007000-00002.


There are a few reports of the application of high PEEP (PEEP greater than or equal to 15 cm H2O) infants and children. Data concerning cardiac index (CI), pulmonary venous admixture (Qsp/Qt), and arterial mixed venous oxygen content difference (avDO2) during mechanical ventilation with high PEEP have not been reported. Fourteen infants and children were treated with high levels of PEEP; 8 of these patients were monitored with pulmonary artery catheters. Cardiopulmonary data were obtained from these 8 patients and pulmonary barotrauma data were tabulated from all 14 patients. At highest PEEP, CI = 3.6 +/- 0.6 L/min x M2, avDO2 = 4,45 +/- 0.83 ml/dl and Qsp/Qt = 16.7 +/- 2.1%. One patient experienced severe cardiac depression unresponsive to therapy; it resolved when PEEP was lowered. Pulmonary barotrauma was a frequent complication. Pneumothroax occurred in 6 patients. No patient died from pulmonary barotrauma. We conclude that PEEP greater than or equal to 15 cm H2O can be used in infants and children to decrease Qsp/Qt toward normal; CI and avDO2 can usually be maintained in an acceptable range. Patients should be frequently monitored for pulmonary barotrauma.

MeSH terms

  • Adolescent
  • Barotrauma / etiology
  • Cardiac Output
  • Cardiovascular System / physiopathology*
  • Child
  • Child, Preschool
  • Heart Injuries / etiology
  • Humans
  • Infant
  • Lung / physiopathology*
  • Oxygen / blood
  • Pneumothorax / etiology
  • Positive-Pressure Respiration* / adverse effects
  • Respiratory Insufficiency / therapy
  • Ventilation-Perfusion Ratio


  • Oxygen