Interactions between hemodynamic and hormonal modifications during PEEP-induced antidiuresis and antinatriuresis

Chest. 1995 Apr;107(4):1095-100. doi: 10.1378/chest.107.4.1095.


The interactions between hemodynamic and hormonal modifications during antidiuresis and antinatriuresis induced by positive end-expiratory pressure (PEEP) were studied in six patients under 15 cm H2O PEEP before PEEP and after the addition of lower body positive pressure (LBPP) to PEEP (PEEP+LBPP). We measured or calculated the following: cardiac index, systemic arterial, right atrial, pulmonary arterial, and pulmonary artery occlusive pressures; indexed renal blood flow (iodohippurate 131 sodium clearance); total blood volume (chromium 51 radiolabeled RBCs); glomerular filtration rate; urinary output; fractional excretion of sodium (FE Na+); plasma concentrations of antidiuretic hormone (ADH), plasma renin activity (PRA), norepinephrine and epinephrine; urinary concentration of PGE2 (PGE2u). Although LBPP application corrected PEEP deleterious effects on systemic and renal hemodynamics, sustained fall in Vu and in FE Na+ were observed. Antidiuresis was not due to ADH release. Sympathetic activation and high PRA appeared the main determinants of renal function alterations in PEEP ventilation.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Diuresis*
  • Female
  • Hemodynamics*
  • Humans
  • Kidney / physiopathology*
  • Male
  • Natriuresis*
  • Positive-Pressure Respiration*
  • Sodium / urine
  • Vasopressins / blood


  • Vasopressins
  • Sodium