OBJECTIVES: To determine the effect of different levels of positive end-expiratory pressure (PEEP) on pulse pressure variation
(PPV).
DESIGN: An observational study.
SETTING: Operating theatres of a tertiary training hospital.
SUBJECTS: Ventilated patients who required intra-arterial blood pressure monitoring.
OOUTCOME MEASURES: PPV during different levels of PEEP.
METHOD: Patients were anaesthetised by means of a standard technique and ventilated with a tidal volume of 9 ml/kg ideal
body mass. The PPV was calculated at PEEP levels of 2, 5, 8 and 10 cmH2O. PPV was compared at the various PEEP levels.
RESULTS: PPV at a PEEP of 8 cmH2O and 10 cmH2O was significantly larger than that at 2 cmH2O (p-value < 0.001). PPV at
a PEEP of 10 cmH2O was significantly larger than that at 8 cmH2O (p-value < 0.001). PPV at a PEEP of 8 cmH2O was larger
than that at 5 cmH2O (p-value = 0.002). PPV at a PEEP of 2 and 5 cmH2O did not differ significantly (p-value = 0.194).
CONCLUSION: We have demonstrated that, in patients with normal lungs, PEEP has a significant influence on PPV. PPV may be
overestimated if PEEP ≥ 8 cmH2O is applied in patients who are ventilated with a tidal volume of 9 ml/kg. It is recommended
that in patients with healthy lungs PPV should be measured at a standardised PEEP of ≤ 5 cmH2O.http://www.sajaa.co.za/index.php/sajaaam2013ay201
