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- W2007681194 abstract "Letters1 April 1994Positive End-Expiratory Pressure and Shunting across Foramen OvaleMark D. Siegel, MDMark D. Siegel, MDYale University School of Medicine; New Haven, CT 06520Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-120-7-199404010-00019 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:The study by Cujec and colleagues [1], showing that positive end-expiratory pressure (PEEP) increased right-to-left shunting in patients with a patent foramen ovale, raises several questions. First, did the echocardiographers know whether the patients were receiving PEEP? The interpretation of contrast echocardiograms is potentially subjective [2], and a nonblinded study is open to bias. Second, did the patients with and without a patent foramen ovale have similar functional residual capacities? The ability of PEEP to improve oxygen delivery varies among patients and correlates well with lower initial functional residual capacity [3]; therefore, this variable should have been ...References1. Cujec B, Polasek P, Mayers I, Johnson D. Positive end-expiratory pressure increases the right-to-left shunt in mechanically ventilated patients with patent foramen ovale. Ann Intern Med. 1993; 119:887-94. Google Scholar2. Cross SJ, Thomson LF, Evans SA, Lee HS, Jennings KP. Inter- and intra-observer variability in detection of patent foramen ovale with contrast echocardiography. Eur Heart J. 1993; 14:388-90. Google Scholar3. Suter PM, Fairley HB, Isenberg MD. Optimum end-expiratory airway pressure in patients with acute pulmonary failure. N Engl J Med. 1975; 292:284-9. Google Scholar4. West JB. Pulmonary Pathophysiology—The Essentials. 3d ed. Baltimore: Williams & Wilkins; 1987;30. Google Scholar5. Ravenscraft SA, Marinelli WA, Johnson T, Henke CA. Profound hypoxemia precipitated by positive-end-expiratory pressure: induction of an intracardiac shunt. Crit Care Med. 1992; 20:434-6. Google Scholar Author, Article, and Disclosure InformationAffiliations: Yale University School of Medicine; New Haven, CT 06520 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 April 1994Volume 120, Issue 7Page: 620KeywordsAcute respiratory distress syndromeAlveoliOxygenPositive end expiratory pressure Issue Published: 1 April 1994 Copyright & PermissionsCopyright © 1994 by American College of Physicians. All Rights Reserved.PDF downloadLoading ..." @default.
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