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Korean J Crit Care Med > Volume 12(2); 1997 > Article
Korean Journal of Critical Care Medicine 1997;12(2): 151-158.
기계적 환기를 받고 있는 중환자에서 호기말 양압이 안압에 미치는 영향
손주태, 안헌영, 배지홍, 이헌근, 이상휘, 정영균
경상대학교 의과대학 마취과학교실, 안과학교실*, 구강외과학교실#
Effect of Positive End-Expiratory Pressure on Intraocular Pressure in the Critically Ill and Mechanically Ventilated Patients
Ju Tae Sohn, Heon Young Ahn, Ji Hong Bae, Heon Keun Lee, Sang Hwy Lee, Young Kyun Chung
1Department of Anesthesiology, College of Medicine, Gyeongsang National University, Chinju, Korea.
2Department of Ophthalmology, College of Medicine, Gyeongsang National University, Chinju, Korea.
3Department of Oral and Maxillofacial Surgery, College of Medicine, Gyeongsang National University, Chinju, Korea.
BACKGOUND: The purpose of this study was to examine the effect of various levels of positive end-expiratory pressure (PEEP) on the intraocular pressure in the patients receiving positive pressure ventilation. METHODS: Twenty, critically ill sedated and hemodynamically stable patients without history of glaucoma were placed on controlled positive pressure ventilation. Measured variables included intraocular pressure (IOP), mean arterial pressure (MAP), central venous pressure (CVP), peak inspiratory pressure (PIP) and arterial blood gas analysis (ABGA), and were recorded at zero end-expiratory pressure (ZEEP), and at 5, 10, 15, 20 cmH2O PEEP, applied in random order. RESULTS: IOP increased significantly from 13+/-3 to 16+/-3 mmHg at 15 cmH2O PEEP and from 14+/-4 to 17+/-6 mmHg at 20 cmH2O PEEP. CVP increased significantly from its corresponding ZEEP measurements at all PEEP levels and from 14+/-4 cmH2O at 5 cmH2O PEEP to 21+/-4 cmH2O at 20 cmH2O PEEP. There was a positive correlation between PEEP levels and PIP or CVP but no relationship between PEEP levels and IOP was observed. CONCLUSIONS: The application of PEEP levels > or = 15 cmH2O resulted in a significant increase in the IOP of patients with normal basal ocular tonometry. This study suggests that further increase in IOP may occur in the mechanically ventilated patients with already increased IOP or normal-tension glaucoma, when higher levels of PEEP are used.
Key Words: Eye; intraocular pressure. Ventilation; peak inspiratory pressure; positive end-expiratory pressure; Veins; central venous pressure
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