{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T05:54:31Z","timestamp":1791093271729,"version":"4.1.0"},"reference-count":39,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[1997,11,1]],"date-time":"1997-11-01T00:00:00Z","timestamp":878342400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[1997,11,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>The associated use of permissive hypercapnia (PHY) and high PEEP levels (PEEPIDEAL) has been recently indicated as part of a lung-protective-approach (LPA) in acute respiratory distress syndrome (ARDS). However, the net hemodynamic effect produced by this association is not known. We analyzed the temporal hemodynamic effects of this combined strategy in 48 patients (mean age 34 \u00b1 13 yr) with ARDS, focusing on its immediate (after 1 h), early (first 36 h), and late (2nd\u20137th d) consequences. Twenty-five patients were submitted to LPA\u2014with the combined use of permissive hypercapnia (PHY), Vt &amp;lt; 6 ml\/kg, distending pressures above PEEP &amp;lt; 20 cm H2O, and PEEP 2 cm H2O above the lower inflection point on the static inspiratory P-V curve (PFLEX)\u2014and 23 control patients were submitted to conventional mechanical ventilation. LPA was initiated at once, resulting in an immediate increase in heart rate (p = 0.0002), cardiac output (p = 0.0002), oxygen delivery (D\u0307o2I, p = 0.0003), and mixed venous Po2 (p = 0.0006), with a maintained systemic oxygen consumption (p = 0.52). The mean pulmonary arterial pressure markedly increased (mean increment 8.8 mm Hg; p &amp;lt; 0.0001), but the pulmonary vascular resistance did not change (p = 0.32). Cardiac filling pressures increased (p &amp;lt; 0.001) and the systemic vascular resistance fell (p = 0.003). All these alterations were progressively attenuated in the course of the first 36 h, despite persisting hypercapnia. Plasma lactate suffered a progressive decrement along the early period in LPA but not in control patients (p &amp;lt; 0.0001). No hemodynamic consequences of LPA were noticed in the late period and renal function was preserved. A multivariate analysis suggested that these acute hyperdynamic effects were related to respiratory acidosis, with no depressant effects ascribed to high PEEP levels. In contrast, high plateau pressures were associated with cardiovascular depression. Thus, as long as sufficiently low distending pressures are concomitantly applied, the sudden installation of PHY plus PEEPIDEAL induces a transitory hyperdynamic state and pulmonary hypertension without harmful consequences to this young ARDS population. Carvalho CRR, Barbas CSV, Medeiros DM, Magaldi RB, Filho GL, Kairalla RA, Deheinzelin D, Munhoz C, Kaufmann M, Ferreira M, Takagaki TY, Amato MBP. Temporal hemodynamic effects of permissive hypercapnia associated with ideal PEEP in ARDS.<\/jats:p>","DOI":"10.1164\/ajrccm.156.5.9604081","type":"journal-article","created":{"date-parts":[[2013,4,4]],"date-time":"2013-04-04T13:26:14Z","timestamp":1365081974000},"page":"1458-1466","source":"Crossref","is-referenced-by-count":114,"title":["Temporal Hemodynamic Effects of Permissive Hypercapnia Associated with Ideal PEEP in ARDS"],"prefix":"10.1093","volume":"156","author":[{"given":"CARLOS ROBERTO RIBEIRO","family":"CARVALHO","sequence":"first","affiliation":[{"name":"Respiratory Intensive Care Unit of the Pulmonary Division of the Hospital das Cl\u00ednicas, University of S\u00e3o Paulo; and General ICU of the Santa Casa de Misenc\u00f3rdia, Porto Alegre, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"CARMEN SILVIA VALENTE","family":"BARBAS","sequence":"additional","affiliation":[{"name":"Respiratory Intensive Care Unit of the Pulmonary Division of the Hospital das Cl\u00ednicas, University of S\u00e3o Paulo; and General ICU of the Santa Casa de Misenc\u00f3rdia, Porto Alegre, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"DENISE MACHADO","family":"MEDEIROS","sequence":"additional","affiliation":[{"name":"Respiratory Intensive Care Unit of the Pulmonary Division of the Hospital das Cl\u00ednicas, University of S\u00e3o Paulo; and General ICU of the Santa Casa de Misenc\u00f3rdia, Porto Alegre, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"RICARDO BORGES","family":"MAGALDI","sequence":"additional","affiliation":[{"name":"Respiratory Intensive Care Unit of the Pulmonary Division of the Hospital das Cl\u00ednicas, University of S\u00e3o Paulo; and General ICU of the Santa Casa de Misenc\u00f3rdia, Porto Alegre, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"GERALDO LORENZI","family":"FILHO","sequence":"additional","affiliation":[{"name":"Respiratory Intensive Care Unit of the Pulmonary Division of the Hospital das Cl\u00ednicas, University of S\u00e3o Paulo; and General ICU of the Santa Casa de Misenc\u00f3rdia, Porto Alegre, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"RONALDO ADIB","family":"KAIRALLA","sequence":"additional","affiliation":[{"name":"Respiratory Intensive Care Unit of the Pulmonary Division of the Hospital das Cl\u00ednicas, University of S\u00e3o Paulo; and General ICU of the Santa Casa de Misenc\u00f3rdia, Porto Alegre, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"DANIEL","family":"DEHEINZELIN","sequence":"additional","affiliation":[{"name":"Respiratory Intensive Care Unit of the Pulmonary Division of the Hospital das Cl\u00ednicas, University of S\u00e3o Paulo; and General ICU of the Santa Casa de Misenc\u00f3rdia, Porto Alegre, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"CARLOS","family":"MUNHOZ","sequence":"additional","affiliation":[{"name":"Respiratory Intensive Care Unit of the Pulmonary Division of the Hospital das Cl\u00ednicas, University of S\u00e3o Paulo; and General ICU of the Santa Casa de Misenc\u00f3rdia, Porto Alegre, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"MAURO","family":"KAUFMANN","sequence":"additional","affiliation":[{"name":"Respiratory Intensive Care Unit of the Pulmonary Division of the Hospital das Cl\u00ednicas, University of S\u00e3o Paulo; and General ICU of the Santa Casa de Misenc\u00f3rdia, Porto Alegre, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"MARCO","family":"FERREIRA","sequence":"additional","affiliation":[{"name":"Respiratory Intensive Care Unit of the Pulmonary Division of the Hospital das Cl\u00ednicas, University of S\u00e3o Paulo; and General ICU of the Santa Casa de Misenc\u00f3rdia, Porto Alegre, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"TERESA YAE","family":"TAKAGAKI","sequence":"additional","affiliation":[{"name":"Respiratory Intensive Care Unit of the Pulmonary Division of the Hospital das Cl\u00ednicas, University of S\u00e3o Paulo; and General ICU of the Santa Casa de Misenc\u00f3rdia, Porto Alegre, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"MARCELO BRITTO PASSOS","family":"AMATO","sequence":"additional","affiliation":[{"name":"Respiratory Intensive Care Unit of the Pulmonary Division of the Hospital das Cl\u00ednicas, University of S\u00e3o Paulo; and General ICU of the Santa Casa de Misenc\u00f3rdia, Porto Alegre, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[1997,11,1]]},"reference":[{"key":"2026032709251985800_B1","doi-asserted-by":"crossref","first-page":"1835","DOI":"10.1164\/ajrccm.152.6.8520744","article-title":"Beneficial effects of the \u201copen lung approach\u201d with low distending pressures in ARDS: a prospective randomized study on mechanical ventilation.","volume":"152","author":"Amato","year":"1995","journal-title":"Am. 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Respir. Crit. Care Med."},{"key":"2026032709251985800_B6","doi-asserted-by":"crossref","first-page":"1327","DOI":"10.1164\/ajrccm.149.5.8173774","article-title":"Tidal ventilation at low airway pressures can augment lung injury.","volume":"149","author":"Muscedere","year":"1994","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"2026032709251985800_B7","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1164\/ajrccm.155.1.9001330","article-title":"Surfactant dysfunction makes lung vulnerable to repetitive collapse and reexpansion.","volume":"155","author":"Taskar","year":"1997","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"2026032709251985800_B8","doi-asserted-by":"crossref","first-page":"730","DOI":"10.1164\/ajrccm\/136.3.730","article-title":"Pressure-volume curve of total respiratory system in acute respiratory failure: computed tomographic scan study.","volume":"136","author":"Gattinoni","year":"1987","journal-title":"Am. Rev. Respir. 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Effect on cardiac output and arterial oxygenation.","volume":"99","author":"Leatherman","year":"1991","journal-title":"Chest"},{"key":"2026032709251985800_B23","doi-asserted-by":"crossref","first-page":"1131","DOI":"10.1164\/ajrccm\/146.5_Pt_1.1131","article-title":"Effect of tidal volume on gas exchange and oxygen transport in the adult respiratory distress syndrome.","volume":"146","author":"Kiiski","year":"1992","journal-title":"Am. Rev. Respir. Dis."},{"key":"2026032709251985800_B24","doi-asserted-by":"crossref","first-page":"773","DOI":"10.1378\/chest.95.4.773","article-title":"Pulmonary vascular resistance before and after cardiopulmonary bypass. 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