{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:41:12Z","timestamp":1760139672339,"version":"build-2065373602"},"reference-count":26,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2022,4,21]],"date-time":"2022-04-21T00:00:00Z","timestamp":1650499200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>The aim of this study was to investigate whether lower PEEP (positive end-expiratory pressure) had beneficial effects on myocardial function among intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) compared to higher PEEP. In this pre-planned substudy of a randomized controlled trial (RELAx), comparing lower to higher PEEP, 44 patients underwent transthoracic echocardiography. The exclusion criteria were known poor left ventricular function and severe shock requiring high dosages of norepinephrine. To create contrast, we also excluded patients who received PEEP between 2 cmH2O and 7 cmH2O in the two randomization arms of the study. The primary outcome was the right ventricular myocardial performance index (MPI), a measure of systolic and diastolic function. The secondary outcomes included systolic and diastolic function parameters. A total of 20 patients were ventilated with lower PEEP (mean \u00b1 SD, 0 \u00b1 1 cmH2O), and 24 patients, with higher PEEP (8 \u00b1 1 cmH2O) (mean difference, \u22128 cmH2O; 95% CI: \u22128.1 to \u22127.9 cmH2O; p = 0.01). The tidal volume size was low in both groups (median (IQR), 7.2 (6.3 to 8.1) versus 7.0 (5.3 to 9.1) ml\/kg PBW; p = 0.97). The median right ventricular MPI was 0.32 (IQR, 0.26 to 0.39) in the lower-PEEP group versus 0.38 (0.32 to 0.41) in the higher-PEEP group; the median difference was \u20130.03; 95% CI: \u22120.11 to 0.03; p = 0.33. The other systolic and diastolic parameters were similar. In patients without ARDS ventilated with a low tidal volume, a lower PEEP had no beneficial effects on the right ventricular MPI.<\/jats:p>","DOI":"10.3390\/jcm11092309","type":"journal-article","created":{"date-parts":[[2022,4,22]],"date-time":"2022-04-22T05:07:22Z","timestamp":1650604042000},"page":"2309","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Myocardial Function during Ventilation with Lower versus Higher Positive End-Expiratory Pressure in Patients without ARDS"],"prefix":"10.3390","volume":"11","author":[{"given":"Anna Geke","family":"Algera","sequence":"first","affiliation":[{"name":"Department of Intensive Care, Amsterdam University Medical Centers Location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands"},{"name":"Laboratory of Experimental Intensive Care and Anesthesiology (LEICA), Amsterdam University Medical Centers Location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charalampos","family":"Pierrakos","sequence":"additional","affiliation":[{"name":"Department of Intensive Care, Amsterdam University Medical Centers Location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands"},{"name":"Department of Intensive Care, Brugmann University Hospital, Universit\u00e9 Libre de Bruxelles, 1020 Brussel, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2675-4604","authenticated-orcid":false,"given":"Michela","family":"Botta","sequence":"additional","affiliation":[{"name":"Department of Intensive Care, Amsterdam University Medical Centers Location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands"},{"name":"Laboratory of Experimental Intensive Care and Anesthesiology (LEICA), Amsterdam University Medical Centers Location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4875-4018","authenticated-orcid":false,"given":"Claudio","family":"Zimatore","sequence":"additional","affiliation":[{"name":"Department of Intensive Care, Amsterdam University Medical Centers Location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands"},{"name":"Laboratory of Experimental Intensive Care and Anesthesiology (LEICA), Amsterdam University Medical Centers Location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands"},{"name":"Section of Anesthesia and Intensive Care, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, 70124 Bari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luigi","family":"Pisani","sequence":"additional","affiliation":[{"name":"Department of Intensive Care, Amsterdam University Medical Centers Location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands"},{"name":"Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok 10400, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pieter-Roel","family":"Tuinman","sequence":"additional","affiliation":[{"name":"Department of Intensive Care & Research VUmc Intensive Care (REVIVE), Amsterdam University Medical Centers Location Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lieuwe D. J.","family":"Bos","sequence":"additional","affiliation":[{"name":"Department of Intensive Care, Amsterdam University Medical Centers Location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands"},{"name":"Laboratory of Experimental Intensive Care and Anesthesiology (LEICA), Amsterdam University Medical Centers Location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2784-1961","authenticated-orcid":false,"given":"Wim K.","family":"Lagrand","sequence":"additional","affiliation":[{"name":"Department of Intensive Care, Amsterdam University Medical Centers Location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marcello","family":"Gama de Abreu","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care, University Hospital Carl Gustav Carus, 01307 Dresden, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paolo","family":"Pelosi","sequence":"additional","affiliation":[{"name":"Department of Surgical Sciences and Integrated Diagnostics, IRCCS San Martino Policlinico Hospital, University of Genoa, 16132 Genoa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ary","family":"Serpa Neto","sequence":"additional","affiliation":[{"name":"Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia"},{"name":"Department of Critical Care Medicine, Melbourne Medical School, Austin Hospital, University of Melbourne, Heidelberg, VIC 3084, Australia"},{"name":"Data Analytics Research and Evaluation (DARE) Centre, Austin Hospital, Heidelberg, VIC 3084, Australia"},{"name":"Department of Intensive Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo 05652-900, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3969-7792","authenticated-orcid":false,"given":"Marcus J.","family":"Schultz","sequence":"additional","affiliation":[{"name":"Department of Intensive Care, Amsterdam University Medical Centers Location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands"},{"name":"Laboratory of Experimental Intensive Care and Anesthesiology (LEICA), Amsterdam University Medical Centers Location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands"},{"name":"Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok 10400, Thailand"},{"name":"Nuffield Department of Medicine, Oxford University, Oxford OX3 7BN, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas G. V.","family":"Cherpanath","sequence":"additional","affiliation":[{"name":"Department of Intensive Care, Amsterdam University Medical Centers Location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frederique","family":"Paulus","sequence":"additional","affiliation":[{"name":"Department of Intensive Care, Amsterdam University Medical Centers Location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands"},{"name":"Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, 1095 DZ Amsterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,4,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"979","DOI":"10.1056\/NEJMc1400293","article-title":"Ventilator-Induced Lung Injury","volume":"370","author":"Fraser","year":"2014","journal-title":"N. Engl. J. 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Cardiol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/9\/2309\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:58:04Z","timestamp":1760137084000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/9\/2309"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4,21]]},"references-count":26,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2022,5]]}},"alternative-id":["jcm11092309"],"URL":"https:\/\/doi.org\/10.3390\/jcm11092309","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2022,4,21]]}}}