• H Artucio, J Hurtado, L Zimet, J de Paula, and M Beron.
• Intensive Care Department, Hospital de Clinicas (University Hospital), Universidad de la Republica, Montevideo, Uruguay.
• Intensive Care Med. 1997 Aug 1; 23 (8): 836-40.

ObjectiveTo determine the presence of tricuspid regurgitation (TR) in patients affected by acute lung injury (ALI) and the adult respiratory distress syndrome (ARDS) during mechanical ventilation with positive end-expiratory pressure (PEEP).DesignA prospective clinical study.Setting10-bed general intensive care unit in a University Hospital.Patients7 consecutive patients an age 44.7 +/- 8.6 years with a diagnosis of ALI or ARDS were studied. All were on mechanical ventilation with PEEP.InterventionsPEEP was increased in steps of 5 cm H2O until the appearance of TR or up to a limit of 20 cm H2O.Measurements And ResultsRight atrial pressure, pulmonary artery pressure, and wedge pressure were measured and cardiac output was determined by thermodilution. TR was graded from 0 to 3. Standard 2D echocardiographic and pulsed-wave images were obtained at each level of PEEP. PEEP was increased from 4 +/- 3 to 17 +/- 2 cm H2O. Mean PAP increased from 27.7 +/- 2.9 to 36.7 +/- 3.5 mm Hg (p < 0.02) when PEEP was increased. Five patients had competent valves and two had mild TR at baseline. In six out of the seven, TR either developed or increased when PEEP was increased.ConclusionsOur study demonstrated the development of TR after the use of PEEP in patients with ALI and ARDS as a consequence of pulmonary hypertension and right ventricular overloading. Since TR may randomly affect cardiac output values and derived parameters, the assessment of cardiac performance by some techniques such as thermodilution should be used with caution.

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