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Letters |1 April 1994

Positive End-Expiratory Pressure and Shunting across Foramen Ovale

Mark D. Siegel, MD

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  • Yale University School of Medicine; New Haven, CT 06520
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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 controlled. Finally, how did the shunt increase in the patent foramen ovale group when the arterial and mixed venous oxygen remained the same [4]? More data on the arterial oxygenation of individual patients might clarify this paradox.
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Siegel MD. Positive End-Expiratory Pressure and Shunting across Foramen Ovale. Ann Intern Med. 1994;120:620. doi: 10.7326/0003-4819-120-7-199404010-00019

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Published: Ann Intern Med. 1994;120(7):620.

DOI: 10.7326/0003-4819-120-7-199404010-00019

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