Extrapulmonary Effects of Positive-pressure Ventilation

Abstract Summary One of the consequences of positive-pressure ventilation is an increase in intrathoracic pressure. This leads to several negative consequences, both in organs situated within the mediastinum and remotely. First, haemodynamic changes can affect cardiovascular performance, cerebral perfusion pressure, and drainage of renal veins. Second, the negative effect of mechanical ventilation on the alveolar–capillary membrane may cause inflammation in susceptible distal organs, such as the central nervous system, kidney, and liver. Intra-abdominal hypertension (IAH) impairs lung and peripheral organ function. The ideal combinations of mechanical ventilation settings necessary to optimize both respiratory function and haemodynamics in the presence of IAH have yet to be elucidated. Finally, ventilator-induced diaphragm dysfunction is discussed. Understanding the effects of positive-pressure ventilation on extrapulmonary organs is important to prevent multiple organ dysfunction and improve long-term outcomes after discharge from the intensive care unit.