Increasing levels of positive end-expiratory pressure cause stepwise biventricular stroke work reduction in a porcine model.

A stepwise increase in PEEP caused stepwise reduction in biventricular stroke work. However, there are important interventricular differences in response to increased PEEP levels. PEEP increased right ventricular afterload leading to uncoupling and right ventricular ejection fraction decline. These findings may support clinical decision-making to further optimize PEEP as a mean to balance between improving lung ventilation and preserving right ventricular function.