Acute cardiac care & resuscitation
Positive end-expiratory pressure (PEEP) titration in cardiogenic shock: impact on congestion and haemodynamic phenotype
Authors' conclusion
Respiratory mechanics-guided PEEP titration frequently modifies ventilatory settings in CS and reveals marked variability in haemodynamic tolerance according to CS phenotype and RV function. Individualized PEEP titration may help balance respiratory benefit, congestion, and haemodynamic stability in mechanically ventilated patients with CS.
Study context
- Population
- Mechanically ventilated patients with cardiogenic shock (CS) undergoing a decremental PEEP titration protocol (15 to 5 cmH2O)patients included
- Participants
- 25 participants
- Exposure
- Respiratory mechanics-guided decremental PEEP titration (15 to 5 cmH2O); parameters assessed at each step
- AMI-CSn = 15
- HF-CSn = 10
- Outcome
- Modification of ventilatory settings
Main finding
As reported in the abstract
Patients with modified ventilatory settings
88%
Observational data: associations, not effects.
Further findings
Static compliance · before vs after titration
- Static compliance before vs after titration
- 62.5 ± 11 vs. 74.7 ± 11.5 mL/cmH2O; P = 0.003
PaO2/FiO2 ratio · before vs after titration
- PaO2/FiO2 ratio before vs after titration
- 244 ± 89 vs. 276 ± 65; P = 0.001
Right atrial pressure (RAP) across PEEP levels
- RAP varied significantly across PEEP levels
- P < 0.001
- Changes were greater in HF-CS and in patients with RV dysfunction
- Patients with impaired RV function showed greater RAP increase and reduced tolerance to higher PEEP levels
Original publication
PEEP titration in cardiogenic shock: impact on congestion and haemodynamic phenotype. Eur Heart J Acute Cardiovasc Care. Published 24 July 2026. doi:10.
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