Neural changes

Stimulation of sympathetic nerves present in renal glomeruli and tubules not only increases renal renin release but also directly decreases the glomerular filtration rate and the reabsorption of water and sodium (F.arge.efa/ 1995) The effect of the deactivation of low- and high-pressure intrathoracic baroreceptors has also been previously described.

All these neural and hormonal responses, which could be regarded as potential homeostatic mechanisms protecting circulatory stability during mechanical ventilation with PEEP, may lead to excessive fluid retention in severely ill intensive care patients.

Correction of systemic circulatory depression by volume expansion and increasing water and sodium excretion by low-dose dopamine administration may attenuate the effects of elevated intrathoracic pressure on renal function. The potential therapeutic benefit of angiotensin-converting enzyme inhibitors in this setting is under investigation.

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