Hostname: page-component-cd9895bd7-gxg78 Total loading time: 0 Render date: 2024-12-23T17:10:18.209Z Has data issue: false hasContentIssue false
  • English
  • Français

Effects of positive end-expiratory pressure on systemic haemodynamics, with special interest to central venous and common iliac venous pressure in liver transplanted patients

Published online by Cambridge University Press:  24 May 2006

F. H. Saner ,
G. Pavlakovic ,
Y. Gu ,
J. Gensicke ,
A. Paul ,
A. Radtke ,
M. Bockhorn ,
N. R. Fruhauf ,
S. Nadalin  and
M. Malagó
...Show all authors
F. H. Saner
Affiliation:
University Essen, Department of General Surgery and Transplantation, Germany
G. Pavlakovic
Affiliation:
University Goettingen, Centers for Anesthesiology, Emergency and Intensive Care Medicine, Germany
Y. Gu
Affiliation:
University Essen, Department of General Surgery and Transplantation, Germany
J. Gensicke
Affiliation:
University Essen, Department of General Surgery and Transplantation, Germany
A. Paul
Affiliation:
University Essen, Department of General Surgery and Transplantation, Germany
A. Radtke
Affiliation:
University Essen, Department of General Surgery and Transplantation, Germany
M. Bockhorn
Affiliation:
University Essen, Department of General Surgery and Transplantation, Germany
N. R. Fruhauf
Affiliation:
University Essen, Department of General Surgery and Transplantation, Germany
S. Nadalin
Affiliation:
University Essen, Department of General Surgery and Transplantation, Germany
M. Malagó
Affiliation:
University Essen, Department of General Surgery and Transplantation, Germany
C. E. Broelsch
Affiliation:
University Essen, Department of General Surgery and Transplantation, Germany
Get access

Abstract

Summary

Background and objectives: Positive end-expiratory pressure may alter cardiac function and systemic haemodynamics. As transplanted livers may be sensitive to liver congestion, the aim of our study was to evaluate the effect of positive end-expiratory pressure on the cardiovascular system and in particular on central venous and iliac venous pressure in liver transplanted patients. Patients and methods: Seventy-two liver transplant patients were enrolled in this prospective, interventional study. On admission to our Intensive Care Unit all patients were ventilated in a biphasic positive airway pressure mode. Haemodynamic effects of three randomly set levels of end-expiratory pressures (0, 5 and 10 mbar) were studied in the immediate postoperative period in all patients. Mean arterial pressure, central venous pressure, pulmonary capillary wedge pressure, central iliac venous pressure and cardiac index were recorded and analysed at each of the three end-expiratory pressure levels. Results: The values of central- and wedge-pressure significantly increased with increased end-expiratory pressure. Central venous pressure increased by 24% and wedge pressure showed a 6% increase at 10 mbar in comparison to 0 mbar. The values for cardiac index and mean arterial pressure showed no statistically significant difference at 10 mbar as compared to 0 and 5 mbar. The mean pulmonary arterial and common iliac venous pressure were unaffected by different positive end-expiratory pressure levels. Conclusions: Short-term pressure controlled ventilation with end-expiratory pressure up to 10 mbar does not significantly impair systemic haemodynamics in liver-transplanted patients. Further studies are needed to determine whether these findings could be confirmed with higher pressure levels and/or over a longer period of ventilation time.

Keywords

CONTINUOUS POSITIVE AIRWAY PRESSUREARTIFICIAL VENTILATIONLIVER TRANSPLANTATIONCENTRAL VENOUS PRESSURECARDIAC INDEX
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 23 , Issue 9 , September 2006 , pp. 766 - 771
Copyright
2006 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Meier-Hellmann A, Reinhart K. Effects of catecholamines on regional perfusion and oxygenation in critically ill patients. Acta Anaesthesiol Scand Suppl 1995; 107: 239–248.Google Scholar
Berendes E, Lippert G, Loick HM, Brussel T. Effects of positive end-expiratory pressure ventilation on splanchnic oxygenation in humans. J Cardiothorac Vasc Anesth 1996; 10: 598–602.Google Scholar
Nasraway SA, Klein RD, Spanier TBet al. Hemodynamic correlates of outcome in patients undergoing orthotopic liver transplantation. Evidence for early postoperative myocardial depression. Chest 1995; 107: 218–224.Google Scholar
Brienza N, Revelly JP, Ayuse T, Robotham JL. Effects of PEEP on liver arterial and venous blood flows. Am J Respir Crit Care Med 1995; 152: 504–510.Google Scholar
Bredenberg CE, Paskanik AM. Relation of portal hemodynamics to cardiac output during mechanical ventilation with PEEP. Ann Surg 1983; 198: 218–222.Google Scholar
Fujita Y. Effects of PEEP on splanchnic haemodynamics and blood volume. Acta Anaesthesiol Scand 1993; 37: 427–431.Google Scholar
Matuschak GM, Pinsky MR, Rogers RM. Effects of positive end-expiratory pressure on hepatic blood flow and performance. J Appl Physiol 1987; 62: 1377–1383.Google Scholar
Fessler HE, Brower RG, Wise RA, Permutt S. Effects of positive end-expiratory pressure on the canine venous return curve. Am Rev Respir Dis 1992; 146: 4–10.Google Scholar
Fernandez EG, Green TP, Sweeney M. Low inferior vena caval catheters for hemodynamic and pulmonary function monitoring in pediatric critical care patients. Pediatr Crit Care Med 2004; 5: 14–18.Google Scholar
Dillon PJ, Columb MO, Hume DD. Comparison of superior vena caval and femoroiliac venous pressure measurements during normal and inverse ratio ventilation. Crit Care Med 2001; 29: 37–39.Google Scholar
Jones RM, Moulton CE, Hardy KJ. Central venous pressure and its effect on blood loss during liver resection. Br J Surg 1998; 85: 1058–1060.Google Scholar
Staudinger T, Kordova H, Roggla Met al. Comparison of oxygen cost of breathing with pressure-support ventilation and biphasic intermittent positive airway pressure ventilation. Crit Care Med 1998; 26: 1518–1522.Google Scholar
Hormann C, Baum M, Putensen C, Mutz NJ, Benzer H. Biphasic positive airway pressure (BIPAP) – a new mode of ventilatory support. Eur J Anaesthesiol 1994; 11: 37–42.Google Scholar
Fegler G. Measurement of cardiac output in anaesthetized animals by a thermodilution method. Q J Exp Physiol Cogn Med Sci 1954; 39: 153–164.Google Scholar
Moreno AH, Burchell AR, Van der Woude R, Burke JH. Respiratory regulation of splanchnic and systemic venous return. Am J Physiol 1967; 213: 455–465.Google Scholar
Takata M, Robotham JL. Effects of inspiratory diaphragmatic descent on inferior vena caval venous return. J Appl Physiol 1992; 72: 597–607.Google Scholar
Krenn CG, Krafft P, Schaefer Bet al. Effects of positive end-expiratory pressure on hemodynamics and indocyanine green kinetics in patients after orthotopic liver transplantation. Crit Care Med 2000; 28: 1760–1765.Google Scholar
Tsubono T, Todo S, Jabbour Net al. Indocyanine green elimination test in orthotopic liver recipients. Hepatology 1996; 24: 1165–1171.Google Scholar
Niemann CU, Roberts JP, Ascher NL, Yost CS. Intraoperative hemodynamics and liver function in adult-to-adult living liver donors. Liver Transpl 2002; 8: 1126–1132.Google Scholar
Ho KM, Joynt GM, Tan P. A comparison of central venous pressure and common iliac venous pressure in critically ill mechanically ventilated patients. Crit Care Med 1998; 26: 461–464.Google Scholar
Walsh JT, Hildick-Smith DJ, Newell SAet al. Comparison of central venous and inferior vena caval pressures. Am J Cardiol 2000; 85: 518–520, A511.Google Scholar
Giebler R, Scherer R, Erhard Jet al. [Percutaneous puncture technique for portofemorosubclavicular venovenous bypass in orthotopic liver transplantation]. Anaesthesist 1996; 45: 59–65.Google Scholar
Hakim TS, Gilbert E, Camporesi E. Positive end-expiratory pressure increases capillary pressure relative to wedge pressure in the closed and open chest. J Crit Care 1993; 8: 80–86.Google Scholar
Koganov Y, Weiss YG, Oppenheim A, Elami A, Pizov R. Positive end-expiratory pressure increases pulmonary venous vascular resistance in patients after coronary artery surgery. Crit Care Med 1997; 25: 767–772.Google Scholar
Le Gall JR, Lemeshow S, Saulnier F. A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA 1993; 270: 2957–2963.Google Scholar