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Positive end-expiratory pressure does not affect indocyanine green plasma disappearance rate or gastric mucosal perfusion after cardiac surgery

Published online by Cambridge University Press:  29 August 2006

A. Holland ,
O. Thuemer ,
C. Schelenz ,
N. van Hout  and
S. G. Sakka
A. Holland
Affiliation:
Friedrich-Schiller-University of Jena, Department of Anaesthesiology and Intensive Care Medicine, Jena, Germany
O. Thuemer
Affiliation:
Friedrich-Schiller-University of Jena, Department of Anaesthesiology and Intensive Care Medicine, Jena, Germany
C. Schelenz
Affiliation:
Friedrich-Schiller-University of Jena, Department of Anaesthesiology and Intensive Care Medicine, Jena, Germany
N. van Hout
Affiliation:
Friedrich-Schiller-University of Jena, Department of Anaesthesiology and Intensive Care Medicine, Jena, Germany
S. G. Sakka
Affiliation:
Friedrich-Schiller-University of Jena, Department of Anaesthesiology and Intensive Care Medicine, Jena, Germany
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Abstract

Summary

Background and objective: Positive end-expiratory pressure (PEEP) may affect hepato-splanchnic blood flow. We studied whether a PEEP of 10 mbar may negatively influence flow-dependent liver function (indocyanine green plasma disappearance rate, ICG-PDR) and splanchnic microcirculation as estimated by gastric mucosal PCO2 (PRCO2). Methods: In a randomized, controlled clinical study, we enrolled 28 patients after elective cardiac surgery using cardiopulmonary bypass. In 14 patients (13 male, 1 female; age 48–74, mean 63 ± 7 yr) we assessed ICG-PDR and PRCO2 on intensive care unit admission with PEEP 5 mbar, after 2 h with PEEP of 10 mbar and again after 2 h at PEEP 5 mbar. Inspiratory peak pressure was adjusted to maintain normocapnia. Fourteen other patients (8 male, 6 female; age 46–86, mean 68 ± 11 yr) in whom PEEP was 5 mbar throughout served as controls. All patients underwent haemodynamic monitoring by measurement of central venous pressure, left atrial pressure and cardiac index using pulmonary artery thermodilution. Results: While doses of vasoactive drugs and cardiac filling pressures did not change significantly, cardiac index slightly increased in both groups. ICG-PDR remained unchanged either within or between both groups (PEEP10 group: 24.0 ± 6.9, 22.0 ± 7.9 and 25.5 ± 7.7% min−1 vs. controls: 22.0 ± 7.5, 23.8 ± 8.4 and 21.4 ± 6.5% min−1) (P = 0.05). The difference between PRCO2 and end-tidal PCO2 (PCO2-gap) did not change significantly (PEEP10 group: 1.1 ± 0.9, 1.3 ± 0.7 and 1.3 ± 0.9 kPa vs. controls: 0.8 ± 0.5, 0.9 ± 0.5 and 0.9 ± 0.5 kPa). Conclusion: A PEEP of 10 mbar for 2 h does not compromise liver function and gastric mucosal perfusion in patients after cardiac surgery with maintained cardiac output.

Keywords

POSITIVE PRESSURE RESPIRATION, positive end-expiratory pressureCARDIAC SURGERYCORONARY ARTERY BYPASS GRAFTINGCARDIOPULMONARY BYPASSREGIONAL BLOOD FLOW, liver, heart
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 2 , February 2007 , pp. 141 - 147
Copyright
2007 European Society of Anaesthesiology

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Footnotes

This work has been presented at the Annual Meeting of the American Society of Anesthesiologists (ASA) in Atlanta (12–17 October 2005).

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