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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
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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
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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

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