Hostname: page-component-cd9895bd7-8ctnn Total loading time: 0 Render date: 2024-12-26T22:57:41.508Z Has data issue: false hasContentIssue false
  • English
  • Français

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
Get access

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

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.)

Footnotes

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

References

Quist J, Pontoppidan H, Wilson RS, Lowenstein E, Laver MB. Hemodynamic responses to mechanical ventilation with PEEP. Anesthesiology 1975; 42: 45–55.Google Scholar
Fessler HE, Brower RG, Wise RA, Permutt S. Effects of positive endexpiratory pressure on the gradient for venous return. Am Rev Respir Dis 1991; 143: 19–24.Google Scholar
Winso O, Biber B, Gustavsson Bet al. Portal blood flow in man during graded positive end-expiratory pressure ventilation. Intens Care Med 1986; 12: 80–85.Google Scholar
Bonnet F, Richard C, Glaser P, Lafay M, Guesde R. Changes in hepatic flow induced by continuous positive pressure ventilation in critically ill patients. Crit Care Med 1982; 10: 703–705.Google Scholar
Berendes E, Lippert G, Loick HM, Brüssel T. Effects of positive end-expiratory pressure ventilation on splanchnic oxygenation in humans. J Cardiothorac Vasc Anesth 1996; 10: 598–602.Google Scholar
Kiefer P, Nunes S, Kosonen Pet al. Effect of positive end-expiratory pressure on splanchnic perfusion in acute lung injury. Intens Care Med 2000; 26: 376–383.Google Scholar
Aneman A, Eisenhofer G, Fandriks Let al. Splanchnic circulation and regional sympathetic outflow during peri-operative PEEP ventilation in humans. Br J Anaesth 1999; 82: 838–842.Google Scholar
Sakka SG, Reinhart K, Meier-Hellmann A. Prognostic value of indocyanine green plasma disappearance rate in critically ill patients. Chest 2002; 122: 1715–1720.Google Scholar
Matuschak G, Pinsky MR. Effects of positive end-expiratory pressure on hepatic blood flow and performance. J Appl Physiol 1987; 62: 1377–1383.Google Scholar
Parviainen I, Ruokonen E, Takala J. Sodium nitroprusside after cardiac surgery: systemic and splanchnic blood flow and oxygen transport. Acta Anaesthesiol Scand 1996; 40: 606–611.Google Scholar
Sakka SG, Koeck H, Meier-Hellmann A. Measurement of indocyanine green plasma disappearance rate by two different dosages. Intens Care Med 2004; 30: 506–509.Google Scholar
Kuntz HD, Schregel W. Indocyanine green: evaluation of liver function; application in intensive care medicine. In: Lewis FR, Pfeiffer UJ, eds. Practical Applications of Fiberoptics in Critical Care Monitoring.Berlin: Springer, 1990: 57–62.
Kolkman JJ, Groeneveld AB, van der Berg FGet al. Increased gastric PCO2 during exercise is indicative of gastric ischaemia: a tonometric study. Gut 1999; 44: 163–167.Google Scholar
Bruhn A, Hernandez G, Bugedo G, Castillo L. Effects of positive end-expiratory pressure on gastric mucosal perfusion in acute respiratory distress syndrome. Crit Care 2004; 8: R306–R311.Google Scholar
Akinci IO, Cakar N, Mutlu GMet al. Gastric intramucosal pH is stable during titration of positive end-expiratory pressure to improve oxygenation in acute respiratory distress syndrome. Crit Care 2003; 7: R17–R23.Google Scholar
Claesson J, Lehtipalo S, Winso O. Do lung recruitment maneuvers decrease gastric mucosal perfusion? Intens Care Med 2003; 29: 1314–1321.Google Scholar
Krenn C, Krofft P, Schoefer B. Effects of positive end-expiratory pressure in hemodynamics and indocyanine green kinetics in patients after orthoptic liver transplantation. Crit Care Med 2000; 28: 1760–1765.Google Scholar
Leevy CM, Leevy CB, Howard MM. Indocyanine green and the liver. In: Davidson CS, ed. Problems in Liver Diseases.New York: Georg-Thieme-Verlag, 1979: 42–52.
Joly LM, Monchi M, Cariou Aet al. Effects of dobutamine on gastric mucosal perfusion and hepatic metabolism in patients with septic shock. Am J Respir Crit Care Med 1999; 160: 1983–1986.Google Scholar
Lehmann C, Taymoorian K, Wauer Het al. Effects of the stable prostacyclin analogue iloprost on the plasma disappearance rate of indocyanine green in human septic shock. Intens Care Med 2000; 26: 1557–1560.Google Scholar
Bredenberg CE, Paskanck A, Fromm D. Portal hemodynamics in dogs during mechanical ventilation with positive end-expiratory pressure. Surgery 1981; 90: 817–822.Google Scholar
Johnson E. Splanchnic hemodynamic response to passive hyperventilation. J Appl Physiol 1975; 38: 156–162.Google Scholar
Stehr A, Ploner F, Traeger Ket al. Plasma disappearance of indocyanine green: a marker for excretory liver function? Intens Care Med 2005; 31: 1719–1722.Google Scholar
Goedje O, Peyerl M, Seebauer Tet al. Reproducibility of double indicator dilution measurements of intrathoracic blood volume compartments, extravascular lung water, and liver function. Chest 1998; 113: 1070–1077.Google Scholar
Hofmann D, Thuemer O, Schelenz C, van Hout N, Sakka SG. Increasing cardiac output by fluid loading: effects on indocyanine green plasma disappearance rate and splanchnic microcirculation. Acta Anaesth Scand 2005; 49: 1280–1286.Google Scholar
Sakka SG, Hofmann D, Thuemer Oet al. Increasing cardiac output by epinephrine after cardiac surgery: effects on indocyanine green plasma disappearance rate and splanchnic microcirculation. J Cardiothor Vasc Anesth (in press).
Sakka SG, Reinhart K, Meier-Hellmann A. Comparison between invasive vs. non-invasive measurement of indocyanine-green plasma disappearance rate in critically ill patients with mechanical ventilation and stable haemodynamics. Intens Care Med 2000; 26: 1553–1556.Google Scholar
Bonnet F, Richard C, Glaser Pet al. Changes in hepatic flow induced by continuous positive pressure ventilation in critically ill patients. Crit Care Med 1982; 10: 703–705.Google Scholar
Uusaro A, Ruokonen E, Takala J. Estimation of splanchnic blood flow by the Fick principle in man and problems in the use of indocyanine green. Cardiovasc Res 1995; 30: 106–112.Google Scholar
Heinonen PO, Jousela IT, Blomqvist KAet al. Validation of air tonometric measurement of gastric regional concentrations of CO2 in critically ill septic patients. Intens Care Med 1997; 23: 524–529.Google Scholar
Parviainen I, Ruokonen E, Takala J. Dobutamine-induced dissociation between changes in splanchnic blood flow and gastric intramucosal pH after cardiac surgery. Br J Anaesth 1995; 74: 277–282.Google Scholar