Document Detail

Does PEEP impair the hepatic outflow in patients following liver transplantation?
MedLine Citation:
PMID:  16941166     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Evaluation of the impact of end-expiratory pressure (PEEP) ventilation on venous liver outflow, portal vein, and hepatic artery flows as well as systemic hemodynamics in patients following liver transplantation (LT). DESIGN: Prospective, interventional patient study. SETTING: University hospital intensive care unit. PATIENTS: 65 consecutive patients after LT. INTERVENTIONS: All patients were intubated and mechanically ventilated with biphasic positive airway pressure (BIPAP). The effects of three levels of PEEP (0, 5, and 10 mbar) applied at random order on hepatic inflow and outflow were studied in the immediate postoperative period. MEASUREMENT AND RESULTS: Central venous-, arterial pressure, and cardiac index was recorded from every patient at three different PEEP levels (0, 5, and 10 mbar). Simultaneously, flow velocities in the hepatic-, portal vein, and hepatic artery were determined by Doppler ultrasound. PEEP of 10 mbar significantly increased central venous pressure in comparison with zero PEEP. Mean arterial pressure and cardiac index was not influenced. Hepatic inflow and outflow of the transplanted livers were not impaired by any of the used PEEP levels. CONCLUSIONS: BIPAP ventilation with PEEP levels up to 10 mbar does not affect systemic hemodynamics. Furthermore, neither venous outflow nor portal venous or hepatic artery inflow of the liver are impaired at PEEP levels up to 10 mbar immediately following liver transplantation. Although these results suggest that PEEP ventilation up to 10 mbar does not affect liver hemodynamics, further studies are needed to determine whether these findings could be confirmed for a longer ventilation period with PEEP.
Fuat H Saner; Goran Pavlaković; Yanli Gu; Nils R Fruhauf; Andreas Paul; Arnold Radtke; Silvio Nadalin; Massimo Malagó; Christoph E Broelsch
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Publication Detail:
Type:  Journal Article     Date:  2006-08-29
Journal Detail:
Title:  Intensive care medicine     Volume:  32     ISSN:  0342-4642     ISO Abbreviation:  Intensive Care Med     Publication Date:  2006 Oct 
Date Detail:
Created Date:  2006-10-02     Completed Date:  2007-03-16     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7704851     Medline TA:  Intensive Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1584-90     Citation Subset:  IM    
University Clinic Essen, Department of General-, Visceral-, and Transplant Surgery, Hufelandstrasse 55, 45122 Essen, Germany.
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MeSH Terms
Analysis of Variance
Blood Flow Velocity
Chi-Square Distribution
Hepatic Artery / ultrasonography
Intensive Care Units
Intervention Studies
Liver / blood supply*,  ultrasonography
Liver Transplantation*
Middle Aged
Portal Vein / ultrasonography
Positive-Pressure Respiration*
Prospective Studies
Statistics, Nonparametric
Ultrasonography, Doppler, Color
Comment In:
Liver Transpl. 2006 Dec;12(12):1903   [PMID:  17193700 ]

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