| Effect of positive end-expiratory pressure on splanchnic perfusion in acute lung injury. | |
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MedLine Citation:
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PMID: 10872128 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: To evaluate the acute effects of an increased positive end-expiratory pressure (PEEP) on splanchnic tissue perfusion. DESIGN: Clinical prospective study. SETTING: Intensive care unit in a university clinic. PATIENTS: Six patients with severe acute lung injury (ALI) requiring mechanical ventilation. All patients had bilateral infiltrates in chest X-ray, PaO2/FiO2 < 200 mmHg and stable hemodynamics without vasoactive drugs. INTERVENTIONS: PEEP was increased by 5 cmH2O from a clinically selected PEEP level (8/6-11 cmH2O) up to (13/10-14 cmH2O) followed by a return to baseline. MEASUREMENTS AND MAIN RESULTS: Splanchnic blood flow was measured using primed continuous infusion of indocyanine green dye with hepatic venous sampling and systemic hemodynamics by routine monitoring. In addition, we estimated gastric mucosal-arterial PCO2 difference and splanchnic lactate/pyruvate exchange. After a baseline measurement, PEEP was increased. After 60 min all measurements were repeated. PEEP was returned to the baseline level and a third measurement followed. PEEP had no effect on cardiac index (baseline I: 3.2/6.1-2.5 l/min/m2; PEEP: 3.3/5.7-2.3 l/min/m2; baseline II: 3.4/6.0-2.5 l/min/m2); neither did PEEP have any effect on splanchnic blood flow (baseline I: 0.91/1.39-0.62 l/min/m2; PEEP: 1.04/1.75-0.54 l/min/m2; baseline II: 1.07/1.42-0.68 l/min/m2, respectively) or perfusion (gastric mucosal-arterial PCO2 difference baseline I: 2.1/12.8-0.6 kPa; PEEP: 1.7/14.5-0.7 kPa; baseline II: 1.7/8.8-0.1 kPa; lactate uptake baseline I: 0.5/1.1-0.3 mmol/min/m2; PEEP: 0.4/1.0-0.3 mmol/min/m2; baseline II: 0.5/0.9-0.3 mmol/min/m2; hepatic venous lactate/pyruvate baseline I: 9.7/10.6-5.7; PEEP: 9.7/14.2-6.4; baseline II: 8.4/12.4-7.3; respectively). CONCLUSION: PEEP by itself does not have a consistent effect on splanchnic blood flow and metabolism when cardiac index is stable and patients are ventilated within the linear part of the pv curve. |
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Authors:
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P Kiefer; S Nunes; P Kosonen; J Takala |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Intensive care medicine Volume: 26 ISSN: 0342-4642 ISO Abbreviation: Intensive Care Med Publication Date: 2000 Apr |
Date Detail:
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Created Date: 2000-10-24 Completed Date: 2000-10-24 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 7704851 Medline TA: Intensive Care Med Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 376-83 Citation Subset: IM |
Affiliation:
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Department of Anesthesiology and Intensive Care, Kuopio University Hospital, Finland. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Acute Disease Aged Blood Pressure Cardiac Output Female Hemodynamics Humans Indocyanine Green Intensive Care Units Lactic Acid / blood Male Middle Aged Oxygen Consumption Positive-Pressure Respiration* Prospective Studies Pyruvic Acid / blood Regional Blood Flow Respiratory Distress Syndrome, Adult / physiopathology, therapy* Splanchnic Circulation* Statistics, Nonparametric |
| Chemical | |
Reg. No./Substance:
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127-17-3/Pyruvic Acid; 3599-32-4/Indocyanine Green; 50-21-5/Lactic Acid |
| Comments/Corrections | |
Comment In:
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Intensive Care Med. 2000 Apr;26(4):361-3
[PMID:
10872126
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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