Document Detail


How far can we go with positive end-expiratory pressure (PEEP) in liver transplant patients?
MedLine Citation:
PMID:  20304351     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
STUDY OBJECTIVE: To assess the effect of positive end-expiratory pressure (PEEP) up to 15 cm H(2)O on blood flow throughput of the liver and its effects on systemic hemodynamics in patients following liver transplantation. DESIGN: Prospective, interventional study. SETTING: Intensive care unit (ICU) of a university hospital. PATIENTS: 74 consecutive liver transplant recipients with a regular allocated cadaveric graft. INTERVENTION: The lungs of all study patients were postoperatively mechanically ventilated with biphasic positive airway pressure. Three different PEEP levels (5, 10, and 15 cm H(2)O) were randomly set within 4 hours of admission to the ICU. Systemic hemodynamic parameters were recorded using a pulmonary artery catheter and flow velocities were measured of the hepatic artery, portal vein, and right hepatic vein using a Doppler. MEASUREMENTS AND MAIN RESULTS: PEEP of 15 cm H(2)O induced a significant increase in central venous pressure and pulmonary capillary wedge pressure versus PEEP 5 cm H(2)O. Flow velocities of the right hepatic vein, portal vein, and hepatic artery were not influenced by PEEP. There also was no impact of increased PEEP on mean arterial pressure or cardiac index. CONCLUSION: PEEP up to 15 cm H(2)O does not impair liver outflow or systemic hemodynamics in liver transplant patients.
Authors:
Fuat H Saner; Steven W M Olde Damink; Goran Pavlaković; Georgios C Sotiropoulos; Arnold Radtke; Jürgen Treckmann; Susanne Beckebaum; Vito Cicinnati; Andreas Paul
Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of clinical anesthesia     Volume:  22     ISSN:  1873-4529     ISO Abbreviation:  J Clin Anesth     Publication Date:  2010 Mar 
Date Detail:
Created Date:  2010-03-22     Completed Date:  2010-07-15     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8812166     Medline TA:  J Clin Anesth     Country:  United States    
Other Details:
Languages:  eng     Pagination:  104-9     Citation Subset:  IM    
Copyright Information:
Copyright 2010 Elsevier Inc. All rights reserved.
Affiliation:
Department of General-, Visceral- and Transplant Surgery, University Hospital Essen, 45122 Essen, Germany. fuat.saner@uni-due.de
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MeSH Terms
Descriptor/Qualifier:
Algorithms
Blood Flow Velocity
Cardiac Output / physiology
Central Venous Pressure / physiology
Female
Hemodynamics / physiology*
Humans
Liver / blood supply*,  ultrasonography
Liver Diseases / physiopathology,  surgery
Liver Transplantation*
Male
Middle Aged
Positive-Pressure Respiration / methods*
Prospective Studies
Pulmonary Wedge Pressure / physiology

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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