Document Detail

Positive end-expiratory pressure does not affect indocyanine green plasma disappearance rate or gastric mucosal perfusion after cardiac surgery.
MedLine Citation:
PMID:  16938155     Owner:  NLM     Status:  MEDLINE    
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.
A Holland; O Thuemer; C Schelenz; N van Hout; S G Sakka
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2006-08-29
Journal Detail:
Title:  European journal of anaesthesiology     Volume:  24     ISSN:  0265-0215     ISO Abbreviation:  Eur J Anaesthesiol     Publication Date:  2007 Feb 
Date Detail:
Created Date:  2007-01-04     Completed Date:  2007-04-04     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8411711     Medline TA:  Eur J Anaesthesiol     Country:  England    
Other Details:
Languages:  eng     Pagination:  141-7     Citation Subset:  IM    
Department of Anaesthesiology and Intensive Care Medicine, Friedrich-Schiller-University of Jena, Erlanger Allee 101, D-07747 Jena, Germany.
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MeSH Terms
Aged, 80 and over
Analysis of Variance
Blood Pressure / physiology
Cardiac Surgical Procedures / methods*
Cardiopulmonary Bypass / methods
Coloring Agents / diagnostic use*,  pharmacokinetics
Gastric Mucosa / blood supply*
Heart Rate / physiology
Indocyanine Green / diagnostic use*,  pharmacokinetics
Liver / blood supply
Liver Function Tests / methods
Middle Aged
Positive-Pressure Respiration / methods*
Prospective Studies
Pulmonary Artery / physiology
Regional Blood Flow / physiology
Splanchnic Circulation / physiology*
Surgical Procedures, Elective / methods
Thermodilution / methods
Time Factors
Reg. No./Substance:
0/Coloring Agents; 3599-32-4/Indocyanine Green

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