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Effects of positive end-expiratory pressure on hemodynamics and indocyanine green kinetics in patients after orthotopic liver transplantation

Krenn, CG and Krafft, P and Schaefer, B and Pokorny, H and Schneider, B and Pinsky, MR and Steltzer, H (2000) Effects of positive end-expiratory pressure on hemodynamics and indocyanine green kinetics in patients after orthotopic liver transplantation. Critical Care Medicine, 28 (6). 1760 - 1765. ISSN 0090-3493

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Abstract

Objective: To determine the impact of positive end-expiratory pressure (PEEP) ventilation on hemodynamics and a clinical test for assessment of dynamic liver performance in patients undergoing orthotopic liver transplantation (OLT). Design: Prospective, descriptive patient study. Setting: University hospital intensive care unit. Patients: A total of 25 patients after OLT. Interventions: All patients were intubated and mechanically ventilated with biphasic positive airway pressure. The effects of three different randomly chosen levels of PEEP (0 cm H2O, 5 cm H2O, and 10 cm H2O) were studied in the immediate postoperative period. Measurements and Main Results: Systemic hemodynamics, arterial and venous blood gas analyses, and plasma disappearance rate of indocyanine green (ICG(PDR)), using the transpulmonary indicator dilution technique, were obtained simultaneously. For data evaluation, patients were grouped retrospectively according to their hemodynamic response to PEEP (Group A and Group B). In Group A (n = 13), PEEP did not alter cardiac index. In Group B (n = 11), PEEP levels of 5 cm H2O and 10 cm H2O significantly reduced cardiac index and oxygen delivery. ICG(PDR) remained statistically unchanged in both groups. Conclusions: Short-term pressure-controlled ventilation with PEEP levels of up to 10 cm H2O does not exert detrimental effects on systemic hemodynamics in OLT patients and does not interfere with ICG(PDR). However, it remains to be determined whether these findings could be confirmed under the application of higher PEEP levels over a longer period of time and whether they could be of clinical relevance for the use of indocyanine green as a dynamic liver function test.

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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Krenn, CG
Krafft, P
Schaefer, B
Pokorny, H
Schneider, B
Pinsky, MRpinsky@pitt.eduPINSKY0000-0001-6166-700X
Steltzer, H
Date: 1 January 2000
Date Type: Publication
Journal or Publication Title: Critical Care Medicine
Volume: 28
Number: 6
Page Range: 1760 - 1765
DOI or Unique Handle: 10.1097/00003246-200006000-00010
Schools and Programs: School of Medicine > Critical Care Medicine
Refereed: Yes
ISSN: 0090-3493
PubMed ID: 10890615
Date Deposited: 22 Mar 2012 20:57
Last Modified: 22 Jun 2021 14:55
URI: http://d-scholarship.pitt.edu/id/eprint/11423

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