Is positive end-expiratory pressure suitable for liver recipients with a rescue organ offer?

F.H. Saner, S. Olde Damink, G. Pavlakovic, G.C. Sotiropoulos, A. Radtke, J. Treckmann, S. Beckebaum, V. Cicinnati, A. Paul

Research output: Contribution to journalArticleAcademicpeer-review

2 Citations (Scopus)

Abstract

PURPOSE: Rescue organ offers may help to overcome the organ shortage. However, because of initial poor liver function, the recipient may develop a severe lung injury with the requirement for higher positive end-expiratory pressure (PEEP) levels to achieve adequate oxygenation. Positive end-expiratory pressure has been associated with perfusion impairment in the hepatosplanchnic area. We assessed the effects of increased PEEP levels on systemic hemodynamic and liver perfusion in liver transplantation (LT) patients with a rescue organ. METHODS: Twenty-four LT recipients of a rescue organ offer were enrolled. All patients were postoperatively mechanically ventilated with biphasic positive airway pressure, and 3 different PEEP levels (0, 5, 10 mbar) were randomly set within 4 hours after admission at the intensive care unit. Systemic hemodynamic parameters were recorded using a pulmonary artery catheter; and flow velocities of the hepatic artery, portal vein, and right hepatic vein were measured using Doppler. RESULTS: Positive end-expiratory pressure of 10 mbar did not impair the systemic hemodynamic. Flow velocities in the right hepatic vein, the portal vein, and the hepatic artery were not influenced by PEEP. CONCLUSION: Our study demonstrates that PEEP up to 10 mbar did not impair the liver outflow in recipients with a rescue organ offer.
Original languageEnglish
Pages (from-to)477-482
Number of pages6
JournalJournal of Critical Care
Volume25
Issue number3
DOIs
Publication statusPublished - Sep 2010

Keywords

  • Liver transplantation
  • PEEP
  • Ultrasound Doppler
  • Liver congestion
  • Extended donor criteria
  • HEPATIC VEIN
  • ISCHEMIA-REPERFUSION
  • PULMONARY-EDEMA
  • RESISTIVE INDEX
  • PORTAL-VEIN
  • BLOOD-FLOW
  • TRANSPLANTATION
  • HEMODYNAMICS
  • VENTILATION

Cite this

Saner, F. H., Olde Damink, S., Pavlakovic, G., Sotiropoulos, G. C., Radtke, A., Treckmann, J., Beckebaum, S., Cicinnati, V., & Paul, A. (2010). Is positive end-expiratory pressure suitable for liver recipients with a rescue organ offer? Journal of Critical Care, 25(3), 477-482. https://doi.org/10.1016/j.jcrc.2009.11.002