Intensive Care Medicine

, Volume 12, Issue 2, pp 80–85 | Cite as

Portal blood flow in man during graded positive end-expiratory pressure ventilation

  • O. Winsö
  • B. Biber
  • B. Gustavsson
  • C. Holm
  • I. Milson
  • D. Niemand
Original Articles


The cardiovascular response to graded PEEP ventilation (5–10 cm H2O) was studied peroperatively in patients undergoing chllecystectomy (n=8) or hepatic tumour surgery (n=3). Portal blood flow was measured by the continuous thermodilution technique and cardiac output, in a sub-group of the patients, by impedance cardiography. A parallel reduction in cardiac output and portal blood flow was demonstrated in patients undergoing cholecystectomy as the result of the application of PEEP. Thus, ventilation with 5 cm H2O of PEEP elicited a 17% decrease in cardiac output and a 26% decrease in portal blood flow. During 10 cm H2O of PEEP cardiac output decreased by 22% and portal blood flow by 32%. However, there were no significant changes in preportal tissue perfusion pressure by the application of PEEP and preportal vascular resistance increased by 22% and 30%, respectively. This indicates that a vasoconstrictor response, elicited by PEEP, in the preportal tissue is the predominating mechanism for the observed decrease in portal blood flow. Systemic oxygen transport decreased by 214 ml/min during PEEP ventilation, but preportal tissue oxygen utilization was not significantly changed due to a concurrent increase (2.9%; p<0.05) in oxygen extraction.

Key words

Cardiac output PEEP ventilation Portal blood flow Portal venous pressure Preportal tissue oxygen uptake 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Berry A (1981) Respiratory support and renal function. Anaesthesiology 55:655Google Scholar
  2. 2.
    Beyer J, Beckenlechner P, Messmer K (1982) The influence of PEEP ventilation on organ blood flow and peripheral oxygen delivery. Intensive Care Med 8:75Google Scholar
  3. 3.
    Biber B, Holm C, Winsö O, Gustavsson B (1983) Portal blood flow in man during surgery, measured by a modification of the continuous thermodilution method. Scand J Gastroenterol 18:233Google Scholar
  4. 4.
    Bonnet F, Richard C, Glaser P, Lafay M, Guesde R (1982) Changes in hepatic flow induced by continuous positive pressure ventilation in critically ill patients. Crit Care Med 10:703Google Scholar
  5. 5.
    Bredenberg CE, Paskanik A, Fromm D (1981) Portal hemodynamics in dogs during mechanical ventilation with positive endexpiratory pressure. Surgery 90:817Google Scholar
  6. 6.
    Bredenberg CE, Paskanik AM (1983) Relation of portal hemodynamics to cardiac output during mechanical ventilation with PEEP. Ann Surg 198:218Google Scholar
  7. 7.
    Bålfors E, Häggmark S, Ariola S Jr, Biber B, Pontén J, Reiz S (1983) In vitro analysis of thermal transport in coronary sinus thermodilution catheters. Clin Physiol 3:469Google Scholar
  8. 8.
    Dorinsky PM, Whitcomb ME (1983) The effect of PEEP on cardiac output. Chest 84:210Google Scholar
  9. 9.
    Dueck R (1979) PEEP and PaCO 2.Anaesthesiology 50:554Google Scholar
  10. 10.
    Ganz W, Tamura K, Marcus HS, Donoso R, Yoshida S, Swan HJC (1971) Measurement of coronary sinus blood flow by continuous thermodilution in man. Circulation 44:181PubMedGoogle Scholar
  11. 11.
    Haldén E, Jakobson S, Janerås L, Norlén K (1982) Effects of positive end-expiratory pressure on cardiac output distribution in the pig. Acta Anaesthesiol Scand 26:403Google Scholar
  12. 12.
    Hemmer M, Suter P (1969) Treatment of cardiac and renal effects of PEEP with dopamine in patients with acute respiratory failure. Anaesthesiology 50:399Google Scholar
  13. 13.
    Häggmark S, Biber B, Sjödin J-G, Winsö O, Gustavsson B, Reiz S (1982) The continuous thermodilution method for measuring high blood flows. Scand J Clin Lab Invest 42:315Google Scholar
  14. 14.
    Johnson EE, Hedley-Whyte J (1972) Continuous positive-pressure ventilation and portal flow in dogs with pulmonary edema. J Appl Physiol 33:385Google Scholar
  15. 15.
    Lutch JS, Murray JF (1972) Continuous positive-pressure ventilation: Effects on systemic oxygen transport and tissue oxygenation. Ann Intern Med 76:193Google Scholar
  16. 16.
    Manny J, Justice R, Hechtman HB (1979) Abnormalities in organ blood flow and its distribution during positive end-expiratory pressure. Surgery 85:425Google Scholar
  17. 17.
    Milsom I, Forssman L, Biber B, Dottori O, Sivertsson R(1983) Measurement of cardiac stroke volume during cesarean section: A comparison between impedance cardiography and the dye dilution technique. Acta Anaesthesiol Scand 27:421Google Scholar
  18. 18.
    Milsom I, Sivertsson R, Biber B, Olsson T (1982) Measurement of stroke volume with impedance cardiography. Clin Physiol 2:409Google Scholar
  19. 19.
    Owens WD, Felts JA, Spitznagel EL (1978) ASA physical status classifications: a study of consistency of ratings. Anesthesiology 49:239Google Scholar
  20. 20.
    Patten MT, Liebman PR, Hechtman HB (1977) Humorally mediated decreases in cardiac output associated with positive end-expiratory pressure. Microvasc Res 13:137Google Scholar
  21. 21.
    Pepine CJ, Mehta J, Webster WW, Nichols WW (1978) In vivo validation of a thermodilution method to determine regional left ventricular blood flow in patients with coronary disease. Circulation 58:795Google Scholar
  22. 22.
    Robotham JL, Cherry D, Mitzner W, Rabson JL, Lixfeld W, Bromberger-Barnea B (1983), A re-evaluation of the hemodynamic consequences of intermittent positive pressure ventilation. Crit Care Med 11:783Google Scholar
  23. 23.
    Schenk WG, McDonald JC, McDonald K, Drapanas T (1962) Direct measurement of hepatic blood flow in surgical patients: With related observations on hepatic flow dynamics in experimental animals. Ann Surg 156:463Google Scholar
  24. 24.
    Sjövall H, Redfors S, Biber B, Martner J, Winsö O (1984) Evidence for cardiac volume-receptor regulation of feline jejunal blood flow and fluid transport. Am J Physiol 246:G401Google Scholar
  25. 25.
    Sugimoto H, Ohashi N, Sawada Y, Yoshioka T, Sugimoto T (1984) Effects of positive end-expiratory pressure on tissue gas tensions and oxygen transport. Crit Care Med 12:661Google Scholar
  26. 26.
    Winsö O, Biber B, Holm C, Martner J (1983) Influence of dixyrazine on intestinal and renal vasoconstrictor responses during fentanyl-nitrous oxide anaesthesia. Acta Anaestheiol Scand 27:458Google Scholar

Copyright information

© Springer-Verlag 1986

Authors and Affiliations

  • O. Winsö
    • 1
    • 2
  • B. Biber
    • 1
    • 2
  • B. Gustavsson
    • 1
    • 2
  • C. Holm
    • 1
    • 2
  • I. Milson
    • 1
    • 2
  • D. Niemand
    • 1
    • 2
  1. 1.Department of Anaesthesiology, Östra HospitalUniversity of GothenburgGothenburgSweden
  2. 2.Department of Surgery, Östra HospitalUniversity of GothenburgGothenburgSweden

Personalised recommendations