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

Abstract

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 

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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

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