Pharmacologic Interventions to Improve Splanchnic Oxygenation During Ventilation with Positive End-Expiratory Pressure

  • A. FournellEmail author
  • T. W. L. Scheeren
  • O. Picker
  • L. A. Schwarte
Conference paper
Part of the Advances in Experimental Medicine and Biology book series (volume 737)


Mechanical ventilation with positive end-expiratory pressure (PEEP) is an indispensable tool in the management of respiratory failure to preserve or improve lung function and systemic oxygenation. However, PEEP per se may also, as has been shown in experimental animals, impair regional microcirculation and oxygenation. The latter effects have received attention of late because of possible systemic sequelae such as multiple system organ failure (MSOF) in case of the splanchnic region. In this review, we examine the impact of pharmacologic interventions to improve splanchnic mucosal oxygen saturation depressed by mechanical ventilation with PEEP in a canine model of compromised cardiac function. Although much remains to be elucidated about the mechanisms of action, the primary way to improve splanchnic oxygenation seems to be a vasodilatory action of the drugs.


Continuous Positive Airway Pressure Mean Arterial Pressure Adult Respiratory Distress Syndrome Thoracic Epidural Anesthesia Selective Blockade 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The above-mentioned studies have been funded by a grant from the Research Commission, Medical Faculty, Heinrich-Heine-University Düsseldorf and departmental funds.


  1. 1.
    Slutsky AS, Imai Y (2003) Ventilator-induced lung injury, cytokines, PEEP, and mortality: implications for practice and for clinical trials. Intensive Care Med 29:1218–1221PubMedCrossRefGoogle Scholar
  2. 2.
    Plötz FB, Slutsky AS, van Vught AJ et al (2004) Ventilator-induced lung injury and multiple system organ failure: a critical review of facts and hypotheses. Intensive Care Med 30:1865–1872PubMedCrossRefGoogle Scholar
  3. 3.
    Ashbaugh DG, Petty TL, Bigelow DB et al (1969) Continuous positive-pressure breathing (CPPB) in adult respiratory distress syndrome. J Thorac Cardiovasc Surg 57:31–41PubMedGoogle Scholar
  4. 4.
    De Backer D (2000) The effects of positive end-expiratory pressure on the splanchnic circulation. Intensive Care Med 26:361–363PubMedCrossRefGoogle Scholar
  5. 5.
    Carrico CJ, Meakins JL, Marshall et al (1986) Multiple-organ-failure syndrome. Arch Surg 121:196–208PubMedCrossRefGoogle Scholar
  6. 6.
    Parrillo JE (1993) Pathogenetic mechanisms of septic shock. N Engl J Med 328:1471–1477PubMedCrossRefGoogle Scholar
  7. 7.
    Hinshaw LB (1996) Sepsis/septic shock: participation of the microcirculation: an abbreviated review. Crit Care Med 24:1072–1078PubMedCrossRefGoogle Scholar
  8. 8.
    De Backer D, Creteur J, Preiser J-C et al (2002) Microvascular blood flow is altered in patients with sepsis. Am J Respir Crit Care Med 166:98–104PubMedCrossRefGoogle Scholar
  9. 9.
    Fournell A, Scheeren TW, Schwarte LA (1998) PEEP decreases oxygenation of the intestinal mucosa despite normalization of cardiac output. Adv Exp Med Biol 454:435–440PubMedCrossRefGoogle Scholar
  10. 10.
    Fournell A, Schwarte LA, Kindgen-Milles D et al (2003) Assessment of microvascular oxygen saturation in gastric mucosa in volunteers breathing continuous positive airway pressure. Crit Care Med 31:1705–1710PubMedCrossRefGoogle Scholar
  11. 11.
    Frank KH, Kessler M, Appelbaum K et al (1989) The Erlangen micro-lightguide spectrophotometer EMPHO I. Phys Med Biol 34:1883–1900PubMedCrossRefGoogle Scholar
  12. 12.
    Scheeren TW, Schwarte LA, Loer SA et al (2002) Dopexamine but not dopamine increases gastric mucosal oxygenation during mechanical ventilation in dogs. Crit Care Med 30:881–887PubMedCrossRefGoogle Scholar
  13. 13.
    Schwarte LA, Picker O, Schindler A et al (2004) Dopamine under alpha1-blockade, but not dopamine alone or fenoldopam, increases depressed gastric mucosal oxygenation. Crit Care Med 32:150–156PubMedCrossRefGoogle Scholar
  14. 14.
    Schwarte LA, Picker O, Schindler AW et al (2003) Fenoldopam: but not dopamine – selectively increases gastric mucosal oxygenation in dogs. Crit Care Med 31:1999–2005PubMedCrossRefGoogle Scholar
  15. 15.
    Schwarte LA, Picker O, Bornstein SR et al (2005) Levosimendan is superior to milrinone and dobutamine in selectively increasing microvascular gastric mucosal oxygenation in dogs. Crit Care Med 33:135–142PubMedCrossRefGoogle Scholar
  16. 16.
    Schwarte LA, Picker O, Hohne C et al (2004) Effects of thoracic epidural anaesthesia on microvascular gastric mucosal oxygenation in physiological and compromised circulatory conditions in dogs. Br J Anaesth 93:552–559PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • A. Fournell
    • 1
    Email author
  • T. W. L. Scheeren
    • 2
  • O. Picker
    • 1
  • L. A. Schwarte
    • 3
  1. 1.Department of AnesthesiologyHeinrich Heine University DüsseldorfDüsseldorfGermany
  2. 2.Department of AnesthesiologyUniversity Medical Center GroningenGroningenThe Netherlands
  3. 3.Department of AnesthesiologyVU University Medical CenterAmsterdamThe Netherlands

Personalised recommendations