Abstract
Objective: To evaluate the acute effects of an increased positive end-expiratory pressure (PEEP) on splanchnic tissue perfusion.¶Design: Clinical prospective study.¶Setting: Intensive care unit in a university clinic.¶Patients: Six patients with severe acute lung injury (ALI) requiring mechanical ventilation. All patients had bilateral infiltrates in chest X-ray, PaO2/FiO2 < 200 mmHg and stable hemodynamics without vasoactive drugs.¶Interventions: PEEP was increased by 5 cmH2O from a clinically selected PEEP level (8/6–11 cmH2O) up to (13/10–14 cmH2O) followed by a return to baseline.¶Measurements and main results: Splanchnic blood flow was measured using primed continuous infusion of indocyanine green dye with hepatic venous sampling and systemic hemodynamics by routine monitoring. In addition, we estimated gastric mucosal-arterial PCO2 difference and splanchnic lactate/pyruvate exchange. After a baseline measurement, PEEP was increased. After 60 min all measurements were repeated. PEEP was returned to the baseline level and a third measurement followed. PEEP had no effect on cardiac index (baseline I: 3.2/6.1–2.5 l/min/m2; PEEP: 3.3/5.7–¶2.3 l/min/m2; baseline II: 3.4/6.0–2.5 l/min/m2); neither did PEEP have any effect on splanchnic blood flow (baseline I: 0.91/1.39–0.62 l/min/m2; PEEP: 1.04/1.75–0.54 l/min/m2; baseline II:1.07/1.42–0.68 l/min/m2, respectively) or perfusion (gastric mucosal-arterial PCO2 difference baseline I: 2.1/12.8–0.6 kPa; PEEP: 1.7/14.5–0.7 kPa; baseline II: 1.7/8.8–0.1 kPa; lactate uptake baseline I: 0.5/1.1–0.3 mmol/min/m2; PEEP: 0.4/1.0–0.3 mmol/min/m2; baseline II: 0.5/0.9–0.3 mmol/min/m2; hepatic venous lactate/pyruvate baseline I: 9.7/10.6–5.7; PEEP: 9.7/14.2–6.4; baseline II: 8.4/12.4–7.3; respectively).¶Conclusion: PEEP by itself does not have a consistent effect on splanchnic blood flow and metabolism when cardiac index is stable and patients are ventilated within the linear part of the pv curve.
Article PDF
Similar content being viewed by others
Author information
Authors and Affiliations
Additional information
Received: 29 April 1999/Final revision received: 17 November 1999/Accepted: 2 February 2000
Rights and permissions
About this article
Cite this article
Kiefer, P., Nunes, S., Kosonen, P. et al. Effect of positive end-expiratory pressure on splanchnic perfusion in acute lung injury. Intensive Care Med 26, 376–383 (2000). https://doi.org/10.1007/s001340051170
Issue Date:
DOI: https://doi.org/10.1007/s001340051170