Effects of positive end-expiratory pressure ventilation on splanchnic oxygenation in humans.

OBJECTIVES: To examine the influence of positive end-expiratory pressure (PEEP) ventilation on splanchnic oxygenation and lactate production in humans without pulmonary disorders.
DESIGN: Prospective study.
SETTING: Single-institutional surgical intensive care unit in a university hospital. PARTICIPANTS: Twenty patients who underwent major abdominal surgery.
INTERVENTIONS: Radial artery, pulmonary artery, and right hepatic vein catheters. Blood samples were collected to determine lactate concentrations and oxygen saturations.
MEASUREMENTS AND MAIN RESULTS: Six hours postoperatively PEEP levels (5, 10, and 15 cmH2O) were applied in a randomized order, and the following parameters were determined before and at the end of each PEEP level: cardiac output (CO); mean arterial pressure (MAP); arterial (SaO2), mixed venous (SvO2) and hepatic venous oxygen saturation (ShvO2); systemic (C[a-v]O2) and splanchnic (C[a-hv]O2) arterial venous oxygen content difference; and arterial, mixed venous, and hepatic venous lactate concentration. CO and MAP were reduced at PEEP 10 and 15 cmH2O, accompanied by a decrease in SvO2 but unchanged SaO2. A decrease in ShvO2 was seen at PEEP 15 cmH2O. C(a-v)O2 and C(a-hv)O2 were increased at PEEP 15 cmH2O. However, at PEEP 15 cmH2O, the percent increment in C(a-hv)O2 was greater than the increment in C(a-v)O2. Lactate concentrations remained unchanged.
CONCLUSIONS: Ventilation with PEEP causes reductions in CO and MAP, resulting in a comparable impairment of systemic and splanchnic oxygen. The absence of changes in lactate concentrations indicates that a critical reduction in systemic and splanchnic oxygenation is unlikely during ventilation with low or high PEEP levels.

RCT Entities:   Population Interventions Outcomes