Publication

Peep decreases oxygenation of the intestinal mucosa despite normalization of cardiac output

Fournell, A., Scheeren, TWL. & Schwarte, LA., 1998, OXYGEN TRANSPORT TO TISSUE XX. Hudetz, AG. & Bruley, DF. (eds.). Plenum Press, p. 435-440 6 p. (ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY; vol. 454).

Research output: Chapter in Book/Report/Conference proceedingChapterAcademic

OBJECTIVE:

To evaluate if normalization of cardiac output reverses the attenuation of local intracapillary hemoglobin saturation (HbO2) of gastric mucosa by PEEP (positive end-expiratory pressure) during IPPV (intermittent positive pressure ventilation).

MATERIALS AND METHODS:

Four healthy, chronically instrumented, anesthetized dogs were repeatedly studied (n = 7). Local HbO2 of gastric mucosa was measured continuously by tissue lightguide spectrophotometry and cardiac output (CO) was recorded continuously by means of a precalibrated ultrasonic transit time flowmeter chronically implanted around the pulmonary artery. After obtaining baseline values during IPPV and ZEEP (zero end-expiratory pressure) 15 cmH2O PEEP was added. To compensate the reduction of CO during PEEP ventilation, HES (hydroxyethyl starch 6%) was infused until CO reached baseline values during ZEEP.

RESULTS:

Despite of unimpaired systemic oxygen saturation, PEEP reduced HbO2 of gastric mucosa from 55.1 +/- 4.2% to 42.1 +/- 4.7% (mean +/- SEM) and CO dropped from 67.7 +/- 4.9 ml.kg-1.min-1 to 33.9 +/- 4.6 ml.kg-1.min-1. Whereas infusion of HES during PEEP ventilation normalized CO to 65.1 +/- 6.2 ml.kg-1.min-1, HbO2 reached only 48.1 +/- 3.3%, a statistically significant improvement compared to HbO2 during PEEP ventilation before HES infusion (p < 0.03, Wilcoxon signed rank test), but still below baseline values (p < 0.04).

CONCLUSIONS:

Our findings demonstrate that the side effects of PEEP ventilation on cardiac output can be compensated by restoring preload, but normalizing CO did not completely normalize HbO2 of the gastric mucosa. This further emphasizes that global measurements of variables of systemic circulation and oxygenation do not necessarily reflect regional abnormalities of tissue oxygenation. Therefore, in view of the importance of tissue hypoxia especially in the splanchnic region in the pathogenesis of multiple organ failure, monitoring of HbO2 of the intestinal mucosa during PEEP ventilation may be particularly useful in the care of the critically ill patient.

Original languageEnglish
Title of host publicationOXYGEN TRANSPORT TO TISSUE XX
EditorsAG Hudetz, DF Bruley
PublisherPlenum Press
Pages435-440
Number of pages6
ISBN (Electronic)978-1-4615-4863-8
ISBN (Print)0-306-46043-2
Publication statusPublished - 1998
Externally publishedYes
Event25th Annual Meeting of the International-Society-on-Oxygen-Transport-to-Tissue (ISOTT) - MILWAUKEE, Netherlands
Duration: 19-Aug-199723-Aug-1997

Publication series

NameADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY
PublisherPLENUM PRESS DIV PLENUM PUBLISHING CORP
Volume454
ISSN (Print)0065-2598

Conference

Conference25th Annual Meeting of the International-Society-on-Oxygen-Transport-to-Tissue (ISOTT)
CountryNetherlands
Period19/08/199723/08/1997

Event

25th Annual Meeting of the International-Society-on-Oxygen-Transport-to-Tissue (ISOTT)

19/08/199723/08/1997

Netherlands

Event: Conference

    Keywords

  • MULTIPLE-ORGAN-FAILURE

ID: 22383682