Splanchnic circulation is maintained during passive hyperventilation in orthotopic liver recipients.
BACKGROUND
Mechanical hyperventilation is an established treatment to reduce brain edema and intracranial pressure in patients with encephalopathia caused by acute liver failure. Hyperventilation and ensuing hypocarbia may also affect central and systemic circulation and thereby influence graft performance in patients following orthotopic liver transplantation (OLT).


METHODS
We measured the effects of normocapnia and hypocapnia on systemic hemodynamics, gastric tonometry, as a marker of splanchnic oxygenation, and the indocyanine green kinetic, as a global marker of graft function, in humans post OLT.


RESULTS
Hyperventilation was performed to a PaCO2 of 4.2 +/- 0.4 kPa (31 +/- 3.4 mm Hg) for about 1 h in 14 liver transplant recipients. Systemic hemodynamics as well as indices of splanchnic oxygenation and indocyanine green kinetics remained statistically unchanged.


CONCLUSIONS
We did not observe any statistically significant circulatory effects or changes in indocyanine green kinetics in liver transplant recipients in the immediate OLT postoperative period caused by short-term mechanical hyperventilation.
Krenn
C G
CG
Department of Anesthesiology & General Intensive Care, University of Vienna, School of Medicine, Austria.
Pernerstorfer
T
T
Pokorny
H
H
Metnitz
P G
PG
Steltzer
H
H
D001794:Blood Pressure / Q000502:physiology; D001929:Brain Edema / Q000517:prevention & control; D002245:Carbon Dioxide / Q000097:blood; D002496:Central Venous Pressure / Q000502:physiology; D004396:Coloring Agents; D005260:Female; D005753:Gastric Mucosa / Q000503:physiopathology; D006501:Hepatic Encephalopathy / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D006863:Hydrogen-Ion Concentration; D006985:Hyperventilation / Q000503:physiopathology; D016857:Hypocapnia / Q000503:physiopathology; D007208:Indocyanine Green; D007427:Intracranial Pressure / Q000502:physiology; D017114:Liver Failure, Acute / Q000503:physiopathology / Q000601:surgery; D016031:Liver Transplantation / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D010101:Oxygen Consumption / Q000502:physiology; D011669:Pulmonary Wedge Pressure / Q000502:physiology; D012121:Respiration, Artificial / Q000379:methods*; D013152:Splanchnic Circulation / Q000502:physiology*
D004396:Coloring Agents; D002245:Carbon Dioxide; D007208:Indocyanine Green; D010100:Oxygen