Is positive end-expiratory pressure suitable for liver recipients with a rescue organ offer?
OBJECTIVE
Rescue organ offers may help to overcome the organ shortage. However, because of initial poor liver function, the recipient may develop a severe lung injury with the requirement for higher positive end-expiratory pressure (PEEP) levels to achieve adequate oxygenation. Positive end-expiratory pressure has been associated with perfusion impairment in the hepatosplanchnic area. We assessed the effects of increased PEEP levels on systemic hemodynamic and liver perfusion in liver transplantation (LT) patients with a rescue organ.


METHODS
Twenty-four LT recipients of a rescue organ offer were enrolled. All patients were postoperatively mechanically ventilated with biphasic positive airway pressure, and 3 different PEEP levels (0, 5, 10 mbar) were randomly set within 4 hours after admission at the intensive care unit. Systemic hemodynamic parameters were recorded using a pulmonary artery catheter; and flow velocities of the hepatic artery, portal vein, and right hepatic vein were measured using Doppler.


RESULTS
Positive end-expiratory pressure of 10 mbar did not impair the systemic hemodynamic. Flow velocities in the right hepatic vein, the portal vein, and the hepatic artery were not influenced by PEEP.


CONCLUSIONS
Our study demonstrates that PEEP up to 10 mbar did not impair the liver outflow in recipients with a rescue organ offer.
Saner
Fuat H
FH
Department of General-, Visceral- and Transplant Surgery, University Hospital Essen, 45122 Essen, Germany. fuat.saner@uni-due.de
Olde Damink
Steven W M
SW
Pavlaković
Goran
G
Sotiropoulos
Georgios C
GC
Radtke
Arnold
A
Treckmann
Juergen
J
Beckebaum
Susanne
S
Cicinnati
Vito
V
Paul
Andreas
A
D001783:Blood Flow Velocity; D005260:Female; D006801:Humans; D008099:Liver / Q000098:blood supply*; D008102:Liver Circulation / Q000502:physiology; D016031:Liver Transplantation / Q000502:physiology*; D055370:Lung Injury / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011175:Positive-Pressure Respiration / Q000009:adverse effects; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome