title: Effects of different positive end-expiratory pressure values on liver function and indocyanine green clearance test in liver transplantation donors: a prospective, randomized, double-blind study.
abstract: BACKGROUND
  The aim of this study was demonstrate the influence of different positive end-expiratory pressure (PEEP) values on blood flow of the liver by indocyanine green (ICG) clearance test in donor patients.
  
  
  METHODS
  ICG clearance tests were conducted concurrently using a noninvasive monitor that tracks the plasma disappearance rate of ICG (PDR-ICG%/min) and 15-minute retention rate after administration of ICG (ICG-R15%). This study was performed in 40 patients who underwent right hepatectomy.
  
  
  RESULTS
  The positive end-expiratory pressure (PEEP) was 0 cm H20 in the first (control) group (group K) and 10 mm Hg in the second study group (group P). ICG clearance test values before general anesthesia (T0), after induction of general anesthesia (T1), after transection (T2), 24 hours postoperative (T3), and 72 hours postoperative (T4) were recorded. Simultaneously, hemoglobin (Hgb), hematocrit (Hct), platelet count, plasma levels of prothrombin (PT), International Normalized Ratio (INR), total bilirubin, direct bilirubin, albumin, aspartate aminotransferase, and alanine aminotransferase values were analyzed. In terms of the plasma disappearance rate and retention rate of ICG 15 minutes after administration, significant difference was not observed between groups. PT and INR values were different within comparisons groups (P < .05). There were significant differences in Hgb and Hct values compared with the baseline values (T0) within group (T1, T2, T3, T4) measurements and between group comparisons at T0 and T4 (P < .05). Systemic arterial pressure, mean arterial pressure, and central venous pressure were significantly different between the groups (P < .05).
  
  
  CONCLUSIONS
  Given the small magnitude and limited clinical significance of these changes, we conclude that PEEP values between 0 and 10 cm H2O have no effect on global liver function and liver-related liabilities tests in patients undergoing elective liver donor surgery.
authors.affiliation: Department of Anesthesiology and Reanimation, Inonu University, Faculty of Medicine, Malatya, Turkey.
authors.forename: M
authors.initials: M
authors.lastname: Bıcakcıoglu
authors.affiliation: Department of Anesthesiology and Reanimation, Inonu University, Faculty of Medicine, Malatya, Turkey. Electronic address: dr_mustafasaid@hotmail.com.
authors.forename: M S
authors.initials: MS
authors.lastname: Aydogan
authors.affiliation: Department of Anesthesiology and Reanimation, Inonu University, Faculty of Medicine, Malatya, Turkey.
authors.forename: H
authors.initials: H
authors.lastname: Sayan
authors.affiliation: Department of Anesthesiology and Reanimation, Inonu University, Faculty of Medicine, Malatya, Turkey.
authors.forename: H I
authors.initials: HI
authors.lastname: Toprak
authors.affiliation: Department of General Surgery, Inonu University, Faculty of Medicine, Malatya, Turkey.
authors.forename: B
authors.initials: B
authors.lastname: Isik
authors.affiliation: Department of General Surgery, Inonu University, Faculty of Medicine, Malatya, Turkey.
authors.forename: S
authors.initials: S
authors.lastname: Yılmaz
authors.affiliation: Department of Biostatics, Inonu University, Faculty of Medicine, Malatya, Turkey.
authors.forename: S
authors.initials: S
authors.lastname: Yologlu
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D000768:Anesthesia, General / Q000379:methods; D001219:Aspartate Aminotransferases / Q000097:blood; D001663:Bilirubin / Q000097:blood; D004396:Coloring Agents / Q000378:metabolism*; D004311:Double-Blind Method; D017558:Elective Surgical Procedures; D005260:Female; D006439:Hemodynamics; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D007208:Indocyanine Green / Q000378:metabolism*; D008099:Liver / Q000378:metabolism*; D008111:Liver Function Tests; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011175:Positive-Pressure Respiration / Q000379:methods*; D011184:Postoperative Period; D011446:Prospective Studies; D012709:Serum Albumin / Q000378:metabolism; D055815:Young Adult
chemical_list: D004396:Coloring Agents; D012709:Serum Albumin; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D007208:Indocyanine Green; D001663:Bilirubin