title: Positive end-expiratory pressure does not decrease cardiac output during laparoscopic liver surgery: A prospective observational evaluation.
abstract: Positive end-expiratory pressure (PEEP) has beneficial pulmonary effects but may worsen the hemodynamic repercussions induced by pneumoperitoneum (PNP) in patients undergoing laparoscopic liver resection. However, by increasing intraluminal vena cava (VC) pressures, PEEP may prevent PNP-induced VC collapse. The aim of this study was to test the validity of this hypothesis.
  
  
  
  After IRB approval and written informed consent, 20 patients were evaluated prospectively. Measurements were performed before and after the application of 10 cmH2O PEEP on patients without PNP (Control group) and during a 12 cmH20 PNP. Results are provided as means [95%CI]. Comparison used paired-sample t test.
  
  
  
  PEEP induced a decrease in CI in Control subgroup (2.3 [2.0-2.6] and 2.1 [1.8-2.4] l min-1m-2before and after PEEP. P < 0.05). In contrast, PEEP on a pre-established PNP did not significantly modify cardiac index (CI). Transmural pressure on the abdominal vena cava decreased with PNP but was partly reversed by the addition of PEEP.
  
  
  
  The application of PEEP on a pre-established PNP during laparoscopic liver resection in normovolemic patients did not decrease CI. Analysis of transmural VC pressure variations confirms that the addition of PEEP may prevent the vena caval collapse induced by PNP.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, St-Antoine University Hospital, Paris, France.
authors.forename: Denis
authors.initials: D
authors.lastname: Bernard
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, St-Antoine University Hospital, Paris, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Brandely
authors.affiliation: Department of Hepatobiliary Surgery and Liver Transplantation, St-Antoine University Hospital, Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Scatton
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Estaing Hospital, University Teaching Hospital of Clermont-Ferrand, Clermont-Ferrand, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Schoeffler
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Estaing Hospital, University Teaching Hospital of Clermont-Ferrand, Clermont-Ferrand, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Futier
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, St-Antoine University Hospital, Paris, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Lescot
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, St-Antoine University Hospital, Paris, France. Electronic address: marc.beaussier@sat.aphp.fr.
authors.forename: Marc
authors.initials: M
authors.lastname: Beaussier
mesh_terms: D000368:Aged; D002302:Cardiac Output; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D008107:Liver Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects; D011175:Positive-Pressure Respiration / Q000009:adverse effects; D011446:Prospective Studies; D016896:Treatment Outcome; D014682:Vena Cava, Inferior / Q000503:physiopathology*; D014690:Venous Pressure