Positive end-expiratory pressure does not decrease cardiac output during laparoscopic liver surgery: A prospective observational evaluation

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• 作者：Denis Bernard¹ ; Antoine Brandely¹ ; Olivier Scatton² ; Pierre Schoeffler³ ; Emmanuel Futier³ ; Thomas Lescot¹ ; Marc Beaussier¹ ; ^{marc.beaussier@sat.aphp.fr}
• 刊名：HPB
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：19
• 期：1
• 页码：36-41
• 全文大小：309 K
• 卷排序：19

文摘

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.MethodsAfter 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.ResultsPEEP induced a decrease in CI in Control subgroup (2.3 [2.0–2.6] and 2.1 [1.8–2.4] l min−1 m−2 before 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.ConclusionThe 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.