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Titolo:
HEPATIC VENOUS CATHETERIZATION IN PATIENTS UNDERGOING POSITIVE END-EXPIRATORY PRESSURE VENTILATION AFTER OLT - TECHNIQUE AND CLINICAL IMPACT
Autore:
KAISERS U; LANGREHR JM; HAACK M; MOHNHAUPT A; NEUHAUS P; ROSSAINT R;
Indirizzi:
FREE UNIV BERLIN,KLINIKUM RUDOLF VIRCHOW,ANAESTHESIOL & OPERAT INTENSMED KLIN D-13353 BERLIN GERMANY
Titolo Testata:
Clinical transplantation
fascicolo: 4, volume: 9, anno: 1995,
pagine: 301 - 306
SICI:
0902-0063(1995)9:4<301:HVCIPU>2.0.ZU;2-M
Fonte:
ISI
Lingua:
ENG
Keywords:
HEPATIC VENOUS CATHETERIZATION; HEMODYNAMICS; HEPATIC VENOUS OXYGENATION; CONTROLLED MECHANICAL VENTILATION WITH PEEP; ORTHOTOPIC LIVER TRANSPLANTATION;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Science Citation Index Expanded
Citazioni:
NO
Recensione:
Indirizzi per estratti:
Citazione:
U. Kaisers et al., "HEPATIC VENOUS CATHETERIZATION IN PATIENTS UNDERGOING POSITIVE END-EXPIRATORY PRESSURE VENTILATION AFTER OLT - TECHNIQUE AND CLINICAL IMPACT", Clinical transplantation, 9(4), 1995, pp. 301-306

Abstract

The objective of this study was to determine the feasibility and clinical impact of hepatic venous oxygenation monitoring in patients undergoing positive end-expiratory pressure (PEEP) ventilation after OLT. The design comprised a prospective study using repeated-measures design, within an intensive-care unit for liver-transplanted patients in a university hospital. Sixteen consecutive adult patients undergoing orthotopic liver transplantation were enrolled. Postoperatively, a fiber-optic pulmonary artery catheter was inserted into the right hepatic vein. Patients were submitted to controlled ventilation with three different levels of end-expiratory pressure (PEEP): 0, 5 and 10 mbar. Hemodynamics, hepatic venous pressure, mixed venous (SvO(2)) and hepatic venous oxygenation (SvhO(2)) were measured. The average time required forhepatic venous catheterization was 2.9+/-1.2 min; serious complications were not observed. PEEP 5 mbar did not alter hemodynamics and SvhO(2); PEEP 10 mbar significantly reduced cardiac index, SvO(2) and widened arteriovenous content difference (p<0.05). The mean difference between SvO(2) and SvhO(2) was 6.3+/-6.0% and did not change during PEEP ventilation. A significantly positive relationship was observed betweenSvO(2) and SvhO(2) (r=0.91, p<0.05). Hepatic venous catheterization appeared to be practical and could be utilized to evaluate the effects of therapeutic interventions on the transplanted liver. However, the small number of patients studied will not allow the assessment of any risk-benefit ratio of the technique investigated. Low levels of PEEP provided hemodynamic stability and did not alter hepatic oxygen supply-demand ratio. Maintenance of an adequate cardiac index during ventilation with higher levels of PEEP appeared to be mandatory to insure appropriate oxygen delivery to the liver graft.

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Documento generato il 20/01/20 alle ore 16:01:21