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The influence of PEEP and positioning on central venous pressure and venous hepatic hemodynamics in patients undergoing liver resection

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The influence of PEEP and positioning on central venous pressure and venous hepatic hemodynamics in patients undergoing liver resection. / Ukere, Asi; Meisner, Sebastian; Greiwe, Gillis; Opitz, Benjamin; Benten, Daniel; Nashan, Björn; Fischer, Lutz; Trepte, Constantin J C; Reuter, Daniel A; Haas, Sebastian A; Behem, Christoph R.

In: J CLIN MONIT COMPUT, Vol. 31, No. 6, 12.2017, p. 1221-1228.

Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review

Harvard

Ukere, A, Meisner, S, Greiwe, G, Opitz, B, Benten, D, Nashan, B, Fischer, L, Trepte, CJC, Reuter, DA, Haas, SA & Behem, CR 2017, 'The influence of PEEP and positioning on central venous pressure and venous hepatic hemodynamics in patients undergoing liver resection', J CLIN MONIT COMPUT, vol. 31, no. 6, pp. 1221-1228. https://doi.org/10.1007/s10877-016-9970-1

APA

Ukere, A., Meisner, S., Greiwe, G., Opitz, B., Benten, D., Nashan, B., Fischer, L., Trepte, C. J. C., Reuter, D. A., Haas, S. A., & Behem, C. R. (2017). The influence of PEEP and positioning on central venous pressure and venous hepatic hemodynamics in patients undergoing liver resection. J CLIN MONIT COMPUT, 31(6), 1221-1228. https://doi.org/10.1007/s10877-016-9970-1

Vancouver

Ukere A, Meisner S, Greiwe G, Opitz B, Benten D, Nashan B et al. The influence of PEEP and positioning on central venous pressure and venous hepatic hemodynamics in patients undergoing liver resection. J CLIN MONIT COMPUT. 2017 Dec;31(6):1221-1228. https://doi.org/10.1007/s10877-016-9970-1

Bibtex

@article{1d04e385b13842e8813bff0d34d1e9b6,
title = "The influence of PEEP and positioning on central venous pressure and venous hepatic hemodynamics in patients undergoing liver resection",
abstract = "PURPOSE: In order to assess the occurrence of blood congestion in the liver during liver resection, we aimed to evaluate the influence of a positive-end-expiratory-pressure (PEEP) and positioning of patients on central venous pressure (CVP) and venous hepatic blood flow parameters. We further analyzed correlations between CVP and venous hepatic blood flow parameters.METHODS: In 20 patients scheduled for elective liver resection we measured CVP and quantified venous hepatic hemodynamics by ultrasound assessment of flow-velocity and diameter of the right hepatic vein and the portal vein after equilibration following these maneuvers: M1: 0° supine position, PEEP 0 cmH2O; M2: 0° supine position, PEEP 10 cmH2O; M3: 20° reverse-trendelenburg position; PEEP 10 cmH2O; M4: 20° reverse-trendelenburg position, PEEP 0cmH2O.RESULTS: Changing from supine to reverse-trendelenburg position led to a significant decrease in CVP (M3 5.95 ± 2.06 vs. M1 7.35 ± 2.18 mmHg and M2 8.55 ± 1.79 mmHg). A PEEP of 10 cmH2O and reverse-trendelenburg position led to significant reduction of systolic (VsHV) and diastolic (VdHV) flow-velocities of the right hepatic vein (VsHV M3 19.96 ± 6.47 vs. M1 27.81 ± 11.03 cm s(-1);VdHV M3 14.94 ± 6.22 vs. M1 20.15 ± 10.34 cm s(-1) and M2 20.19 ± 13.19 cm s(-1)) whereas no significant changes of flow-velocity occurred in the portal vein. No correlations between CVP and diameters or flow-velocities of the right hepatic and the portal vein were found.CONCLUSIONS: Changes of central venous pressure due to changes of PEEP and positioning were not correlated with changes of venous hepatic blood flow parameters as measured after equilibration. Strategies aiming for low central venous pressure cannot be supported by these results. However, before ruling out low-CVP-strategies during liver resections these results should be confirmed by further studies.",
author = "Asi Ukere and Sebastian Meisner and Gillis Greiwe and Benjamin Opitz and Daniel Benten and Bj{\"o}rn Nashan and Lutz Fischer and Trepte, {Constantin J C} and Reuter, {Daniel A} and Haas, {Sebastian A} and Behem, {Christoph R}",
year = "2017",
month = dec,
doi = "10.1007/s10877-016-9970-1",
language = "English",
volume = "31",
pages = "1221--1228",
journal = "J CLIN MONIT COMPUT",
issn = "1387-1307",
publisher = "Springer Netherlands",
number = "6",

}

RIS

TY - JOUR

T1 - The influence of PEEP and positioning on central venous pressure and venous hepatic hemodynamics in patients undergoing liver resection

AU - Ukere, Asi

AU - Meisner, Sebastian

AU - Greiwe, Gillis

AU - Opitz, Benjamin

AU - Benten, Daniel

AU - Nashan, Björn

AU - Fischer, Lutz

AU - Trepte, Constantin J C

AU - Reuter, Daniel A

AU - Haas, Sebastian A

AU - Behem, Christoph R

PY - 2017/12

Y1 - 2017/12

N2 - PURPOSE: In order to assess the occurrence of blood congestion in the liver during liver resection, we aimed to evaluate the influence of a positive-end-expiratory-pressure (PEEP) and positioning of patients on central venous pressure (CVP) and venous hepatic blood flow parameters. We further analyzed correlations between CVP and venous hepatic blood flow parameters.METHODS: In 20 patients scheduled for elective liver resection we measured CVP and quantified venous hepatic hemodynamics by ultrasound assessment of flow-velocity and diameter of the right hepatic vein and the portal vein after equilibration following these maneuvers: M1: 0° supine position, PEEP 0 cmH2O; M2: 0° supine position, PEEP 10 cmH2O; M3: 20° reverse-trendelenburg position; PEEP 10 cmH2O; M4: 20° reverse-trendelenburg position, PEEP 0cmH2O.RESULTS: Changing from supine to reverse-trendelenburg position led to a significant decrease in CVP (M3 5.95 ± 2.06 vs. M1 7.35 ± 2.18 mmHg and M2 8.55 ± 1.79 mmHg). A PEEP of 10 cmH2O and reverse-trendelenburg position led to significant reduction of systolic (VsHV) and diastolic (VdHV) flow-velocities of the right hepatic vein (VsHV M3 19.96 ± 6.47 vs. M1 27.81 ± 11.03 cm s(-1);VdHV M3 14.94 ± 6.22 vs. M1 20.15 ± 10.34 cm s(-1) and M2 20.19 ± 13.19 cm s(-1)) whereas no significant changes of flow-velocity occurred in the portal vein. No correlations between CVP and diameters or flow-velocities of the right hepatic and the portal vein were found.CONCLUSIONS: Changes of central venous pressure due to changes of PEEP and positioning were not correlated with changes of venous hepatic blood flow parameters as measured after equilibration. Strategies aiming for low central venous pressure cannot be supported by these results. However, before ruling out low-CVP-strategies during liver resections these results should be confirmed by further studies.

AB - PURPOSE: In order to assess the occurrence of blood congestion in the liver during liver resection, we aimed to evaluate the influence of a positive-end-expiratory-pressure (PEEP) and positioning of patients on central venous pressure (CVP) and venous hepatic blood flow parameters. We further analyzed correlations between CVP and venous hepatic blood flow parameters.METHODS: In 20 patients scheduled for elective liver resection we measured CVP and quantified venous hepatic hemodynamics by ultrasound assessment of flow-velocity and diameter of the right hepatic vein and the portal vein after equilibration following these maneuvers: M1: 0° supine position, PEEP 0 cmH2O; M2: 0° supine position, PEEP 10 cmH2O; M3: 20° reverse-trendelenburg position; PEEP 10 cmH2O; M4: 20° reverse-trendelenburg position, PEEP 0cmH2O.RESULTS: Changing from supine to reverse-trendelenburg position led to a significant decrease in CVP (M3 5.95 ± 2.06 vs. M1 7.35 ± 2.18 mmHg and M2 8.55 ± 1.79 mmHg). A PEEP of 10 cmH2O and reverse-trendelenburg position led to significant reduction of systolic (VsHV) and diastolic (VdHV) flow-velocities of the right hepatic vein (VsHV M3 19.96 ± 6.47 vs. M1 27.81 ± 11.03 cm s(-1);VdHV M3 14.94 ± 6.22 vs. M1 20.15 ± 10.34 cm s(-1) and M2 20.19 ± 13.19 cm s(-1)) whereas no significant changes of flow-velocity occurred in the portal vein. No correlations between CVP and diameters or flow-velocities of the right hepatic and the portal vein were found.CONCLUSIONS: Changes of central venous pressure due to changes of PEEP and positioning were not correlated with changes of venous hepatic blood flow parameters as measured after equilibration. Strategies aiming for low central venous pressure cannot be supported by these results. However, before ruling out low-CVP-strategies during liver resections these results should be confirmed by further studies.

U2 - 10.1007/s10877-016-9970-1

DO - 10.1007/s10877-016-9970-1

M3 - SCORING: Journal article

C2 - 28012012

VL - 31

SP - 1221

EP - 1228

JO - J CLIN MONIT COMPUT

JF - J CLIN MONIT COMPUT

SN - 1387-1307

IS - 6

ER -