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  • Open Access

Intrathoracic blood volume (ITBV)-guided volume therapy maintains intestinal perfusion and oxygenation despite positive end expiratory pressure (PEEP) ventilation

  • 1,
  • 1,
  • 1,
  • 1,
  • 1,
  • 1 and
  • 1
Critical Care20048 (Suppl 1) :P60

https://doi.org/10.1186/cc2527

  • Published:

Keywords

  • Femoral Artery
  • Organ Failure
  • Mesenteric Artery
  • Superior Mesenteric Artery
  • Multiple Organ Failure

Introduction

Reduced intestinal perfusion is one major cause in the development of multiple organ failure. Furthermore, the harmful effects of PEEP on intestinal perfusion and oxygenation are well described and it has been demonstrated that volume therapy reduces these effects. But there is no evidence on how to guide volume therapy, or whether volume therapy alone restitutes intestinal perfusion and oxygenation at PEEP levels above 10 cmH2O. Therefore we explored the effects of PEEP in an animal model of ITBV-guided volume loading.

Methods

Twenty anesthetized and ventilated pigs were studied. An ultrasonic flow probe was placed around the superior mesenteric artery, catheters were inserted into the femoral artery and mesenteric vein. Animals were randomly assigned to: group 1 = controls (n = 9), received crystalloids; and group 2 = ITBV (n = 11), received crystalloids and continuous colloid substitution to maintain ITBV at the baseline level. Measurements were made at ZEEP and PEEP of 5, 10, 15 and 20 cmH2O. ITBV was measured by the COLD® System. Oxygen metabolism was calculated according to Fick's Law. Intestinal CO2 was determined by tonometry.

Results

See Table 1. All data are presented as the median.

Table 1

 

PEEP 20

ZEEP

PEEP5

PEEP10

PEEP15

 

Control

ITBV

Control

ITBV

Control

ITBV

Control

ITBV

Control

ITBV

CI (ml/kg/min)

102*

142

167

168

158

162

135

163

120*

154

ITBV (ml/kg)

24*

32

31

33

33

33

30

31

26*

31

SMABF (ml/kg/min)

12*

20

19

19

17

18

18

20

15*

20

DO2 (ml/min)

44*

55

61

65

54

61

55

57

48

62

CO2 gap (kPa)

2.2

1.5

0.9

1.9

1.1

2.1

1.7

1.9

2.0

2.2

SMABF, superior mesenteric artery blood flow. *P < 0.05 versus ZEEP in the same group, P < 0.05 between both groups at corresponding PEEP levels.

Conclusion

ITBV-guided volume loading maintains intestinal blood flow and O2 delivery up to a PEEP level of 20 cmH2O. The intestinal–arterial CO2 gap remained unchanged. In conclusion, ITBV-guided volume therapy is a helpful concept to reduce the harmful intestinal effects of PEEP.

Authors’ Affiliations

(1)
University of Rostock, Germany

Copyright

© BioMed Central Ltd. 2004

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