Skip to main content
Log in

Side effects of positive pressure ventilation on hepatic function and splanchnic circulation

  • Published:
International journal of clinical monitoring and computing

Summary

Positive pressure ventilation is associated with a reduction and redistribution of cardiac output. Splanchnic blood flow is decreased. Blood supply of the liver is reduced exceeding the fall in cardiac output. As a result oxygen transport to the mesenteric bed and liver is curtailed. There is a concomitant impairment of hepatic venous outflow. These hemodynamic changes may cause functional, structural and metabolic disturbances in organs whose blood supply arises from splanchnic circulation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Abraira, C, Virupannavar, C, Nemchausku, B: Protective effect of small amounts of glucose on abnormal liver function tests during starvation. Metabolism 29: 943–948, 1980.

    Article  PubMed  CAS  Google Scholar 

  2. Beyer, J and Messmer, K: Organdurchblutung und Sauerstoffversorgung bei PEEP. Anaesthesiologie und Intensivmedizin, Heidelberg: Springer Verlag, pp 15–40, 1982.

    Google Scholar 

  3. Bonnet, F, Richard, C, Glaser, P, Lafay, M, Guesde, R: Changes in hepatic flow induced by continuous positive pressure ventilation in critically ill patients. Crit Care Med 10: 703–705, 1982.

    Article  PubMed  CAS  Google Scholar 

  4. Brauer, RW: Liver circulation and function. Physiol Rev 43: 115–213, 1963.

    PubMed  CAS  Google Scholar 

  5. Bredenberg, GE, Paskanik, A, Fromm, D: Portal hemodynamics in dogs during mechanical ventilation with positive end-expiratory pressure. Surgery 90: 817–822, 1981.

    PubMed  CAS  Google Scholar 

  6. Cooperman, LH, Warden, JC, Price, HL: Splanchnic circulation during nitrous oxide and hypocarbia in normal man. Anesthesiology 29: 254–258, 1968.

    Article  PubMed  CAS  Google Scholar 

  7. Feely, J, Wade, D, Mc Allister, CB, Wilkinson, GR, Robertson, D: Effect of hypotension on liver blood flow and lidocaine disposition. N Engl J Med 307: 866–869, 1982.

    PubMed  CAS  Google Scholar 

  8. Feely, J, Wilkinson, GR, Mc Allister, CB, Wood, AJJ: Increased toxicity and reduced clearance of lidocaine by cimetidine. Ann Intern Med 96: 592–594, 1982.

    PubMed  CAS  Google Scholar 

  9. Gabriele, G, Rosenfeld, CR, Fixler, DE et al: Continuous airway pressure breathing with the head box in the newborn lamb. Effect on regional blood flows. Pediatrics 59: 858–864, 1977.

    PubMed  CAS  Google Scholar 

  10. Georgieff, M, Geiger, K: Trauma-adapted intravenous nutritional support. In: Geiger K (Ed) European Advances in Intensive Care: International Anesthesiology Clinics. Little, Brown, Boston, Vol 21, No 2, pp 155–167, 1983.

    Google Scholar 

  11. Georgieff, M, Moldawer, LL, Bistrian, BR, Blackburn, GL: TPN-induced liver damage. In: Holm, E, Kasper, H (Eds) Metabolism and Nutrition in Liver Disease. MTP Press Ltd, Lancaster, Boston, The Hague, Dordrecht, pp 287–301, 1985.

    Google Scholar 

  12. Gottlieb, ME, Safreh, IJ, Stratton, H, Goldman, ML, Newell, JC, Shah, DM: Hepatic perfusion and splanchnic oxygen consumption in patients postinjury. J Trauma 23: 836–843, 1983.

    Article  PubMed  CAS  Google Scholar 

  13. Hall, RI, Grant, JP, Ross, LH, Coleman, RA, Bozovic, MG, Quarfordt: Pathogenesis of hepatic steatosis in the parenterally fed rat. J Clin Invest 74: 1658–1668, 1984.

    Article  PubMed  CAS  Google Scholar 

  14. Hedley-Whyte, J, Burgess, GE, Feely, TN, Miller, M: Effect of pattern of ventilation on hepatic, renal and splanchnic function. In: Applied Physiology of Respiratory Care. Little, Brown, Boston, pp 27–35, 1976.

    Google Scholar 

  15. Jacobson, ED, Scott, JB, Frohlich, ED: Hemodynamics of the stomach. I. Resistance-flow relationship in the gastric vascular bed. Am J Digest Dis 7: 779–785, 1962.

    Article  PubMed  CAS  Google Scholar 

  16. Johnson, EE: Splanchnic hemodynamic response to passive hyperventilation. J Appl Physiol 38: 156–162, 1975.

    PubMed  CAS  Google Scholar 

  17. Johnson, EE, Hedley-Whyte, J: Continuous positive-pressure ventilation and portal flow in dogs with pulmonary edema. J Appl Physiol 33: 385–389, 1972.

    PubMed  CAS  Google Scholar 

  18. Johnson, EE, Hedley-Whyte, J: Continuous positive-pressure ventilation and choledochoduodenal flow resistance. J Appl Physiol 39: 937–942, 1975.

    PubMed  CAS  Google Scholar 

  19. Kessler, M, Höper, J, Krumme, BA: Monitoring of tissue perfusion and cellular function. Anesthesiology 45: 184–197, 1976.

    Article  PubMed  CAS  Google Scholar 

  20. Manny, J, Justice, R, Hechtman, HB: Abnormalities in organ blood flow and its distribution during positive end-expiratory pressure. Surgery 85: 425–432, 1979.

    PubMed  CAS  Google Scholar 

  21. Ochs, HR, Carstens, G, Greenblatt, DJ: Reduction in lidocaine clearance during continuous infusion and by co-administration of propanolol. N Engl J Med 303: 373–377, 1980.

    PubMed  CAS  Google Scholar 

  22. Olerud, S: Experimental studies on portal circulation at increased intra-abdominal pressure. Acta Physiol Scand Suppl 109: 1–84, 1954.

    Google Scholar 

  23. Refsum, HE: Arterial hypoxemia, serum activities of GO-T, GP-T and LDH, and centrilobular liver cells necrosis in pulmonary insufficiency. Clin Sci 25: 369–374, 1963.

    PubMed  CAS  Google Scholar 

  24. Richards, TG, Thompson, JY: The effect of back-pressure upon bile flow rate. J Physiol, London 154: 60–61, 1960.

    Google Scholar 

  25. Shingu, G, Eger II, EI, Johnson, BH: Hypoxia per se can produce hepatic damage without death in rats. Anesth Analg 61: 820–823, 1982.

    PubMed  CAS  Google Scholar 

  26. Strasberg, SM, Dorn, BC, Redinger, RN, Small, DM, Egdahl, RH: Effects of alteration of biliary pressure on bile composition — a method for study: primate biliary physiology. Gastroenterology 61: 357–362, 1971.

    PubMed  CAS  Google Scholar 

  27. Tashkin, DP, Goldstein, PJ, Simmons, DH: Hepatic lactate uptake during decreased liver perfusion and hypoxemia. Am J Physiol 223: 968–974, 1972.

    PubMed  CAS  Google Scholar 

  28. Thomson, PD, Melmon, KL, Richardson, JA et al: Lidocaine pharmacokinetics in advanced heart failure, liver disease, and renal failure in humans. Ann Intern Med 78: 499–508, 1973.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Geiger, K., Georgieff, M. & Lutz, H. Side effects of positive pressure ventilation on hepatic function and splanchnic circulation. International Journal of Clinical Monitoring and Computing 3, 103–106 (1986). https://doi.org/10.1007/BF01880762

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01880762

Keywords

Navigation