Abstract
We aimed to assess variations in the portal vein pulsatility index (PI) during mechanical ventilation following cardiac surgery. Method. After ethical approval, we conducted a prospective monocentric study at Amiens University Hospital. Patients under mechanical ventilation following cardiac surgery were enrolled. Doppler evaluation of the portal vein (PV) was performed by transthoracic echography. The maximum velocity (VMAX) and minimum velocity (VMIN) of the PV were measured in pulsed Doppler mode. The PI was calculated using the following formula (VMAX − VMIN)/(VMax). A positive end-expiratory pressure (PEEP) incremental trial was performed from 0 to 15 cmH2O, with increments of 5 cmH2O. The PI (%) was assessed at baseline and PEEP 5, 10, and 15 cmH2O. Echocardiographic and hemodynamic parameters were recorded. Results. In total, 144 patients were screened from February 2018 to March 2019 and 29 were enrolled. Central venous pressure significantly increased for each PEEP increment. Stroke volumes were significantly lower after PEEP incrementation, with 52 mL (50–55) at PEEP 0 cmH2O and 30 mL (25–45) at PEEP 15 cmH2O, (p < 0.0001). The PI significantly increased with PEEP incrementation, from 9% (5–15) at PEEP 0 cmH2O to 15% (5–22) at PEEP 5 cmH2O, 34% (23–44) at PEEP 10 cmH2O, and 45% (25–49) at PEEP 15 cmH2O (p < 0.001). Conclusion. In the present study, PI appears to be a dynamic marker of the interaction between mechanical ventilation and right heart pressure after cardiac surgery. The PI could be a useful noninvasive tool to monitor venous congestion associated with mechanical ventilation.
Highlights
The early detection of venous congestion is strongly recommended during critical-care management to prevent higher mortality and adverse outcomes as well as reduce the length of hospital stay associated with fluid overload [1,2,3]
Central venous pressure (CVP) is the standard measure of venous hypertension but it is an invasive measurement and there is no agreement on the critical value that should be considered in clinical practice [4]
Our findings that, during mechanical anWe increase in positive end-expiratory pressure (PEEP) is associated with increases in CVP and the pulsatility index (PI): a higher PEEP indicates a higher PI
Summary
The early detection of venous congestion is strongly recommended during critical-care management to prevent higher mortality and adverse outcomes as well as reduce the length of hospital stay associated with fluid overload [1,2,3]. Central venous pressure (CVP) is the standard measure of venous hypertension but it is an invasive measurement and there is no agreement on the critical value that should be considered in clinical practice [4]. High CVP is associated with organ failure [5]. Acute kidney injury (AKI) is associated with high CVP values [6,7]
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