Skip to main content

Pharmacologic Interventions to Improve Splanchnic Oxygenation During Ventilation with Positive End-Expiratory Pressure

  • Conference paper
  • First Online:
Oxygen Transport to Tissue XXXIII

Part of the book series: Advances in Experimental Medicine and Biology ((AEMB,volume 737))

Abstract

Mechanical ventilation with positive end-expiratory pressure (PEEP) is an indispensable tool in the management of respiratory failure to preserve or improve lung function and systemic oxygenation. However, PEEP per se may also, as has been shown in experimental animals, impair regional microcirculation and oxygenation. The latter effects have received attention of late because of possible systemic sequelae such as multiple system organ failure (MSOF) in case of the splanchnic region. In this review, we examine the impact of pharmacologic interventions to improve splanchnic mucosal oxygen saturation depressed by mechanical ventilation with PEEP in a canine model of compromised cardiac function. Although much remains to be elucidated about the mechanisms of action, the primary way to improve splanchnic oxygenation seems to be a vasodilatory action of the drugs.

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

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 219.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Slutsky AS, Imai Y (2003) Ventilator-induced lung injury, cytokines, PEEP, and mortality: implications for practice and for clinical trials. Intensive Care Med 29:1218–1221

    Article  PubMed  Google Scholar 

  2. Plötz FB, Slutsky AS, van Vught AJ et al (2004) Ventilator-induced lung injury and multiple system organ failure: a critical review of facts and hypotheses. Intensive Care Med 30:1865–1872

    Article  PubMed  Google Scholar 

  3. Ashbaugh DG, Petty TL, Bigelow DB et al (1969) Continuous positive-pressure breathing (CPPB) in adult respiratory distress syndrome. J Thorac Cardiovasc Surg 57:31–41

    PubMed  CAS  Google Scholar 

  4. De Backer D (2000) The effects of positive end-expiratory pressure on the splanchnic circulation. Intensive Care Med 26:361–363

    Article  PubMed  Google Scholar 

  5. Carrico CJ, Meakins JL, Marshall et al (1986) Multiple-organ-failure syndrome. Arch Surg 121:196–208

    Article  PubMed  CAS  Google Scholar 

  6. Parrillo JE (1993) Pathogenetic mechanisms of septic shock. N Engl J Med 328:1471–1477

    Article  PubMed  CAS  Google Scholar 

  7. Hinshaw LB (1996) Sepsis/septic shock: participation of the microcirculation: an abbreviated review. Crit Care Med 24:1072–1078

    Article  PubMed  CAS  Google Scholar 

  8. De Backer D, Creteur J, Preiser J-C et al (2002) Microvascular blood flow is altered in patients with sepsis. Am J Respir Crit Care Med 166:98–104

    Article  PubMed  Google Scholar 

  9. Fournell A, Scheeren TW, Schwarte LA (1998) PEEP decreases oxygenation of the intestinal mucosa despite normalization of cardiac output. Adv Exp Med Biol 454:435–440

    Article  PubMed  CAS  Google Scholar 

  10. Fournell A, Schwarte LA, Kindgen-Milles D et al (2003) Assessment of microvascular oxygen saturation in gastric mucosa in volunteers breathing continuous positive airway pressure. Crit Care Med 31:1705–1710

    Article  PubMed  Google Scholar 

  11. Frank KH, Kessler M, Appelbaum K et al (1989) The Erlangen micro-lightguide spectrophotometer EMPHO I. Phys Med Biol 34:1883–1900

    Article  PubMed  CAS  Google Scholar 

  12. Scheeren TW, Schwarte LA, Loer SA et al (2002) Dopexamine but not dopamine increases gastric mucosal oxygenation during mechanical ventilation in dogs. Crit Care Med 30:881–887

    Article  PubMed  CAS  Google Scholar 

  13. Schwarte LA, Picker O, Schindler A et al (2004) Dopamine under alpha1-blockade, but not dopamine alone or fenoldopam, increases depressed gastric mucosal oxygenation. Crit Care Med 32:150–156

    Article  PubMed  CAS  Google Scholar 

  14. Schwarte LA, Picker O, Schindler AW et al (2003) Fenoldopam: but not dopamine – selectively increases gastric mucosal oxygenation in dogs. Crit Care Med 31:1999–2005

    Article  PubMed  CAS  Google Scholar 

  15. Schwarte LA, Picker O, Bornstein SR et al (2005) Levosimendan is superior to milrinone and dobutamine in selectively increasing microvascular gastric mucosal oxygenation in dogs. Crit Care Med 33:135–142

    Article  PubMed  CAS  Google Scholar 

  16. Schwarte LA, Picker O, Hohne C et al (2004) Effects of thoracic epidural anaesthesia on microvascular gastric mucosal oxygenation in physiological and compromised circulatory conditions in dogs. Br J Anaesth 93:552–559

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The above-mentioned studies have been funded by a grant from the Research Commission, Medical Faculty, Heinrich-Heine-University Düsseldorf and departmental funds.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to A. Fournell .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2012 Springer Science+Business Media, LLC

About this paper

Cite this paper

Fournell, A., Scheeren, T.W.L., Picker, O., Schwarte, L.A. (2012). Pharmacologic Interventions to Improve Splanchnic Oxygenation During Ventilation with Positive End-Expiratory Pressure. In: Wolf, M., et al. Oxygen Transport to Tissue XXXIII. Advances in Experimental Medicine and Biology, vol 737. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-1566-4_34

Download citation

Publish with us

Policies and ethics