Impact of Positive End-expiratory Pressure on Hepatic Venous Flow

Konkuk University Medical Center

Status: Unknown

Conditions: Valvular Heart Disease

Treatments: Procedure: low PEEP protective ventilation; Procedure: moderate PEEP protective ventilation; Procedure: low PEEP conventional ventilation; Procedure: moderate PEEP conventional ventilation

Study type: Interventional

Funder types: Other

Identifiers

NCT02700581

KUH000000 TBD

Details and patient eligibility

About

The purpose of this study is to determine the difference in the impact of moderate positive end-expiratory pressure (PEEP) on hepatic venous flow Doppler in patients undergoing cardiac surgery: conventional versus protective ventilation strategy The possible changes in forward and backward flows (Doppler profiles) of hepatic venous flow at different degrees of PEEP in conventional and protective ventilation strategies are analyzed by using intraoperative transesophageal echocardiography (TEE) in patients undergoing cardiac surgery .

Full description

Following data would be determined after 5 min-exposure volume controlled ventilation employing tidal volume of 10 ml/kg and 6 ml/kg with low PEEP (with 2 mmHg) and moderate PEEP (7 mmHg) during remifentanil-based anesthesia (1.0 mcg/kg/min) for cardiac surgery (n=12)

1. sum of forward hepatic venous flow
2. sum of backward hepatic venous flow
3. peak velocity of diastolic hepatic venous flow
4. lung compliance
5. peak airway pressure
6. mean airway pressure
7. other pressure derived hemodynamic parameters:heart rate; systolic, diastolic, and mean blood pressures; systolic, diastolic, and mean pulmonary artery pressures; central venous pressure (CVP), pulmonary capillary

Enrollment: 15 estimated patients

Sex: All

Ages: 19 to 65 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Patients undergoing cardiac surgery
• Patients provide written informed consents

Exclusion criteria

• Re-do or tri-do surgery
• Patients with active infection
• Patients with endocrine disease
• Patients ischemic heart disease
• patients with tricuspid valve regurgitation greater than mild degree

Trial design

Primary purpose: Supportive Care

Allocation: Non-Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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15 participants in 4 patient groups

low PEEP conventional ventilation

Active Comparator group

Description:

PEEP 2 mmHg tidal volume 10ml/kg

Treatment:

Procedure: low PEEP conventional ventilation

moderate PEEP conventional ventilation

Experimental group

Description:

PEEP 7 mmHg tidal volume 10ml/kg

Treatment:

Procedure: moderate PEEP conventional ventilation

low PEEP protective ventilation

Experimental group

Description:

PEEP 2 mmHg with tidal volume 6 ml/kg

Treatment:

Procedure: low PEEP protective ventilation

moderate PEEP protective ventilation

Experimental group

Description:

PEEP 7 mmHg tidal volume 6ml/kg

Treatment:

Procedure: moderate PEEP protective ventilation