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Effects of Trendelenburg position and increased airway pressure on hepatic regional blood flow of normal and resected liver.

07:00 EST 13th February 2020 | BioPortfolio

Summary of "Effects of Trendelenburg position and increased airway pressure on hepatic regional blood flow of normal and resected liver."

Background High portal venous blood flow (Qpv) may contribute to post-hepatectomy liver failure. Both Trendelenburg position (TP) and elevated airway pressure (Paw) increase backpressure to venous return and may thereby reduce Qpv. Aim To evaluate the effects of TP and increased Paw on hepato-splanchnic hemodynamics before and after major liver resection. Methods Arterial and venous blood pressures, Qpv, extra-splanchnic inferior vena cava (Qivc), superior mesenteric (Qsma), hepatic (Qha), and carotid artery blood flows (Qca) were measured in 14 anesthetized and mechanically ventilated pigs in supine and 30° TP during end-expiratory hold at 5 cm HO PEEP, and during inspiratory hold with Paw of 15, 20, 25 and 30 cmHO. After major liver resection, the interventions were repeated in 7 randomly selected animals. Results At baseline, TP increased right atrial pressure (Pra) and Qpv but not Qivc or Qsma. With increased Paw in supine position, Pra increased and all regional blood flows decreased. TP during increasing Paw attenuated the decrease in Qpv, Qsma and Qivc, but not in Qha or Qca. After liver resection, effects of TP during increasing Paw remained, albeit at higher portal vein pressures. However, TP alone did not increase IVC venous return. Conclusion Increasing Paw in supine position reduces Qpv and all other regional flows, while the reduction in Qpv is attenuated in TP, suggesting partly preserved liver waterfall or decreased intra-hepatic resistance. Liver resection, despite resulting in major intra-hepatic blood flow changes, does not fundamentally influence the interaction of increasing Paw and TP on regional perfusion.

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This article was published in the following journal.

Name: Journal of applied physiology (Bethesda, Md. : 1985)
ISSN: 1522-1601
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