J.Jpn. Surg. Soc.. 91(8): 1031-1039, 1990

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Original article

AN EXPERIMENTAL STUDY OF THE INFLUENCE OF POSITIVE END-EXPIRATORY PRESSURE FOR A BIDIRECTIONAL CAVOPULMONARY SHUNT

In 8 mongreal dogs (weight 9-13kg), we created a bidirectional cavopulmonary shunt through 4th intercostal thoracotomy.
Positive end･expiratory pressure(PEEP)was added from 0cmH₂O to 16cmH₂O at the steps of 2cmH₂O.
The heart rate (HR), central venous pressure (CVP), pulmonary artery pressure (PAP), femoral artery pressure (FAP), pulmonary vascular resistance index (PVRI), and systemic vascular resistance index (SVRI) were measured as parameters of hemodynamics.
Cardiac output (CO), pulmonary artery flow at proximal and distal site of this shunt (D-SF, P-SF) were measured using a magnetic fiow meter. Blood gas analysis (PH, PaO₂, PaCO₂, HCO₃^-) were performed at the same time.
HR had no significant change.
CVP, PAP, PVRI, SVRI increased significantly (p＜0.05, p＜0.05, p＜0.05, p＜0.05) at 2cmH₂O (9.2±2.5mmHg), 10cmH₂O (29.3±5.5mmHg), 4cmHb (287±56 dyne･sec･cm^-5･m²), and 8cmHb (1298±156dyne･sec･cm^-5･m²) compared with 0cmHb (87.3±2.6mmHg, 26.8±3.4mmHg, 240±29 dyne･sec･cm^-5･m², 1136±176 dyne･sec･cm^-5･m²).
FAP, CO, D-SF, P-SF decreased significantly (p＜0.01, p＜0.05, p＜0.01, p＜0.05)at 6cmH₂O (129±7mmHg), 2cmH₂O (0.44±0.05L/min), 2cmH₂O (449±47ml/min), and 8cmH₂O (105±17ml/min) compared with 0cmH₂O (148±11mmHg, 048±0.06L/min,471±44ml/min,132±19ml/min).
On blood gas analysis, PaO₂ increased significantly(p＜0.05) from 2cmH₂O PEEP except PH, PaCO₂, HCO₃^-.
Amechanism for decline in D-SF was considered of being a secondary effect due to increase in CVP.
When we use PEEP as postoperative respirator management after bidirectional cavopulmonary shunt procedure, we should maintain a low level of PEEP carefully considering a hemodynamics (CVP).

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