Abstract:
Introduction. The aim of this study was demonstrate the influence of different positive
end-expiratory pressure (PEEP) values on blood flow of the liver by indocyanine green
(ICG) clearance test in donor patients.
Methods. ICG clearance tests were conducted concurrently using a noninvasive monitor
that tracks the plasma disappearance rate of ICG (PDR-ICG%/min) and 15-minute
retention rate after administration of ICG (ICG-R15%). This study was performed in 40
patients who underwent right hepatectomy.
Results. The positive end-expiratory pressure (PEEP) was 0 cm H20 in the first (control)
group (group K) and 10 mm Hg in the second study group (group P). ICG clearance test
values before general anesthesia (T0), after induction of general anesthesia (T1), after
transection (T2), 24 hours postoperative (T3), and 72 hours postoperative (T4) were
recorded. Simultaneously, hemoglobin (Hgb), hematocrit (Hct), platelet count, plasma
levels of prothrombin (PT), International Normalized Ratio (INR), total bilirubin, direct
bilirubin, albumin, aspartate aminotransferase, and alanine aminotransferase values were
analyzed. In terms of the plasma disappearance rate and retention rate of ICG 15
minutes after administration, significant difference was not observed between groups. PT
and INR values were different within comparisons groups (P < .05). There were
significant differences in Hgb and Hct values compared with the baseline values (T0)
within group (T1, T2, T3, T4) measurements and between group comparisons at T0 and
T4 (P < .05). Systemic arterial pressure, mean arterial pressure, and central venous
pressure were significantly different between the groups (P < .05).
Conclusions. Given the small magnitude and limited clinical significance of these changes,
we conclude that PEEP values between 0 and 10 cm H2O have no effect on global liver
function and liver-related liabilities tests in patients undergoing elective liver donor surgery
