Portal Vein Pulsatility as a Dynamic Marker of Venous Congestion Following Cardiac Surgery: An Interventional Study Using Positive End-Expiratory Pressure.

UNLABELLED

We aimed to assess variations in the portal vein pulsatility index (PI) during mechanical ventilation following cardiac surgery.

METHOD

After ethical approval, we conducted a prospective monocentric study at Amiens University Hospital. Patients under mechanical ventilation following cardiac surgery were enrolled. Doppler evaluation of the portal vein (PV) was performed by transthoracic echography. The maximum velocity (VMAX) and minimum velocity (VMIN) of the PV were measured in pulsed Doppler mode. The PI was calculated using the following formula (VMAX - VMIN)/(VMax). A positive end-expiratory pressure (PEEP) incremental trial was performed from 0 to 15 cmHO, with increments of 5 cmHO. The PI (%) was assessed at baseline and PEEP 5, 10, and 15 cmHO. Echocardiographic and hemodynamic parameters were recorded.

RESULTS

In total, 144 patients were screened from February 2018 to March 2019 and 29 were enrolled. Central venous pressure significantly increased for each PEEP increment. Stroke volumes were significantly lower after PEEP incrementation, with 52 mL (50-55) at PEEP 0 cmHO and 30 mL (25-45) at PEEP 15 cmHO, ( < 0.0001). The PI significantly increased with PEEP incrementation, from 9% (5-15) at PEEP 0 cmHO to 15% (5-22) at PEEP 5 cmHO, 34% (23-44) at PEEP 10 cmHO, and 45% (25-49) at PEEP 15 cmHO ( < 0.001).

CONCLUSION

In the present study, PI appears to be a dynamic marker of the interaction between mechanical ventilation and right heart pressure after cardiac surgery. The PI could be a useful noninvasive tool to monitor venous congestion associated with mechanical ventilation.