Am. J. Respir. Crit. Care Med., Vol 152, No. 1, Jul 1995, 103-107.
Renal hemodynamic and functional effect of PEEP ventilation in human renal transplantations
LP Jacob, JJ Chazalet, DM Payen, SM Villiers, S Boudaoud, P Teillac, AS Pruna, JM Idatte and BG Eurin
Department of Anesthesiology and Intensive Care, Hopital Universitaire Saint-Louis, Paris, France.
Increased intrathoracic pressure with positive pressure breathing (PPB)
induces renal hypoperfusion and excretion function impairment the mechanism
of which may be partially related to reflex sympathetic nerve activation.
The consequences of renal denervation on PPB-induced renal impairment are
unknown. This study was conducted to evaluate the effects of increasing
intrathoracic pressure with positive end- expiratory pressure (PEEP) on
renal blood flow (RBF, pulsed Doppler implantable microprobes) and function
in 12 kidney transplantation recipients during the immediate
post-transplantation period. Three sets of measurements were performed
during successively zero end-expiratory pressure (ZEEP), 15 cm H2O PEEP,
and back to ZEEP. PEEP ventilation was associated with mean arterial
pressure (MAP) and cardiac output (CO) decrease (-12%, p < 0.01; -26%, p
< 0.01, respectively). RBF remained constant in the three protocol
conditions. PEEP ventilation was associated with a decrease in urinary
output (8.5 +/- 5.6 versus 12.9 +/- 8.6 ml/min; p < 0.01), urinary
sodium concentration (115 +/- 14 versus 121 +/- 12 mmol/L; p < 0.01)
sodium excretion rate (1 +/- 0.7 versus 1.6 +/- 1.1 mmol/min; p < 0.01),
and creatinine clearance (17.1 +/- 10 versus 23.2 +/- 13.6 ml/min; p <
0.01). PEEP-induced urinary output decrease was correlated to renal
perfusion pressure decrease (r = 0.7, p = 0.016). These results suggest
that despite denervation and renal blood flow stability, renal handling of
water and salt is perfusion pressure-dependent during PEEP in human renal
allograft recipients.
