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

Pierre Huette; Pierre-Grégoire Guinot; Guillaume Haye; Mouhamed Djahoum Moussa; Christophe Beyls; Mathieu Guilbart; Lucie Martineau; Hervé Dupont; Yazine Mahjoub; Osama Abou-Arab

doi:10.3390/jcm10245810

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

J Clin Med. 2021 Dec 12;10(24):5810. doi: 10.3390/jcm10245810.

Affiliations

¹ Anesthesia and Critical Care Medicine Department, Amiens Hospital University, 80000 Amiens, France.
² Anesthesia and Critical Care Medicine Department, Dijon Hospital University, 21000 Dijon, France.
³ Anesthesia and Critical Care Medicine Department, Lille Hospital University, 59000 Lille, France.

Abstract

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 cmH₂O, with increments of 5 cmH₂O. The PI (%) was assessed at baseline and PEEP 5, 10, and 15 cmH₂O. 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 cmH₂O and 30 mL (25-45) at PEEP 15 cmH₂O, (p < 0.0001). The PI significantly increased with PEEP incrementation, from 9% (5-15) at PEEP 0 cmH₂O to 15% (5-22) at PEEP 5 cmH₂O, 34% (23-44) at PEEP 10 cmH₂O, and 45% (25-49) at PEEP 15 cmH₂O (p < 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.

Keywords: cardiac surgery; echography; mechanical ventilation; portal vein pulsatility; venous congestion.