Pharmacologic Interventions to Improve Splanchnic Oxygenation During Ventilation with Positive End-Expiratory Pressure

Mechanical ventilation with positive end-expiratory pressure (PEEP) is an indispensable tool in the management of respiratory failure to preserve or improve lung function and systemic oxygenation. However, PEEP per se may also, as has been shown in experimental animals, impair regional microcirculation and oxygenation. The latter effects have received attention of late because of possible systemic sequelae such as multiple system organ failure (MSOF) in case of the splanchnic region. In this review, we examine the impact of pharmacologic interventions to improve splanchnic mucosal oxygen saturation depressed by mechanical ventilation with PEEP in a canine model of compromised cardiac function. Although much remains to be elucidated about the mechanisms of action, the primary way to improve splanchnic oxygenation seems to be a vasodilatory action of the drugs