Interaction between intra-abdominal pressure and positive-end expiratory pressure
Clinics
;
64(2): 105-112, 2009. ilus, graf, tab
Article
in English
| LILACS
| ID: lil-505371
ABSTRACT
OBJECTIVE:
The aim of this study was to quantify the interaction between increased intra-abdominal pressure and Positive-End Expiratory Pressure.METHODS:
In 30 mechanically ventilated ICU patients with a fixed tidal volume, respiratory system plateau and abdominal pressure were measured at a Positive-End Expiratory Pressure level of zero and 10 cm H2O. The measurements were repeated after placing a 5 kg weight on the patients' belly.RESULTS:
After the addition of 5 kg to the patients' belly at zero Positive-End Expiratory Pressure, both intra-abdominal pressure (p<0.001) and plateau pressures (p=0.005) increased significantly. Increasing the Positive-End Expiratory Pressure levels from zero to 10 cm H2O without weight on the belly did not result in any increase in intra-abdominal pressure (p=0.165). However, plateau pressures increased significantly (p< 0.001). Increasing Positive-End Expiratory Pressure from zero to 10 cm H2O and adding 5 kg to the belly increased intra-abdominal pressure from 8.7 to 16.8 (p<0.001) and plateau pressure from 18.26 to 27.2 (p<0.001). Maintaining Positive-End Expiratory Pressure at 10 cm H2O and placing 5 kg on the belly increased intra-abdominal pressure from 12.3 +/- 1.7 to 16.8 +/- 1.7 (p<0.001) but did not increase plateau pressure (26.6+/-1.2 to 27.2 +/-1.1 -p=0.83).CONCLUSIONS:
The addition of a 5kg weight onto the abdomen significantly increased both IAP and the airway plateau pressure, confirming that intra-abdominal hypertension elevates the plateau pressure. However, plateau pressure alone cannot be considered a good indicator for the detection of elevated intra-abdominal pressure in patients under mechanical ventilation using PEEP. In these patients, the intra-abdominal pressure must also be measured.
Full text:
Available
Index:
LILACS (Americas)
Main subject:
Respiration, Artificial
/
Positive-Pressure Respiration
/
Abdomen
/
Hemodynamics
Limits:
Adolescent
/
Adult
/
Aged
/
Aged80
/
Female
/
Humans
/
Male
Language:
English
Journal:
Clinics
Journal subject:
Medicine
Year:
2009
Type:
Article
Affiliation country:
Brazil
Institution/Affiliation country:
Hospital das Clinicas/BR
Similar
MEDLINE
...
LILACS
LIS