ABSTRACT
ObjetivoAnalizar la correlación entre la presión intraabdominal e intratorácica en pacientes con sospecha de hipertensión intraabdominal (HIA).DiseñoEstudio prospectivo observacional de una cohorte.ÁmbitoUnidad de medicina intensiva polivalente de un hospital universitario.PacientesSe incluyó a 27 pacientes medicoquirúrgicos dependientes de ventilación mecánica controlada por fallo respiratorio agudo y con factores de riesgo de hipertensión intraabdominal.Principales variablesMedimos las presiones intraabdominal (PIA), esofágica (Peso) y de la vía aérea en condiciones estáticas (est) y dinámicas (din). Calculamos la distensibilidad del sistema respiratorio (Csr), pulmón (Cp) y pared torácica (Cpt).ResultadosEn 10 pacientes la PIAest fue mayor de 12mmHg (HIA, PIAest, 14±2 [12-21] mmHg) y en el resto fue normal (n=17; PIAest, 8±2 [3-11] mmHg). La Pesoest fue 11±5 (2-27) y Pesodin, 7±4 (2-24) cmH2O. Considerando la presencia o no de HIA, Pesoest fue 9±4 vs. 7±3cmH2O (p=0,2) y Pesodin, 6±2 vs. 4±3cmH2O (p=0,3), respectivamente. La correlación de Pesoest y din con PIAest fue 0,5 (p=0,003) y 0,4 (p=0,03), respectivamente. Los componentes de la distensibilidad del sistema respiratorio estaban disminuidos (Csr, 31±8; Cp, 52±22; Cpt, 105±50ml/cmH2O), Cpt fue significativamente más baja en los pacientes con HIA (81±31 vs. 118±55ml/cmH2O; p=0,02). El coeficiente de correlación entre la PIAest y Cpt fue 0,7 (p<0,001) y de 0,5 (p=0,002) con Csr.ConclusionesLa pared torácica es más rígida en pacientes con hipertensión abdominal. En presencia de factores de riesgo de HIA las presiones en estos compartimentos son muy variables (AU)
Objective: To study the correlation between intraabdominal and intrathoracic pressure inpatients with suspected intraabdominal hypertension.Design: A prospective, observational cohort study.Setting: Polyvalent intensive care unit of a University hospital.Patients: Twenty-seven medical-surgical patient dependent upon controlled mechanical ventilationdue to acute respiratory failure and with several risk factors for intraabdominalhypertension (IAH).Main variables: Intraabdominal (IAP), esophageal (Peso) and airways pressure were measuredunder static (st) and dynamic (dyn) conditions. Respiratory system (Crs), lung (Cl) and chestwall compliance (Ccw)were calculated.Results: In 10 patients IAP > 12mmHg (IAH, IAPst, 14±2 [12-21] mmHg), while in the rest thepressure proved normal (n = 17; IAPst, 8±2 [3-11] mmHg). Peso st was 11±5 (2-27) and Pesodyn 7±4 (2-24) cmH2O. Depending on the presence or absence of IAH, Peso st was 9±4 vs7±3 cmH2O (p = 0.2) and Peso dyn 6±2 vs 4±3 cmH2O (p = 0.3), respectively. The correlationbetween Peso st and dyn with IAPst was 0.5 (p = 0.003) and 0.4 (p = 0.03), respectively. Thecompliance components were decreased (Crs, 31±8; Cl, 52±22 and Ccw, 105±50 ml/cmH2O);Ccw was significantly lower in patients with IAH (81±31 vs 118±55 ml/cmH2O; p = 0.02). Thecorrelation coefficient between IAPst and Ccw was 0.7 (p < 0.001), and 0.5 (p = 0.002) withrespect to Crs.Conclusions: A stiffer chest wall was observed in patients with IAH. In patients with risk factorsfor IAH, pressures in these compartments were highly variable (AU)
Subject(s)
Humans , Blood Pressure Determination/methods , Hypertension/diagnosis , Respiratory Insufficiency/therapy , Respiration, Artificial/adverse effects , Prospective Studies , Risk FactorsABSTRACT
OBJECTIVE: To study the correlation between intraabdominal and intrathoracic pressure in patients with suspected intraabdominal hypertension. DESIGN: A prospective, observational cohort study. SETTING: Polyvalent intensive care unit of a University hospital. PATIENTS: Twenty-seven medical-surgical patient dependent upon controlled mechanical ventilation due to acute respiratory failure and with several risk factors for intraabdominal hypertension (IAH). MAIN VARIABLES: Intraabdominal (IAP), esophageal (Peso) and airways pressure were measured under static (st) and dynamic (dyn) conditions. Respiratory system (Crs), lung (Cl) and chest wall compliance (Ccw)were calculated. RESULTS: In 10 patients IAP > 12 mmHg (IAH, IAPst, 14 ± 2 [12-21] mmHg), while in the rest the pressure proved normal (n = 17; IAPst, 8 ± 2 [3-11] mmHg). Peso st was 11 ± 5 (2-27) and Peso dyn 7 ± 4 (2-24) cmH2O. Depending on the presence or absence of IAH, Peso st was 9 ± 4 vs 7 ± 3 cmH2O (p = 0.2) and Peso dyn 6 ± 2 vs 4 ± 3 cmH2O (p = 0.3), respectively. The correlation between Peso st and dyn with IAPst was 0.5 (p= 0.003) and 0.4 (p = 0.03), respectively. The compliance components were decreased (Crs, 31 ± 8; Cl, 52 ± 22 and Ccw, 105 ± 50 ml/cmH2O); Ccw was significantly lower in patients with IAH (81 ± 31 vs 118 ± 55 ml/cmH2O; p = 0.02). The correlation coefficient between IAPst and Ccw was -0.7 (p < 0.001), and -0.5 (p = 0.002) with respect to Crs. CONCLUSIONS: A stiffer chest wall was observed in patients with IAH. In patients with risk factors for IAH, pressures in these compartments were highly variable.
Subject(s)
Abdominal Cavity , Hypertension/physiopathology , Thorax , Aged , Critical Illness , Female , Humans , Male , Pressure , Prospective StudiesABSTRACT
La administración de estatinas se ha mostrado eficaz en reducir la mortalidad cardiovascular. Su beneficio podría expandirse hacia otras áreas de la medicina intensiva, pudiendo disminuir la mortalidad del paciente críticamente enfermo. Existen diversos estudios, aunque sin un alto nivel de evidencia, en el que parece detectarse un posible beneficio en su administración, y un empeoramiento clínico con la discontinuación de estos fármacos, sobre los pacientes que previamente las tomaban.A pesar de que la mayoría de los pacientes que tomaban previamente estatinas, lo hacían como prevención primaria o secundaria, teniendo por tanto una mayor comorbilidad, en global se detecta una disminución de la mortalidad en dichos subgrupos. Este beneficio podría ser generalizado ante toda la patología crítica, aunque se requieren estudios con un mayor nivel de evidencia, para su adecuada contrastación (AU)
Administration of statins has been shown to be effective in reducing cardiovascularmortality. Their benefit could expand towards other areas of intensive medicine, it beingpossible to decrease mortality of the critically ill patient. There are several studies, althoughwithout a high level of evidence, that have detected a possible benefit when they are administeredas well as clinical deterioration when they are discontinued, compared to those patientswho had previously taken them.Even though most of the patients who had previously taken statins did so as primary orsecondary prevention, thus having greater comorbidity, overall, a decrease is detected in themortality of these subgroups. This benefit could be generalized to all the critical conditions,although studies with a higher level of evidence are needed for their adequate comparison.© 2009 Elsevier Espana, S.L. y SEMICYUC. All rights reserved (AU)
Subject(s)
Humans , Animals , Cerebrovascular Disorders/drug therapy , Critical Care/methods , Critical Illness/therapy , /therapeutic use , Cerebrovascular Disorders/prevention & control , Critical Illness/mortality , /pharmacology , Hyperlipidemias/drug therapy , Liver Cirrhosis/drug therapy , Pulmonary Disease, Chronic Obstructive/drug therapy , Sepsis/drug therapy , Sepsis/prevention & controlABSTRACT
Administration of statins has been shown to be effective in reducing cardiovascular mortality. Their benefit could expand towards other areas of intensive medicine, it being possible to decrease mortality of the critically ill patient. There are several studies, although without a high level of evidence, that have detected a possible benefit when they are administered as well as clinical deterioration when they are discontinued, compared to those patients who had previously taken them. Even though most of the patients who had previously taken statins did so as primary or secondary prevention, thus having greater comorbidity, overall, a decrease is detected in the mortality of these subgroups. This benefit could be generalized to all the critical conditions, although studies with a higher level of evidence are needed for their adequate comparison.
