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.
