medigraphic.com

2010, Number 2

<< Back Next >>

Med Crit 2010; 24 (2)

Intraabdominal pressure changes secondary to PEEP for ARDS

Montes OSMA, Rodríguez RJ, Padua GMAX, Aguirre SJ, Poblano MM, Olvera GCI, Franco GJ

Language: Spanish
References: 12
Page: 72-78
PDF size: 67.54 Kb.


ABSTRACT

Introduction: The abdominal compartment syndrome, elevated intraabdominal pressure (IAP) + organ failure, increases airway pressures during mechanical ventilation (MV). PEEP/MV can be risk factors to develop it. It is not known how much PEEP (intrathoracic pressure) modifies the IAP.
Objective: To determine if IAP changes after PEEP in ARDS patients.
Methods: In severe ARDS (PaO2/FiO2 ≤ 150 mmHg) patients, IAP was measured (AbViser®) in different PEEP levels (0, 5, 10, 15 y 20 cmH2O).
Results: 30 patients with ARDS were included, 17 of pulmonary origin and 13 of extrapulmonary origin. The compliance increased when PEEP was raised from 0-20 cmH2O, but did not correlated with IAP increment. Pulmonary pressures (peak, plateau and mean), correlated with IAP if PEEP ›10 cmH2O, specifically in pulmonary ARDS.
Conclusions: IAP must be measured when PEEP is higher than 10 cmH2O and ARDS has a pulmonary origin.


REFERENCES

  1. Results from the International Conference of Experts on Intra-abdominal Hypertension and Abdominal Compartment Syndrome. I Definitions Intensive Care Med 2006;32:1722-1732.

  2. Bailey J, Shapiro MJ. Abdominal compartment syndrome. Crit Care 2000;4:23.

  3. Malbrain ML, Chiumello D, Pelosi P, et al. Incidence and prognosis of intraabdominal hypertension in a mixed population of critically ill patients: a multiple-center epidemiological study. Crit Care Med 2005;33:315.

  4. Malbrain ML, Chiumello D, Pelosi P, et al. Prevalence of intra-abdominal hypertension in critically ill patients: a multicentre epidemiological study. Intensive Care Med 2004;30:822.

  5. Kron IL, Harman PK, Nolan SP. The measurement of intra-abdominal pressure as a criterion for abdominal re-exploration. Ann Surg 1984;199:28.

  6. Obeid F, Saba A, Fath J, Guslits B. Increases in intra-abdominal pressure affect pulmonary compliance. Arch Surg 1995;130:544.

  7. Simon RJ, Friedlander MH, Ivatury RR, DiRaimo R. Hemorrhage lowers the threshold for intra-abdominal hypertension-induced pulmonary dysfunction. J Trauma 1997;42:398.

  8. Quintel M, Pelosi P, Caironi P, et al. An increase of abdominal pressure increases pulmonary edema in oleic acid-induced lung injury. Am J Respir Crit Care Med 2004;169:534.

  9. Aprahamian C, Wittmann DH, Bergstein JM, Quebbeman EJ. Temporary abdominal closure (TAC) for planned relaparotomy (etappenlavage) in trauma. J Trauma 1990;30:719.

  10. AbViser TM. Intra-abdominal pressure monitoring kit. Instructions for use. [En línea] [fecha de acceso: 7/09/06] URL disponible en, www.wolfetory.com.

  11. Fisiología respiratoria de West 7a edición. West John B. Médica Panamericana Pag. Sandur S, Stoller JK: Pulmonary complications of mechanical ventilation. Clin Chest Med 1999;20:223-47.

  12. Acute respiratory distress syndrome caused by pulmonary and extrapulmonary disease. Different syndromes? Am J Respir Crit Care Med 1998;158:3-11.




2020     |     www.medigraphic.com