Effect of mechanical ventilation on intra-abdominal pressure in critically ill patients without other risk factors for abdominal hypertension: an observational multicenter epidemiological study

Abstract

BackgroundMechanical ventilation (MV) is considered a predisposing factor for increased intra-abdominal pressure (IAP), especially when positive end-expiratory pressure (PEEP) is applied or in the presence of auto-PEEP. So far, no prospective data exists on the effect of MV on IAP. The study aims to look on the effects of MV on IAP in a group of critically ill patients with no other risk factors for intra-abdominal hypertension (IAH).MethodsAn observational multicenter study was conducted on a total of 100 patients divided into two groups: 50 patients without MV and 50 patients with MV. All patients were admitted to the intensive care units of the Medical and Surgical Research Centre, the Carlos J. Finlay Hospital, the Julio Trigo University Hospital, and the Calixto García Hospital, in Havana, Cuba between July 2000 and December 2004. The IAP was measured twice daily on admission using a standard transurethral technique. IAH was considered if IAP was greater than 12 mmHg. Correlations were made between IAP and body mass index (BMI), diagnostic category, gender, age, and ventilatory parameters.ResultsThe mean IAP in patients on MV was 6.7 ± 4.1 mmHg and significantly higher than in patients without MV (3.6 ± 2.4 mmHg, p < 0.0001). This difference was maintained regardless of gender, age, BMI, and diagnosis. The use of MV and BMI were independent predictors for IAH for the whole population, while male gender, assisted ventilation mode, and the use of PEEP were independent factors associated with IAH in patients on MV.ConclusionsIn this study, MV was identified as an independent predisposing factor for the development of IAH. Critically ill patients, which are on MV, present with higher IAP values on admission and should be monitored very closely, especially if PEEP is applied, even when they have no other apparent risk factors for IAH.

The role of abdominal compliance, the neglected parameter in critically ill patients — a consensus review of 16. Part 2: measurement techniques and management recommendations

“…13). This occurs in patients under positive pressure ventilation [65], application of positive end-expiratory pressure (PEEP) [66], presence of intrinsic or auto-PEEP, or a tension pneumothorax [67,68]. Conversely, transmission of pressure from the abdomen to the thorax is called ATI and occurs in any physiologic (pregnancy) or pathologic condition associated with increased IAP; the ATI ranges from 20 to 80%, average 50% [69,70].…”

“…• Umbilical hernia repair [145,146] • Muscle contractions (pain) [93] • Body builders (six-pack) [115] • Interstitial and anasarc oedema (skin, abdominal wall) • Abdominal burn eschars (circular) [97,98,147] • Thoracic burn eschars (circular) • Tight closure after abdominal surgery • Abdominal Velcro belt or adhesive drapes [148] • Prone positioning [103] • HOB > 45° [102] • Pneumoperitoneum • Pneumatic anti-shock garments • Abdominal wall bleeding • Rectus sheath haematoma [149] • Correction of large hernias • Gastroschisis • Omphalocoele • Mechanical ventilation (positive pressure) [65] • Fighting with the ventilator • Use of accessory muscles • Use of positive end expiratory pressure (PEEP) [66] • Presence of auto-PEEP (tension pneumothorax) • COPD emphysema (diaphragm flattening)…”

The effect of reference position versus right lateral position on the intra-abdominal pressure in mechanically ventilated patients

“…[2] Various factors such as recent operation in the abdomen, sepsis, system failure and need for connection to mechanical ventilation with the use of positive end-expiratory pressure (PEEP) or auto-PEEP are associated with elevations in IAP. [5] Intra-abdominal hypertension has a prevalence of at least 50% in the critically ill population and has been identified as an independent risk factor of death. However, many members of the critical care team do not evaluate the high blood pressure in the abdomen and do not realize the consequences of intra-abdominal hypertension without treatment.…”

Lunge-Nieren-Interaktionen bei kritisch Kranken

“…Auch kann die mechanische Beatmung eine Erhöhung des intraabdominellen Drucks ("intra-abdominal pressure", IAP) induzieren. Dies wirkt sich direkt auf den abdominellen Perfusionsdruck ("abdominal perfusion pressure", APP = MAP ["mean arterial pressure"] -IAP) aus, der mit Zunahme des IAP entsprechend sinkt [16,17]. Bei Zunahme des IAP kommt es zu einer Abnahme des renalen Perfusionsdrucks und des renalen Filtrationsgradienten.…”