Hemorrhage Lowers the Threshold for Intra-abdominal Hypertension-induced Pulmonary Dysfunction

Evaluating the degree of organ dysfunction is a cornerstone in distinguishing patients with critical illness from those without. However, evaluation of the gastrointestinal function in critically ill patients is not unified, and is still largely based on subjective clinical evaluation. Although intra-abdominal pressure has been proposed as a parameter to facilitate monitoring of abdominal compartment in critical illness, the interactions between intra-abdominal pressure and gastrointestinal function are poorly clarified. The aim of this current review is to describe interactions and associations between gastrointestinal dysfunction and intra-abdominal pressure from a pathophysiological and clinical point of view.

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“…Hypovolemia and high PEEP both appear to aggravate the effects of increased IAP, causing organ damage [91,92].…”

Section: The Effect Of Iah and Critical Illness On Gut Permeability Amentioning

confidence: 99%

Abdominal pressure and gastrointestinal function: an inseparable couple?

Blaser¹,

Malbrain²,

Regli³

2017

Anaesthesiol Intensive Ther

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“…The different effects on preload, afterload and contractility are summarized in Figure 1. The cardiovascular effects can be aggravated in hypovolemic patients and with the application of high levels of positive end-expiratory pressure (PEEP) [12,13], whereas hypervolemia usually has a temporary protective effect [14]. Cardiac function may be distilled into three essential components: preload, contractility, and afterload.…”

Section: Cardiovascular Effects Associated With Intra-abdominal Hypermentioning

confidence: 99%

What every ICU clinician needs to know about the cardiovascular effects caused by abdominal hypertension

Malbrain

Waele²,

Keulenaer³

2015

Anaesthesiol Intensive Ther

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The effects of increased intra-abdominal pressure (IAP) on cardiovascular function are well recognized and include a combined negative effect on preload, afterload and contractility. The aim of this review is to summarize the current knowledge on this topic. The presence of intra-abdominal hypertension (IAH) erroneously increases barometric filling pressures like central venous (CVP) and pulmonary artery occlusion pressure (PAOP) (since these are zeroed against atmospheric pressure). Transmural filling pressures (calculated by subtracting the pleural pressure from the end-expiratory CVP value) may better reflect the true preload status but are difficult to obtain at the bedside. Alternatively, since pleural pressures are seldom measured, transmural CVP can also be estimated by subtracting half of the IAP from the end-expiratory CVP value, since abdominothoracic transmission is on average 50%. Volumetric preload indicators, such as global and right ventricular end-diastolic volumes or the left ventricular end-diastolic area, also correlate better with true preload. When using functional hemodynamic monitoring parameters like stroke volume variation (SVV) or pulse pressure variation (PPV) one must bear in mind that increased IAP will increase these values (via a concomitant increase in intrathoracic pressure). The passive leg raising test may be a false negative in IAH. Calculation of the abdominal perfusion pressure (as mean arterial pressure minus IAP) has been shown to be a better resuscitation endpoint than IAP alone. Finally, it is re-assuring that transpulmonary thermodilution techniques have been validated in the setting of IAH and abdominal compartment syndrome. In conclusion, the clinician must be aware of the different effects of IAH on cardiovascular function in order to assess the volume status accurately and to optimize hemodynamic performance.

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“…Mean arterial blood pressure may initially rise due to shunting of blood away from the abdominal cavity but thereafter normalizes or decreases [36,38]. The cardiovascular effects are aggravated by hypovolemia and the application of positive end expiratory pressure (PEEP) [43][44][45][46][47], whereas hypervolemia has a temporary protective effect [48].…”

Section: Effect On the Cardiovascular Systemmentioning

confidence: 99%

Current insights in intra-abdominal hypertension and abdominal compartment syndrome: open the abdomen and keep it open!

laet

Ravyts

Vidts

et al. 2008

Langenbecks Arch Surg

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The ACS was first described in surgical patients with abdominal trauma, bleeding, or infection, but in recent years ACS has also been described in patients with other pathologies such as burn injury and sepsis. Some of these so-called nonsurgical patients will require surgery to treat their ACS. This review article is intended to provide surgeons with a clear insight into the current state of knowledge regarding IAH, ACS, and the impact of IAP on the critically ill patient.

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Hemorrhage Lowers the Threshold for Intra-abdominal Hypertension-induced Pulmonary Dysfunction

Cited by 94 publications

References 16 publications

Abdominal pressure and gastrointestinal function: an inseparable couple?

Abdominal pressure and gastrointestinal function: an inseparable couple?

What every ICU clinician needs to know about the cardiovascular effects caused by abdominal hypertension

Current insights in intra-abdominal hypertension and abdominal compartment syndrome: open the abdomen and keep it open!

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