Influence of increased abdominal pressure on steady-state cardiac performance

Kitano, Yoshihiro; Takata, Masao; Sasaki, Nobuyoshi; Zhang, Qinming; Yamamoto, Shin; Miyasaka, Katsuyuki

doi:10.1152/jappl.1999.86.5.1651

Cited by 73 publications

(55 citation statements)

References 23 publications

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“…Together, these findings imply that IAH blunts the response of parameters that in the absence of IAH can accurately predict fluid responsiveness, which may be due to an IAH-induced increase in right ventricular afterload [63].…”

Section: Goal-directed Resuscitationmentioning

confidence: 73%

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Fluid therapy and perfusional considerations during resuscitation in critically ill patients with intra-abdominal hypertension

Regli

Keulenaer²,

Laet³

et al. 2014

Anaesthesiol Intensive Ther

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Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are consistently associated with morbidity and mortality among the critically ill or injured. Thus, avoiding or potentially treating these conditions may improve patient outcomes. With the aim of improving the outcomes for patients with IAH/ACS, the World Society of the Abdominal Compartment Syndrome recently updated its clinical practice guidelines. In this article, we review the association between a positive fluid balance and outcomes among patients with IAH/ACS and how optimisation of fluid administration and systemic/regional perfusion may potentially lead to improved outcomes among this patient population. Evidence consistently associates secondary IAH with a positive fluid balance. However, despite increased research in the area of non-surgical management of patients with IAH and ACS, evidence supporting this approach is limited. Some evidence exists to support implementing goal-directed resuscitation protocols and restrictive fluid therapy protocols in shocked and recovering critically ill patients with IAH. Data from animal experiments and clinical trials has shown that the early use of vasopressors and inotropic agents is likely to be safe and may help reduce excessive fluid administration, especially in patients with IAH. Studies using furosemide and/or renal replacement therapy to achieve a negative fluid balance in patients with IAH are encouraging. The type of fluid to be administered in patients with IAH remains far from resolved. There is currently insufficient evidence to recommend the use of abdominal perfusion pressure as a resuscitation endpoint in patients with IAH. However, it is important to recognise that IAH either abolishes or increases threshold values for pulse pressure variation and stroke volume variation to predict fluid responsiveness, while the presence of IAH may also result in a false negative passive leg raising test. Correct fluid therapy and perfusional support during resuscitation form the cornerstone of medical management in patients with abdominal hypertension. Controlled studies determining whether the above medical interventions may improve outcomes among those with IAH/ACS are urgently required.

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Section: Goal-directed Resuscitationmentioning

confidence: 73%

“…IAH is associated with an increased systemic vascular resistance, decreased venous return, reduced cardiac output [63], and diminished intra-abdominal organ perfusion [73]. The question therefore arises as to how vasopressor/inotropic agents affect systemic and abdominal perfusion in patients with IAH.…”

Section: Vasoactive Medicationsmentioning

confidence: 99%

Fluid therapy and perfusional considerations during resuscitation in critically ill patients with intra-abdominal hypertension

Regli

Keulenaer²,

Laet³

et al. 2014

Anaesthesiol Intensive Ther

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“…Low levels of IAP have been shown to increase blood pressure and cardiac output [32][33][34][35][36][37]. This increase in cardiac output is thought to result from an increase in venous return as a result of a redistribution of abdominal blood to the thoracic compartment [33,38].…”

Section: Effects Of Iah On Systemic Blood Flow and Vascular Resistancementioning

confidence: 99%

“…Static preload parameters such as right atrial pressure and pulmonary artery occlusion pressure are misleadingly elevated [40]. Venous return is reduced due to a compression of the inferior vena cava [33,38]. The critical opening pressure of the inferior vena cava will depend on IAP, intra-thoracic pressure and fluid status [41].…”

Section: Effects Of Iah On Systemic Blood Flow and Vascular Resistancementioning

confidence: 99%

Abdominal pressure and gastrointestinal function: an inseparable couple?

Blaser¹,

Malbrain²,

Regli³

2017

Anaesthesiol Intensive Ther

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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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“…Høiseth et al's analysis of PPV, SVV, DPOP (a nonproprietary estimate of PPG-based respiratory variation), and PVI in patients subject to pneumoperitoneum (i.e., which leads to increased intra-abdominal pressure, increased central venous pressure, and decreased venous return) [73][74][75] revealed an increase in DPOP and PVI but not in PPV or SVV, 65 supporting the hypothesis that a physiologically meaningful venous contribution to the photoplethysmographic waveform may explain the relatively poor correlation between DPOP (or PVI) and PPV.…”

Section: 6470-72mentioning

confidence: 99%

Advances in photoplethysmography: beyond arterial oxygen saturation

Bartels

Thiele

2015

Can J Anesth/J Can Anesth

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Purpose Photoplethysmography permits continuous measurement of heart rate and peripheral oxygen saturation and has been widely used to inform clinical decisions. Recently, a myriad of noninvasive hemodynamic monitoring devices using this same technology have been increasingly available. This narrative review aims to summarize the principles that form the basis for the function of these devices as well as to comment on trials evaluating their accuracy and clinical application. Principal findings Advanced monitoring devices extend photoplethysmography technology beyond measuring oxygen concentration and heart rate. Quantification of respiratory variation of the photoplethysmographic waveform reflects respiratory variation of the arterial pressure waveform and can be used to gauge volume responsiveness. Both the volume-clamp and physiocal techniques are extensions of conventional photoplethysmography and permit continuous measurement of finger arterial blood pressure. Finger arterial pressure waveforms can subsequently inform estimations of cardiac output. Conclusions Although respiratory variations of the plethysmographic waveform correlate only modestly with the arterial blood pressure waveform, fluid responsiveness can be relatively consistently assessed using both approaches. Continuous blood pressure measurements obtained using the volume-clamp technique may be as accurate as conventional brachial noninvasive blood pressure measurements. Most importantly, clinical comparative effectiveness studies are still needed in order to determine if these technologies can be translated into improvement of relevant patient outcomes. RésuméObjectif La photopléthysmographie permet la mesure continue de la fréquence cardiaque et de la saturation en oxygène périphérique, et elle est largement utilisée pour les prises de décisions cliniques. Depuis peu, un très grand nombre de dispositifs non invasifs de surveillance hémodynamique utilisant la même technologie envahit le marché. Cette synthèse narrative vise à résumer les principes à la base du fonctionnement de ces dispositifs et à commenter les essais évaluant leur exactitude ainsi que leurs applications cliniques. Constatations principales Les dispositifs de surveillance avancée étendent la technologie de photopléthysmographie au-delà de la mesure de la concentration en oxygène et de la fréquence cardiaque. La quantification de la variation respiratoire du tracé photopléthysmographique reflète la variation respiratoire du tracé de pression artérielle et peut servir à jauger la réactivité au volume. Les deux techniques de compression volumique (volume-clamp) au doigt et la technique physiocal sont des prolongements de Author contributions Karsten Bartels wrote approximately 50% of the manuscript and critically edited the remainder. Robert H. Thiele wrote approximately 50% of the manuscript and critically edited the remainder.

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Influence of increased abdominal pressure on steady-state cardiac performance

Cited by 73 publications

References 23 publications

Fluid therapy and perfusional considerations during resuscitation in critically ill patients with intra-abdominal hypertension

Fluid therapy and perfusional considerations during resuscitation in critically ill patients with intra-abdominal hypertension

Abdominal pressure and gastrointestinal function: an inseparable couple?

Advances in photoplethysmography: beyond arterial oxygen saturation

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