Intra-abdominal Hypertension in Medical Critically Ill Patients

Ortiz-Diaz, Enrique; Lan, Charlie

doi:10.1097/shk.0000000000000100

Cited by 11 publications

(5 citation statements)

References 52 publications

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“…Although the adverse effects of IAH have received much attention, the effects of slightly elevated IAPs remain unclear. Despite critically ill patients, the intraperitoneal pressures in adults are rarely more than 5–7 mmHg [13] – [16] , which is within the acceptable normal range for such patients [1] , [17] . In fact, based on the IAH diagnostic standards (12 mmHg for adults and 10 mmHg for children), 60% of adults in the intensive care unit have slightly elevated IAPs of 5–12 mmHg; the corresponding range for children is approximately 4–10 mmHg [1] .…”

Section: Introductionmentioning

confidence: 99%

Effect of Acute, Slightly Increased Intra-Abdominal Pressure on Intestinal Permeability and Oxidative Stress in a Rat Model

et al. 2014

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IntroductionIntra-abdominal hypertension (IAH) is known as a common, serious complication in critically ill patients. Bacterial translocation and permeability changes are considered the pathophysiological bases for IAH-induced enterogenic endotoxemia and subsequent multiorgan failure. Nevertheless, the effects of slightly elevated intra-abdominal pressures (IAPs) on the intestinal mucosa and the associated mechanisms remain unclear.MethodsTo investigate the acute effects of different nitrogen pneumoperitoneum grades on colonic mucosa, male Sprague-Dawley rats were assigned to six groups with different IAPs (0 [control], 4, 8, 12, 16, and 20 mmHg, n = 6/group). During 90 min of exposure, we dynamically monitored the heart rate and noninvasive hemodynamic parameters. After gradual decompression, arterial blood gas analyses were conducted. Thereafter, structural injuries to the colonic mucosa were identified using light microscopy. Colon permeability was determined using the expression of tight junction proteins, combined with fluorescein isothiocyanate dextran (FD-4) absorption. The pro-oxidant-antioxidant balance was determined based on the levels of malondialdehyde (MDA) and antioxidant enzymes.ResultsIAH significantly affected the histological scores of the colonic mucosa, tight junction protein expression, mucosal permeability, and pro-oxidant-antioxidant balance. Interestingly, elevations of IAP that were lower than the threshold for IAH also showed a similar, undesirable effect. In the 8 mmHg group, mild hyponatremia, hypocalcemia, and hypoxemia occurred, accompanied by reduced blood and abdominal perfusion pressures. Mild microscopic inflammatory infiltration and increased MDA levels were also detected. Moreover, an 8-mm Hg IAP markedly inhibited the expression of tight junction proteins, although no significant differences in FD-4 permeability were observed between the 0- and 8-mmHg groups.ConclusionsAcute exposure to slightly elevated IAP may result in adverse effects on intestinal permeability and the pro-oxidant-antioxidant balance. Therefore, in patients with critical illnesses, IAP should be dynamically monitored and corrected, as soon as possible, to prevent intestinal mucosal injury and subsequent gut-derived sepsis.

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Section: Introductionmentioning

confidence: 99%

Effect of Acute, Slightly Increased Intra-Abdominal Pressure on Intestinal Permeability and Oxidative Stress in a Rat Model

et al. 2014

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“…A great number of pathophysiological changes occur due to IAH, including an increase in thoracic pressure and CVP, a decrease in the returned blood volume and a compensatory increase in the HR, and finally respiratory failure, which calls for ventilatory support (22)(23)(24). The present study demonstrated that compared with those obtained by PCV, the PIP, P mean and Cst were significant improved, all which is beneficial to the respiratory system of patients, with PRVCV.…”

Section: Discussionmentioning

confidence: 99%

Comparison of pressure‑regulated volume control ventilation and pressure control ventilation in patients with abdominal compartment syndrome

et al. 2019

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Mechanical ventilation support is commonly required in abdominal compartment syndrome (ACS). In the present study, pressure-regulated volume control ventilation (PRVCV) was compared to pressure control ventilation (PCV) in patients with ACS. The prospective study included 40 patients with ACS who were randomized into the PCV or PRVCV groups and subjected to the different modes of ventilation. After 6 h of ventilation, arterial blood gas, respiratory mechanics and hemodynamics parameters, as well as the intra-abdominal pressure (IAP) and Sequential Organ Failure Assessment (SOFA) scores were calculated. Compared to the PCV mode, mechanical ventilation with PRVCV lead to a significant decrease in the partial pressure of carbon dioxide, the peak inspiratory pressure, the mean inspiratory pressure, the central venous pressure, the heart rate and the extravascular lung water index. In addition, a marked improvement in pH, partial pressure of oxygen, oxygenation index and pulmonary static compliance was noted. However, no significant differences in airway resistance, mean arterial pressure, or IAP and SOFA scores were obtained. In conclusion, the PRVCV mode is better than the PCV mode in ventilation patients with ACS, and should therefore be used as a lung protective strategy. The present study was registered at Chictr.org (no. ChiCTR1800016869).

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“…28 Elevated IAP compresses the IVC and results in smaller and unreliable IVC parameters. For example, a patient with fluid overload may develop IAH or ACS due to ascites or bowel edema and present with reduced renal output or hypotension.…”

Section: Intra-abdominal Pressurementioning

confidence: 98%