Is intra-abdominal hypertension a risk factor for ventilator-associated pneumonia?

Abstract

In the last years, there has been a significant amount of research about the impact of intraabdominal hypertension (IAH) on the outcomes of critical care patients. IAH is increasingly recognized as potential complication in intensive care unit (ICU) patients. IAH affects all body systems, most notably the cardiac, respiratory, renal, and neurologic systems. IAH affects blood flow to various organs and plays a significant role in the prognosis of the patients. Recognition of IAH, its risk factors and clinical signs can reduce the morbidity and mortality associated. Moreover, knowledge of the pathophysiology may help rationalize the therapeutic approach. On the other hand, ICU patients present frequently ventilatorassociated respiratory infections. Ventilator-associated pneumonia (VAP) is the most common healthcareassociated infection (HAI) in adult critical care units. It is associated with increased ICU stay, patient ventilator days and mortality. This paper reviews the relationship between IAH and VAP. Despite animal experimentation and physiological studies on humans, in favor of the impact of IAH to VAP, there is no definitive clinical data that IAH is associated with VAP. Microaspirations form the gastrointestinal track is a pathophysiological mechanism for VAP. This review provides data suggesting that under IAH conditions bacterial translocation might be an additional responsible mechanism for VAP in those patients that merits further investigation in the future.

Risk Factors of Ventilator-Associated Pneumonia in Critically III Patients

“…The reason may be that long-term smoking leads to impaired pulmonary macrophage function resulting in decreased bacterial clearance, which makes the lungs vulnerable to pathogenic bacteria attack. A single-center prospective study by Papakrivou et al (2018a, b) identified that intra-abdominal hypertension was an independent risk factor for VAP in ICU patients. Recent studies have shown that intra-abdominal hypertension increases the risk of infection by severely affecting the function of the respiratory system and peripheral organs.…”

Ventilator Bundles in Transition: From Prevention of Ventilator-Associated Pneumonia to Prevention of Ventilator-Associated Events

“…5 Positive pressure gradients between the gastric and esophageal compartments (ie, intra-abdominal vs intrathoracic) facilitate reflux that is magnified further by gastric distention, 6 compression by abdominal viscera, 7 and intra-abdominal hypertension. 8 Regardless of size, the presence of any gastric tube enhances reflux by stenting open the lower esophageal sphincter. 9 In the past, mechanically ventilated patients often were kept supine and frequently had nasogastric tubes in place.…”

“…Other risk factors, such as intra-abdominal hypertension and sepsis, are, at best, questionably modifiable. Intra-abdominal hypertension often develops after abdominal trauma, burns, and other conditions, 8,105 and it is associated with VAP. 106 The incidence and associated mortality with severe sepsis is related to poverty, 105 poor access to medical care, 107 and race.…”

WITHDRAWN: Development and validation of a nomogram for predicting carbapenem-resistant organism infection and prognostic risk factors analysis in elderly hospitalized patients

“…But the respiratory tract and urethra communicate with the outside world which can easily cause bacterial colonization and infection. Previous studies reported that mechanical ventilation could cause the intubation -13membrane to fall off, and the bacteria that form the membrane spread to the lower respiratory tract to cause infection, so there were many reports of ventilator-associated pneumonia [32][33][34]. Da Silva et al [35] indicated that invasive operations such as indwelling catheters were significant factors for infection and colonization of multidrug-resistant bacteria.…”