Morbid Obesity Causes Chronic Increase of Intraabdominal Pressure

Frezza, Eldo E.; Shebani, Khaled O.; Robertson, Jana; Wachtel, Mitchell S.

doi:10.1007/s10620-006-9203-4

Cited by 96 publications

(68 citation statements)

References 16 publications

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“…Frezza et al measured opening abdominal pressure in patients of varying BMI by connecting a Verress needle to a pressure monitor. 16 They proved that for every 1-kg m À2 increase in BMI, there was on average a 0.07-mm Hg increase in opening pressure. Thus, the increased abdominal pressure may increase pressure on the cervix, resulting in failure of the cerclage.…”

Section: Discussionmentioning

confidence: 97%

Does increasing body mass index affect cerclage efficacy?

et al. 2012

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Objective: To study the relationship between body mass index (BMI) and gestational age (GA) at delivery in patients with cervical insufficiency (CI) undergoing cerclage.Study Design: We accessed a database of patients with singleton gestations undergoing cerclage (N ¼ 168) for a well-characterized history of CI, shortened cervix <2.5 cm with a history of prior preterm delivery or prolapse of membranes through the external os. Univariate and multivariate logistic regression analysis were performed to compare obstetrical outcomes between obese and normal-weight patients.Result: Prior preterm delivery <35 weeks in obese vs normal-weight patients was significantly higher (44% vs 9%), odds ratio ¼ 6.9 (95% CI: 2.5, 18.5), with lower mean GA at delivery (32.6 ± 7.0 vs 37.2 ± 3.4 weeks, P<0.001). After controlling for confounders, BMI remained significantly predictive of prematurity (coefficient: À0.12, adjusted R 2 ¼ 0.24), such that every additional 1 unit of BMI was associated with a 1-day reduction in GA at delivery (P ¼ 0.03).Conclusion: An inverse correlation exists between BMI and GA at delivery in patients with CI receiving cerclage. The findings are unexpected given the protective effect of obesity on spontaneous preterm delivery.

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Section: Discussionmentioning

confidence: 97%

Does increasing body mass index affect cerclage efficacy?

et al. 2012

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“…While the exact pathogenesis of elevated IAP among patients with obesity is currently not known, Lambert et al hypothesize that this association may be due to a direct mass effect of intra-abdominal adipose tissue [32]. Recent studies have found that obesity leads to chronic elevation of IAP and that IAP is positively correlated with BMI [29]. In many patients IAP is 12 mm Hg or higher, putting them at risk of acute organ dysfunction.…”

Section: Intra-abdominal Hypertension and Obesity Epidemiology Of Intmentioning

confidence: 99%

“…Thus, in the setting of chronic IAP and morbid obesity, recent studies have suggested that obesity-induced IAH contributes to systemic arterial hypertension and many other serious conditions [29,32,33,40,41]. In contrast, a normal IAP appears to offer a protective effect against systemic hypertension.…”

Section: Pathophysiology Of Iah In Obese Patientsmentioning

confidence: 99%

Intra-abdominal hypertension and abdominal compartment syndrome in burns, obesity, pregnancy, and general medicine

Malbrain¹,

Keulenaer²,

Oda³

et al. 2015

Anaesthesiol Intensive Ther

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Intra-abdominal hypertension (IAH) is an important contributor to early organ dysfunction in trauma and sepsis. However, relatively little is known about the impact of intra-abdominal pressure (IAP) in general internal medicine, pregnant patients, and those with obesity or burns. The aim of this paper is to review the pathophysiologic implications and treatment options for IAH in these specific situations. A MEDLINE and PubMed search was performed and the resulting body-of-evidence included in the current review on the basis of relevance and scientific merit. There is increasing awareness of the role of IAH in different clinical situations. Specifically, IAH will develop in most (if not all) severely burned patients, and may contribute to early mortality. One should avoid over-resuscitation of these patients with large volumes of fluids, especially crystalloids. Acute elevations in IAP have similar effects in obese patients compared to non-obese patients, but the threshold IAP associated with organ dysfunction may be higher. Chronic elevations in IAP may, in part, be responsible for the pathogenesis of obesity-related co-morbid conditions such as hypertension, pseudotumor cerebri, pulmonary dysfunction, gastroesophageal reflux disease, and abdominal wall hernias. At the bedside, measuring IAP and considering IAH in all critical maternal conditions is essential, especially in preeclampsia/eclampsia where some have hypothesized that IAH may have an additional role. IAH in pregnancy must take into account the precautions for aorto-caval compression and has been associated with ovarian hyperstimulation syndrome. Recently, IAP has been associated with the cardiorenal dilemma and hepatorenal syndrome, and this has led to the recognition of the polycompartment syndrome. In conclusion, IAH and ACS have been associated with several patient populations beyond the classical ICU, surgical, and trauma patients. In all at risk conditions the focus should be on the early recognition of IAH and prevention of ACS. Patients at risk for IAH should be identified early through measurements of IAP. Appropriate actions should be taken when IAP increases above 15 mm Hg, especially if pressures reach above 20 mm Hg with new onset organ failure. Although non-operative measures come first, surgical decompression must not be delayed if these fail. Percutaneous drainage of ascites is a simple and potentially effective tool to reduce IAP if organ dysfunction develops, especially in burn patients. Escharotomy may also dramatically reduce IAP in the case of abdominal burns.

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“…7 Intra-abdominal pressure seems to be chronically increased in severely obese patients. 8 Finally, twin studies suggested that venous compliance and capacity are heritable. 9 It is tempting to speculate that genes affecting venous function could also promote hypertension.…”

Section: Mind the Vein 311mentioning

confidence: 99%

Mind the Vein

Chobanyan-Jürgens

Jordan

2016

Hypertension

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V eins lack luster when it comes to hypertension research. Compared with the scientist working on arterial branches, heart, or kidney, the vein researcher commonly feels like being at the bottom of the cardiovascular food chain. Convincing peers that project proposals or articles dealing with venous regulation are any good can be challenging. The study by Okamoto et al 1 is a strong reminder that veins are more than blood sampling outlets, sources of blood clots, or commodities for cardiovascular surgeons. Indeed, in patients with severe autonomic failure, venous capacitance vessels, particularly those in the splanchnic area, take over command of blood pressure control. Moreover, veins can serve as a treatment target to improve blood pressure control in such patients.Veins contain ≈75% of total body blood volume such that small changes in venous capacitance or compliance substantially affect cardiac loading conditions. Venous function is governed by various feedback mechanisms and reflexes, including arterial baroreflexes. Furthermore, increased intravenous volume and associated venous distension elicit local arteriolar constriction. This so-called venoarteriolar reflex suggests that veins can truly be in charge of local hemodynamic control. With standing, ≈500 to 1000 mL of blood are rapidly redistributed from the upper body to venous capacitance vessels below the diaphragm. Human venous compliance is particularly high in splanchnic and cutaneous areas. Yet, a larger proportion of the venous pooling with standing takes place in splanchnic compared with cutaneous veins. In healthy individuals, baroreflex mechanisms adjust efferent sympathetic and parasympathetic activity, so that blood pressure is maintained with standing. Venous responses may be important in this regard as splanchnic veins are more sensitive to adrenergic stimulation and express more α 1 -and α 2 -adrenoreceptors than mesenteric arteries.In patients with autonomic failure, sympathetic and parasympathetic efferent nerves are either destroyed or disconnected from brain stem input. Thus, changes in cardiac preload with standing cannot be buffered by adjusting efferent autonomic activity and blood pressure decreases profoundly.The orthostatic hypotension can be so severe that patients are unable to stand for more than a few seconds, which dramatically restricts their quality of life.In patients with severe orthostatic hypotension, causative treatments are rare. Nonpharmacological treatments, including optimized salt and water ingestion, compression garments, and sleeping in the head-up tilt position, may not provide sufficient symptom relief in severely affected patients. Symptomatic pharmacological management with pressor agents has a slow onset of action and tends to worsen hypertension in the supine position. Therefore, Okamoto et al 1 developed and tested a servocontrolled automated inflatable abdominal binder for the treatment of orthostatic hypotension. External pressure on the abdomen likely compresses splanchnic capacitance vessels, thereby...

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Morbid Obesity Causes Chronic Increase of Intraabdominal Pressure

Cited by 96 publications

References 16 publications

Does increasing body mass index affect cerclage efficacy?

Does increasing body mass index affect cerclage efficacy?

Intra-abdominal hypertension and abdominal compartment syndrome in burns, obesity, pregnancy, and general medicine

Mind the Vein

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