The Physiologic Effects of Externally Applied Continuous Negative Abdominal Pressure for Intra-abdominal Hypertension

Bloomfield, GL; Saggi, BH; Blocher, Charles R.; Sugerman, H J

doi:10.1097/00005373-199807000-00078

Cited by 14 publications

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“…However, this was questioned by others. Bloomfield et al [29] could not find a positive correlation between FVP and IAP intraperitoneal in a swine model and concluded that FVP overestimated IAP. Similar findings were published by Ishizaki et al [30] in 21 dogs where the IVCPs were much higher than the corresponding insufflation pressures and by Jakob et al [31] in a pig model.…”

Section: Discussionmentioning

confidence: 89%

Does femoral venous pressure measurement correlate well with intrabladder pressure measurement? A multicenter observational trial

et al. 2011

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Section: Discussionmentioning

confidence: 89%

Does femoral venous pressure measurement correlate well with intrabladder pressure measurement? A multicenter observational trial

et al. 2011

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“…10 Porcine studies have shown that increased intraabdominal pressure produces increased inferior vena caval and femoral venous pressure by both a direct effect on the vena cava and an indirect effect through increased intrathoracic pressure. 11,12 The increased venous pressure presumably leads to venous valve failure with extravasation of red blood cells, producing the bronze edema, and impaired epidermal nutrient flow, leading to skin breakdown and ulceration and an increased risk of venous thrombosis. Presumably, this is why the venous stasis disease resolves after surgically induced weight loss.…”

Section: Discussionmentioning

confidence: 99%

Risks and Benefits of Gastric Bypass in Morbidly Obese Patients With Severe Venous Stasis Disease

et al. 2001

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ObjectiveTo determine the risks and benefits of gastric bypass-induced weight loss on severe venous stasis disease in morbid obesity. Summary Background DataSevere obesity is associated with a risk of lower extremity venous stasis disease, pretibial ulceration, cellulitis, and bronze edema. MethodsThe GBP database was queried for venous stasis disease including pretibial venous stasis ulcers, bronze edema, and cellulitis. ResultsOf 1,976 patients undergoing GBP, 64 (45% female) met the criteria. Mean age was 44 Ϯ 10 years. Thirty-seven patients had pretibial venous stasis ulcers, 4 had bronze edema, 23 had both, and 17 had recurrent cellulitis. All had 2 to 4ϩ pitting pretibial edema. Mean preoperative body mass index (BMI) was 61 Ϯ 12 kg/m 2 and weight was 179 Ϯ 39 kg (270 Ϯ 51% ideal body weight), significantly greater than in patients who underwent GBP without venous stasis disease. Two patients had a pulmonary embolus and four had Greenfield filters in the remote past. Additional comorbidities included obesity hypoventilation syndrome, sleep apnea syndrome, hypertension, gastroesophageal reflux, degenerative joint disease symptoms, type 2 diabetes mellitus, pseudotumor cerebri, and urinary incontinence. Comorbidities were significantly more frequent in the patients with venous stasis disease than for those without. At 3.9 Ϯ 4 years after surgery, patients lost 55 Ϯ 21% of excess weight, 62 Ϯ 33 kg, reaching 40 Ϯ 9 kg/m 2 BMI or 176 Ϯ 41% ideal body weight. Venous stasis ulcers resolved in all but three patients. Complications included anastomotic leaks with peritonitis and death, fatal pulmonary embolism, fatal respiratory arrest, wound infections or seromas, staple line disruptions, marginal ulcerations treated with acid suppression, stomal stenoses treated with endoscopic dilatation, late small bowel obstructions, and incisional hernias. There were six other late deaths.

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“…Previous acute porcine studies with an increased intraabdominal pressure have documented an immediate decrease in directly measured intra-abdominal, intrapleural, central venous and intracranial pressures with application of continuous negative abdominal pressure (CNAP 2 ). 11 We tried to measure CSF pressures in several of these patients prior to, during or following application of this device; however, the data appeared to be inaccurate as the pressures did not oscillate with respirations. In a previous case report, we noted a marked decrease in directly measured ventriculostomy ICP pressure in a head injury patient with an acute abdominal compartment syndrome following surgical abdominal decompression, permitting removal of the ventriculostomy which was being used to drain CSF¯uid to maintain an ICP 20 mmHg.…”

Section: Discussionmentioning

confidence: 99%

Continuous negative abdominal pressure device to treat pseudotumor cerebri

et al. 2001

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OBJECTIVE:To study the effects of an externally applied negative abdominal pressure device designed to lower the effects of intra-abdominal pressure (IAP) on headaches and pulsatile tinnitus in severely obese women with pseudotumor cerebri (PTC). DESIGN: Short-term clinical intervention trial in the Clinical Research Center. Days 1 and 3 were`control' days; on days 2 and 4 ± 6 patients were in the device from 8:00 am to noon and from 1:00 to 5:00 pm, and on nights 7 ± 11 they were in the device from 10:00 pm to 8:00 am. The last four patients were treated in a device with a counter-traction mechanism. SUBJECTS: Seven centrally obese women with PTC. MEASUREMENTS: Headache and pulsatile tinnitus severity were graded by the patient using visual analog scale (1 ± 10) and averaged for the time that the device was in use or not in use. IAP was estimated from urinary bladder pressure (UBP) before and during device use. The internal jugular vein (IJV) elliptical cross-sectional area was measured with B-mode ultrasonography; the timed average velocity was measured by Doppler. RESULTS: There was a decrease in both headache (6.8 AE 0.8 to 4.2 AE 0.8, P`0.05) and pulsatile tinnitus (4.2 AE 0.5 to 1.8 AE 0.5, P`0.02) within 5 min, and in headache (to 2.2 AE 0.8, P`0.01) and tinnitus (to 1.7 AE 0.5, P`0.01) within 1 h of device activation. UBP decreased (P`0.001) from 19.1 AE 3 to 12.5 AE 2.8 cmH 2 O. Headache remained improved throughout time that the device was used. During the second week, ®ve of seven patients slept in the device without dif®culty and four awoke without headache. There was a progressive decrease (P`0.01) in headache during the day after sleeping in the device at night as compared with days 1 and 3 when it was not used (6.5 AE 0.5, day 1; 4.1 AE 0.7, day 3; 3.1 AE 0.8, day 8; 2.3 AE 0.8, day 10). Headaches returned late in the afternoon in two patients; the device was reactivated and headache again improved. Five patients underwent IJV sonography; the IJV area decreased (129 AE 53 to 100 AE 44 mm 2 , P 0.06) without a change in IJV¯ow (1004 AE 802 to 1000 AE 589 mlamin) with the device. When activated, the device was pulled into the patient, creating discomfort that was alleviated with the counter-traction mechanism in the last four patients. One patient developed a 5 cm area of blisters that resolved when the device was worn over a hospital gown. CONCLUSIONS: Decreasing IAP relieved headaches and pulsatile tinnitus in PTC. When patients slept in the device, they awoke without headache or tinnitus, which remained markedly improved throughout most of the following day. This study supports the hypothesis that PTC in obese women is secondary to an increased IAP.

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The Physiologic Effects of Externally Applied Continuous Negative Abdominal Pressure for Intra-abdominal Hypertension

Cited by 14 publications

References 0 publications

Does femoral venous pressure measurement correlate well with intrabladder pressure measurement? A multicenter observational trial

Does femoral venous pressure measurement correlate well with intrabladder pressure measurement? A multicenter observational trial

Risks and Benefits of Gastric Bypass in Morbidly Obese Patients With Severe Venous Stasis Disease

Continuous negative abdominal pressure device to treat pseudotumor cerebri

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