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Interaction between intra-abdominal pressure and positive-end expiratory pressure
Torquato, Jamili Anbar; Lucato, Jeanette Janaina Jaber; Antunes, Telma; Barbas, Carmen Valente.
Afiliación
  • Torquato, Jamili Anbar; Hospital das Clinicas. Faculdade de Medicina. Departamento de Patologia. São Paulo. BR
  • Lucato, Jeanette Janaina Jaber; Hospital das Clinicas. Faculdade de Medicina. Departamento de Patologia. São Paulo. BR
  • Antunes, Telma; Hospital das Clinicas. Faculdade de Medicina. Disciplina de Pneumologia. São Paulo. BR
  • Barbas, Carmen Valente; Hospital das Clinicas. Faculdade de Medicina. Disciplina de Pneumologia. São Paulo. BR
Clinics ; 64(2): 105-112, 2009. ilus, graf, tab
Article en En | LILACS | ID: lil-505371
Biblioteca responsable: BR1.1
ABSTRACT

OBJECTIVE:

The aim of this study was to quantify the interaction between increased intra-abdominal pressure and Positive-End Expiratory Pressure.

METHODS:

In 30 mechanically ventilated ICU patients with a fixed tidal volume, respiratory system plateau and abdominal pressure were measured at a Positive-End Expiratory Pressure level of zero and 10 cm H2O. The measurements were repeated after placing a 5 kg weight on the patients' belly.

RESULTS:

After the addition of 5 kg to the patients' belly at zero Positive-End Expiratory Pressure, both intra-abdominal pressure (p<0.001) and plateau pressures (p=0.005) increased significantly. Increasing the Positive-End Expiratory Pressure levels from zero to 10 cm H2O without weight on the belly did not result in any increase in intra-abdominal pressure (p=0.165). However, plateau pressures increased significantly (p< 0.001). Increasing Positive-End Expiratory Pressure from zero to 10 cm H2O and adding 5 kg to the belly increased intra-abdominal pressure from 8.7 to 16.8 (p<0.001) and plateau pressure from 18.26 to 27.2 (p<0.001). Maintaining Positive-End Expiratory Pressure at 10 cm H2O and placing 5 kg on the belly increased intra-abdominal pressure from 12.3 +/- 1.7 to 16.8 +/- 1.7 (p<0.001) but did not increase plateau pressure (26.6+/-1.2 to 27.2 +/-1.1 -p=0.83).

CONCLUSIONS:

The addition of a 5kg weight onto the abdomen significantly increased both IAP and the airway plateau pressure, confirming that intra-abdominal hypertension elevates the plateau pressure. However, plateau pressure alone cannot be considered a good indicator for the detection of elevated intra-abdominal pressure in patients under mechanical ventilation using PEEP. In these patients, the intra-abdominal pressure must also be measured.
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Texto completo: 1 Colección: 01-internacional Base de datos: LILACS Asunto principal: Respiración Artificial / Respiración con Presión Positiva / Abdomen / Hemodinámica Límite: Adolescent / Adult / Aged / Aged80 / Female / Humans / Male Idioma: En Revista: Clinics Asunto de la revista: MEDICINA Año: 2009 Tipo del documento: Article País de afiliación: Brasil Pais de publicación: Brasil
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: LILACS Asunto principal: Respiración Artificial / Respiración con Presión Positiva / Abdomen / Hemodinámica Límite: Adolescent / Adult / Aged / Aged80 / Female / Humans / Male Idioma: En Revista: Clinics Asunto de la revista: MEDICINA Año: 2009 Tipo del documento: Article País de afiliación: Brasil Pais de publicación: Brasil