Influence of Ventilation Parameters on Intraabdominal Pressure

Puiac, Claudiu; Szederjesi, Janos; Lazar, Alexandra; Almasy, Emoke; Rad, Paul; Puscasiu, Lucian

doi:10.1515/jccm-2016-0016

Abstract

Introduction: Intraabdominal pressure monitoring is not routinely performed because the procedure assumes some invasiveness and, like other invasive procedures, it needs to have a clear indication to be performed. The causes of IAH are various. Mechanically ventilated patients have numerous parameters set in order to be optimally ventilated and it is important to identify the ones with the biggest interference in abdominal pressure. Although it was stated that mechanical ventilation is a potential factor of high intraabdominal pressure the set parameters which may lead to this diagnostic are not clearly named.

Objectives: To evaluate the relation between intraabdominal pressure and ventilator parameters in patients with mechanical ventilation and to determine the correlation between intraabdominal pressure and body mass index. Material and method: This is an observational study which enrolled 16 invasive ventilated patients from which we obtained 61 record sheets. The following parameters were recorded twice daily: ventilator parameters, intraabdominal pressure, SpO2, Partial Oxygen pressure of arterial blood. We calculated the Body Mass Index (BMI) for each patient and the volume tidal/body weight ratio for every recorded data point.

Results: We observed a significant correlation between intraabdominal pressure (IAP) and the value of PEEP (p=0.0006). A significant statistical correlation was noted regarding the tidal volumes used for patient ventilation. The mean tidal volume was 5.18 ml/kg. Another significant correlation was noted between IAP and tidal volume per kilogram (p=0.0022). A positive correlation was found between BMI and IAP (p=0.0049), and another one related to the age of the enrolled patients. (p=0.0045).

Conclusions: The use of positive end-expiratory pressures and high tidal volumes during mechanical ventilation may lead to the elevation of intraabdominal pressure, a possible way of reducing this risk would be using low values of PEEP and also low volumes for the setting of ventilation parameters. There is a close positive correlation between the intraabdominal pressure levels and body mass index.

References

1. Cheatham ML, Malbrain ML, Kirkpatrick A, et al. Results from the International Conference of Experts on Intra-Abdominal hypertension and Abdominal Compartment Syndrome. I. Definitions. Intensive Care Med. 2006;32:1722-32.
Search in Google Scholar
2. Kirkpatrick AW, Roberts DJ, De Waele J, et al. Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome. Intensive Care Med. 2013;39:1190-206.10.1007/s00134-013-2906-z368065723673399
Search in Google Scholar
3. Dalfino L, Tullo L, Donadio I, et al. Intra-abdominal hypertensionand acute renal failurein critically ill patient. Intensive Care Med 2008;34:707-13.10.1007/s00134-007-0969-418157662
Search in Google Scholar
4. Balogh ZJ, Martin A, van Wessem KP et al. Mission to eliminate postinjury abdominal compartment syndrome. Arch Surg. 2011;146:938–43.10.1001/archsurg.2011.7321502442
Search in Google Scholar
5. Reintam Blaser A, Parm P, Kitus R et al. Risk factors for intraabdominal hypertension in mechanically ventilated patients. Acta Anaesthesiol Scand. 2011;55:607–14.10.1111/j.1399-6576.2011.02415.x21418151
Search in Google Scholar
6. Ke L, Ni HB, Sun JK, et al. Risk factors and outcome of intra-abdominal hypertension in patients with severe acute pancreatitis. World J Surg. 2012;36:171–8.10.1007/s00268-011-1295-021964817
Search in Google Scholar
7. Smit M, Hofker HS, Leuvenink H, et al. A human model of intra-abdominal hypertension: even slightly elevated pressures lead to increased acute systemic inflammation and signs of acute kidney injury. Crit Care. 2013;17:425.10.1186/cc12568367247523566574
Search in Google Scholar
8. Cheng, Z. Wei, X. Liu, et al. The role of intestinal mucosa injury induced by intra-abdominal hypertension in the development of abdominal compartment syndrome and multiple organ dysfunction syndrome. Crit Care. 2013:283.10.1186/cc13146405711524321230
Search in Google Scholar
9. Ke L, Ni HB, Tong ZH, et al. The importance of timing of decompression in severe acute pancreatitis combined with abdominal compartment syndrome. J Trauma Acute Care Surg. 2013;74:1060–6.10.1097/TA.0b013e318283d92723511145
Search in Google Scholar
10. De Laet, E. Hoste, E. Verholen, et al. The effect of neuromuscular blockers in patients with intra-abdominal hypertension. Intensive Care Med. 2007;33:1811–4.10.1007/s00134-007-0758-017594072
Search in Google Scholar
11. Cheatham ML, Safcsak K. Percutaneous catheter decompression in the treatment of elevated intraabdominal pressure. Chest. 2011;140:1428–35.10.1378/chest.10-278921903735
Search in Google Scholar
12. Struck MF, Reske AW, Schmidt T, et al. Respiratory functions of burn patients undergoing decompressive laparotomy due to secondary abdominal compartment syndrome. Burns. 2014;40:120–6.10.1016/j.burns.2013.05.00723790395
Search in Google Scholar
13. Obeid F, Saba A, Fath J, et al. Increases in intra-abdominal pressure affect pulmonary compliance. Arch Surg. 1995;130:544-7.10.1001/archsurg.1995.014300500940167748095
Search in Google Scholar
14. Krebs J, Pelosi P, Tsagogiorgas C, et al. Effects of positive endexpiratory pressure on respiratory function and hemodynamics in patients with acute respiratory failure with and without intra-abdominal hypertension: a pilot study. Crit Care. 2009;13:R160.10.1186/cc8118278438719804634
Search in Google Scholar
15. Ferrón R, Pedregosa AT, García R, A, et al. Intraabdominal and Thoracic Pressures in Critically Ill Patients with Suspected Intraabdominal Hypertension. Med Intensiva. 2011;35:274-9.
Search in Google Scholar

Influence of Ventilation Parameters on Intraabdominal Pressure

Abstract

Paradigm

My account