ABDOMINO-THORACIC TRANSMISSION DURING ACS: FACTS AND FIGURES

Abstract Elevated intra-abdominal pressure (IAP) exerts effects not only on intra-abdominal organs, but also on organs distant to the abdominal compartment. Abdomino-thoracic interaction during intra-abdominal hypertension (IAH) or abdominal compartment syndrome (ACS) interferes with pulmonary, cardiovascular and cerebral function. In accordance with recent guidelines, IAH is defined as IAP above 12 mmHg and ACS as IAP more than 20 mmHg with one or more new organ failures. In this review we will first discuss the effects of elevated IAP on pulmonary dynamics and the relevance for interpreting airway pressures and adjusting ventilator settings. We will then discuss the interaction between abdomino-thoracic pressure transmission and global haemodynamics, the knowledge of which is necessary for correct assessment of cardiac preload and to optimize fluid therapy in the setting of IAH/ACS. A discussion on the relationship between increased IAP, increased intracranial pressure (ICP) and decreased cerebral perfusion pressure (CPP) will follow. Finally, we will review ventilator-induced thoracic pressure swings and their transmission to the abdominal compartment.

[1]  K. Hillman,et al.  Results from the International Conference of Experts on Intra-abdominal Hypertension and Abdominal Compartment Syndrome. II. Recommendations , 2006, Intensive Care Medicine.

[2]  G. Germann,et al.  Correlations between cardiac output, stroke volume, central venous pressure, intra-abdominal pressure and total circulating blood volume in resuscitation of major burns. , 2006, Resuscitation.

[3]  B. Guignard,et al.  Cardiac Function During Intraperitoneal CO2 Insufflation for Aortic Surgery: A Transesophageal Echocardiographic Study , 2006, Anesthesia and analgesia.

[4]  P. Claus,et al.  Quantitative relationship between increased intra-abdominal pressure and intrathoracic pressures and volumetric filling parameters in the pig , 2006, Critical Care.

[5]  J. Viale,et al.  Increased intra-abdominal pressure affects respiratory variations in arterial pressure in normovolaemic and hypovolaemic mechanically ventilated healthy pigs , 2006, Intensive Care Medicine.

[6]  Paolo Pelosi,et al.  Clinical review: Positive end-expiratory pressure and cardiac output , 2005, Critical care.

[7]  A. Schachtrupp,et al.  FLUID RESUSCITATION PRESERVES CARDIAC OUTPUT BUT CANNOT PREVENT ORGAN DAMAGE IN A PORCINE MODEL DURING 24 H OF INTRAABDOMINAL HYPERTENSION , 2005, Shock.

[8]  P. Aspelin,et al.  Effect of Carbon Dioxide Pneumoperitoneum on Development of Atelectasis during Anesthesia, Examined by Spiral Computed Tomography , 2005, Anesthesiology.

[9]  P. Pelosi,et al.  An increase of abdominal pressure increases pulmonary edema in oleic acid-induced lung injury. , 2004, American journal of respiratory and critical care medicine.

[10]  Paolo Pelosi,et al.  Assessment of cardiac preload and left ventricular function under increasing levels of positive end-expiratory pressure , 2004, Intensive Care Medicine.

[11]  Luciano Gattinoni,et al.  Effects of continuous negative extra-abdominal pressure on cardiorespiratory function during abdominal hypertension: an experimental study , 2004, Intensive Care Medicine.

[12]  N. Bottino,et al.  Intra-abdominal pressure may be decreased non-invasively by continuous negative extra-abdominal pressure (NEXAP) , 2003, Intensive Care Medicine.

[13]  A. Schachtrupp,et al.  Intravascular volume depletion in a 24-hour porcine model of intra-abdominal hypertension. , 2003, The Journal of trauma.

[14]  P. Pelosi,et al.  Recruitment and derecruitment during acute respiratory failure: an experimental study. , 2001, American journal of respiratory and critical care medicine.

[15]  A. Pesenti,et al.  Induced abdominal compartment syndrome increases intracranial pressure in neurotrauma patients: A prospective study , 2001, Critical care medicine.

[16]  R. S. Smith,et al.  What is Normal Intra-Abdominal Pressure? , 2001, The American surgeon.

[17]  J. Pittet,et al.  Measuring intra-esophageal pressure to assess transmural pulmonary arterial occlusion pressure in patients with acute lung injury: a case series and review. , 2000, Respiratory care.

[18]  D. Schoenfeld,et al.  Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. , 2000, The New England journal of medicine.

[19]  C. Blocher,et al.  Physiologic effects of externally applied continuous negative abdominal pressure for intra-abdominal hypertension. , 1998, The Journal of trauma.

[20]  U. Losert,et al.  The role of intra-abdominal pressure on splanchnic and pulmonary hemodynamic and metabolic changes during carbon dioxide pneumoperitoneum. , 1999, Gastrointestinal endoscopy.

[21]  L. Nelson,et al.  Preload assessment in patients with an open abdomen. , 1999, The Journal of trauma.

[22]  G. Lebuffe,et al.  Systolic Pressure Variation as a Guide to Fluid Therapy in Patients with Sepsis‐induced Hypotension , 1998, Anesthesiology.

[23]  L. Nelson,et al.  Right ventricular end-diastolic volume index as a predictor of preload status in patients on positive end-expiratory pressure. , 1998, Critical care medicine.

[24]  P. Pelosi,et al.  Acute respiratory distress syndrome caused by pulmonary and extrapulmonary disease. Different syndromes? , 1998, American journal of respiratory and critical care medicine.

[25]  J. Viale,et al.  Left Ventricular Loading Modifications Induced by Pneumoperitoneum: A Time Course Echocardiographic Study , 1998, Anesthesia and analgesia.

[26]  D. Dreyfuss,et al.  Ventilator-induced lung injury: lessons from experimental studies. , 1998, American journal of respiratory and critical care medicine.

[27]  H. Simms,et al.  Abdominal compartment syndrome: case reports and implications for management in critically ill patients. , 1997, The American surgeon.

[28]  A. Marmarou,et al.  A proposed relationship between increased intra-abdominal, intrathoracic, and intracranial pressure. , 1997, Critical care medicine.

[29]  P. Ridings,et al.  Cardiopulmonary effects of raised intra-abdominal pressure before and after intravascular volume expansion. , 1995, The Journal of trauma.

[30]  B. Fahy,et al.  The Effects of Increased Abdominal Pressure on Lung and Chest Wall Mechanics During Laparoscopic Surgery , 1995, Anesthesia and analgesia.

[31]  H. Sugerman,et al.  Effects of surgically induced weight loss on idiopathic intracranial hypertension in morbid obesity , 1995, Neurology.

[32]  M. Schein,et al.  The abdominal compartment syndrome: the physiological and clinical consequences of elevated intra-abdominal pressure. , 1995, Journal of the American College of Surgeons.

[33]  D. Birkett,et al.  Diagnostic laparoscopy increases intracranial pressure. , 1994, The Journal of trauma.

[34]  P. Coriat,et al.  A comparison of systolic blood pressure variations and echocardiographic estimates of end-diastolic left ventricular size in patients after aortic surgery. , 1994, Anesthesia and analgesia.

[35]  J. Meakins,et al.  Diaphragmatic Function before and after Laparoscopic Cholecystectomy , 1993, Anesthesiology.

[36]  A. Cunningham,et al.  Transoesophageal echocardiographic assessment of haemodynamic function during laparoscopic cholecystectomy. , 1993, British journal of anaesthesia.

[37]  D. Mcgregor,et al.  The effects of positive expiratory pressure on peritoneovenous shunt flow. , 1992, The Journal of surgical research.

[38]  G. Puri,et al.  Ventilatory effects of laparoscopy under general anaesthesia. , 1992, British journal of anaesthesia.

[39]  J. Bates,et al.  Factors affecting the accuracy of esophageal balloon measurement of pleural pressure in dogs. , 1992, Journal of applied physiology.

[40]  James S. Williams,et al.  Effect of Positive End‐Expiratory Pressure on Intra‐abdominal Pressure , 1991, Southern medical journal.

[41]  K. Burchard.  Cardiovascular, pulmonary, and renal effects of massively increased intra-abdominal pressure in critically ill patients. , 1990, Critical care medicine.

[42]  M. Pinsky,et al.  Effect of positive-pressure ventilatory frequency on regional pleural pressure. , 1988, Journal of applied physiology.

[43]  J. Corbett,et al.  The incidence of pseudotumor cerebri. Population studies in Iowa and Louisiana. , 1988, Archives of neurology.

[44]  A. Perel,et al.  Systolic Blood Pressure Variation is a Sensitive Indicator of Hypovolemia in Ventilated Dogs Subjected to Graded Hemorrhage , 1986, Anesthesiology.

[45]  G. Hedenstierna,et al.  Pulmonary Densities during Anesthesia with Muscular Relaxation—A Proposal of Atelectasis , 1985, Anesthesiology.

[46]  I. Kron,et al.  The Measurement of Intra‐abdominal Pressure as a Criterion for Abdominal Re‐exploration , 1984, Annals of surgery.

[47]  J. Marini,et al.  Estimation of transmural cardiac pressures during ventilation with PEEP. , 1982, Journal of applied physiology: respiratory, environmental and exercise physiology.

[48]  J. Luce,et al.  Mechanism by which positive end-expiratory pressure increases cerebrospinal fluid pressure in dogs. , 1982, Journal of applied physiology: respiratory, environmental and exercise physiology.

[49]  J. Holcroft,et al.  Hemodynamic effect of increased abdominal pressure. , 1981, The Journal of surgical research.

[50]  L. Saidman,et al.  Hemodynamics of Increased Intra-abdominal Pressure: Interaction with Hypovolemia and Halothane Anesthesia , 1978, Anesthesiology.

[51]  J. Richardson,et al.  Hemodynamic and respiratory alterations with increased intra-abdominal pressure. , 1976, The Journal of surgical research.

[52]  R. Albrecht,et al.  Cardiovascular Effects of Intraperitoneal Insufflation with Carbon Dioxide and Nitrous Oxide in the Dog , 1975, Anesthesiology.