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Interaction between intra-abdominal pressure and positive-end expiratory pressure.

Torquato JA, Lucato JJ, Antunes T, Barbas CV - Clinics (Sao Paulo) (2009)

Bottom Line: 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).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).

View Article: PubMed Central - PubMed

Affiliation: Departamento de Patologia, Faculdade de Medicina e Instituto Central, Central do Hospital das Clinicas, Universidade Cruzeiro do Sul, São Paulo/SP, Brasil. jamilianbar@yahoo.com

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 5 kg 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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Related in: MedlinePlus

Changes in intra-abdominal and respiratory system plateau pressure with PEEP and external abdominal weight
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getmorefigures.php?uid=PMC2666478&req=5

f2-07-oa-0170: Changes in intra-abdominal and respiratory system plateau pressure with PEEP and external abdominal weight

Mentions: The weight consisted of a 5kg bag with a surface that measured 35 X 27 cm (an area of 945 cm2) with the objective of maintaining a consistent area of abdominal compression and elevating the intra-abdominal pressure (Figure 2).


Interaction between intra-abdominal pressure and positive-end expiratory pressure.

Torquato JA, Lucato JJ, Antunes T, Barbas CV - Clinics (Sao Paulo) (2009)

Changes in intra-abdominal and respiratory system plateau pressure with PEEP and external abdominal weight
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2666478&req=5

f2-07-oa-0170: Changes in intra-abdominal and respiratory system plateau pressure with PEEP and external abdominal weight
Mentions: The weight consisted of a 5kg bag with a surface that measured 35 X 27 cm (an area of 945 cm2) with the objective of maintaining a consistent area of abdominal compression and elevating the intra-abdominal pressure (Figure 2).

Bottom Line: 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).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).

View Article: PubMed Central - PubMed

Affiliation: Departamento de Patologia, Faculdade de Medicina e Instituto Central, Central do Hospital das Clinicas, Universidade Cruzeiro do Sul, São Paulo/SP, Brasil. jamilianbar@yahoo.com

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 5 kg 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.

Show MeSH
Related in: MedlinePlus