Is it wise not to think about intraabdominal hypertension in the ICU?

Current Opinion in Critical Care

Volumn 10, Issue 2, 2004, Pages 132-145

  Malbrain, Manu L N G ^a,b  

^a ACZA Campus Stuivenberg   (Belgium)

^b NONE   (Belgium)

Author keywords

Abdominal compartment; Abdominal hypertension; Abdominal pressure; Diagnosis; Pathophysiology; Treatment

Indexed keywords

CURARE; FENTANYL;

ABDOMINAL HYPERTENSION; ABDOMINAL PRESSURE; ACUTE KIDNEY FAILURE; ATELECTASIS; BACTERIAL TRANSLOCATION; BLADDER PRESSURE; BODY MASS; BODY POSITION; CENTRAL VENOUS PRESSURE; COMPARTMENT SYNDROME; DECOMPRESSION SURGERY; HUMAN; HYPERTENSION; INTENSIVE CARE UNIT; INTRACRANIAL PRESSURE; LUNG ARTERY PRESSURE; LUNG FLUID; MEDLINE; MULTIPLE ORGAN FAILURE; NONHUMAN; POSITIVE END EXPIRATORY PRESSURE; PRESSURE MEASUREMENT; RESPIRATORY DISTRESS SYNDROME; RESUSCITATION; REVIEW;

ABDOMEN; ANIMALS; COMPARTMENT SYNDROMES; HUMANS; INCIDENCE; INTENSIVE CARE UNITS; MONITORING, PHYSIOLOGIC; PRESSURE; PREVALENCE;

EID: 1942519284     PISSN: 10705295     EISSN: None     Source Type: Journal    
DOI: 10.1097/00075198-200404000-00010     Document Type: Review

References (95)

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23. 2 gap), and an increased incidence of IAH, ACS, multiple organ failure, and death. This study questions the recent early goal-oriented protocol for the care of septic patients in the emergency department, as recently written by Rivers in the New England Journal of Medicine (2001, 345:1368-1377).
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33. Malbrain ML, Cheatham ML: Cardiovascular effects and optimal preload markers in intra-abdominal hypertension. In Yearbook of Intensive Care and Emergency Medicine. Edited by Vincent JL Berlin: Springer-Verlag; 2004, in press. A concise review looks at the cardiovascular effects of IAH and the advantages and disadvantages of different preload indices in IAH.
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39. Malbrain ML, Van Mieghem N, Verbrugghe W, et al.: PiCCO derived parameters versus filling pressures in intra-abdominal hypertension. Intensive Care Med 2003, 29(suppl 1):S130.
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42. Luecke T, Roth H, Herrmann P, et al.: Assessment of cardiac preload and left ventricular function under increasing levels of positive end-expiratory pressure. Intensive Care Med 2003 (epub DOI: 10.1007/s00134-003-1993-7). The results of this animal study (ie, that ventilation with increasing levels of PEEP impaired left ventricular function at the highest level of PEEP and that ITBV and RVEDV, unlike cardiac filling pressures, provide valid estimates of cardiac preload even at high intrathoracic pressures) could easily be translated to the setting of IAH, a condition known to be associated with high intrathoracic pressures.
43. Greim CA, Broscheit J, Kortlander J, et al.: Effects of intra-abdominal CO2-insufflation on normal and impaired myocardial function: an experimental study. Acta Anaesthesiol Scand 2003, 47:751-760. This original animal study assesses the effects of IAH on myocardial function in pigs with and without baseline diminished myocardial reserve. After the acute elevation of IAP, the right ventricular volume load shifted more extensively in the sick animals than in the animals with normal myocardial function. Myocardial function in the impaired heart may worsen during IAP elevation because of right ventricular load alterations rather than a left ventricular afterload increase.
44. Huettemann E, Sakka SG, Petrat G, et al.: Left ventricular regional wall motion abnormalities during pneumoperitoneum in children. Br J Anaesth 2003, 90:733-736. This is another good study, this time of children undergoing laparoscopic surgery. An IAP of 12 mm Hg caused significant septal hypokinesia compared with baseline, whereas anterior and posterior wall motion was not affected. In addition, a lateral hyperkinesia occurred, although this change was not statistically significant. The authors conclude that pneumoperitoneum may affect left ventricular regional wall motion in pediatric patients undergoing laparoscopic surgery.
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46. Pelosi P, Bottino N, Chiumello D, et al.: Sigh in supine and prone position during acute respiratory distress syndrome. Am J Respir Crit Care Med 2003, 167:521-527. A good study in which the authors conclude that adding a recruitment maneuver such as cyclical sighs during ventilation in the prone position may provide optimal lung recruitment in the early stage of ARDS. The same authors previously found that the prone position with sighs may be more beneficial in patients with IAH.
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51. Quintel M, Pelosi P, Caironi P, et al.: An increase of abdominal pressure increases pulmonary edema in oleic acid induced lung injury. Am J Respir Crit Care Med 2003, in press. A must read for anyone who is concerned about lung protective ventilation in case of IAH. The clinical consequences of this provocative animal study may be substantial, although they need to be proved in humans.
52. Rezende-Neto JB, Moore EE, Melo de Andrade MV, et al.: Systemic inflammatory response secondary to abdominal compartment syndrome: stage for multiple organ failure. J Trauma 2002, 53:1121-1128. An innovative study, and the first so far, that demonstrates that IAH provokes the release of proinflammatory cytokines (interleukin-1b, interleukin-6, and tumor necrosis factor α), which may serve as a second insult for the induction of multiple organ system failure.
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