Influence of intra-abdominal hypertension on the respiratory mechanics of critically ill adult patients with invasive mechanical ventilation
DOI:
https://doi.org/10.31053/1853.0605.v77.n4.28148Keywords:
intra-abdominal hypertension, respiration, artificial, respiratory mechanics, intensive care unitsAbstract
Objective: to describe the modifications in respiratory mechanics, the proposed ventilatory strategies and the correct positioning of critically ill adult patients with HIA and ACS with the requirement of IMV in the ICU.
Data sources: the bibliographic search was carried out in Pubmed, Cochrane Library and Google Scholar® without restriction of the language with publication date until July 31, 2019.
Study selection: adult patients with a requirement for IMV and diagnosis of HIA and / or ACS who have performed the ventilatory monitoring and patient positioning analysis. Laboratory studies on animals will be excluded.
Data extraction: the initial search identified 681 studies, of which 30 articles were included for data analysis.
Synthesis of data: patients with VMI requirement should be allowed to increase airway pressures and use of high PEEP; Only in specific cases could recruitment and prone maneuvering be applied to maintain adequate alveolar ventilation. Inverted Trendelemburg positioning is useful, as it improves respiratory mechanics and prevents abdominal compression.
Conclusions: alterations in respiratory mechanics produce a decrease in thoracic compliance, lung volumes and oxygenation disorders. The ventilatory strategy should consider Vt between 6-8 ml / kg according to predicted body weight, working pressure less than 14 cm H2O, plateau pressure of 30 cm H2O + PIA / 2 and sufficient levels of PEEP to prevent lung collapse in order to expiration.
Downloads
Download data is not yet available.
References
1) Atema JJ, van Buijtenen JM, Lamme B, Boermeester MA. Clinicalstudieson intra-abdominal hypertension and abdominal compartment syndrome. J Trauma Acute Care Surg. 2014;76(1):234–240
2) Malbrain ML, Cheatham ML. Definitions and pathophysiological implications of intra-abdominal hypertension and abdominal compartment syndrome. Am Surg. 2011 Jul;77 Suppl1:S6-11.
3) Malbrain ML, De Laet IE, De Waele JJ, Kirkpatrick AW. Intra-abdominal hypertension: definitions, monitoring, interpretation and management. Best Pract Res ClinAnaesthesiol. 2013;27(2):249–270.
4) Malbrain ML, Chiumello D, Cesana BM, et al. A systematic review and individual patient data meta-analysis on intra-abdominal hypertension in critically ill patients: the wake-up project. World initiative on Abdominal Hypertension Epidemiology, a Unifying Project (WAKE-Up!). Minerva Anestesiol. 2014;80(3):293–306.
5) Pelosi P, Luecke T, Rocco PR. Chest wall mechanics and abdominal pressure during general anaesthesia in normal and obese individuals and in acute lung injury. Curr Opin Crit Care. 2011;17(1):72–79.
6) Regli A, Pelosi P, Malbrain MLNG. Ventilation in patients with intra-abdominal hypertension: what every critical care physician needs to know. Ann Intensive Care. 2019;9(1):52.
7) Ortiz-Diaz E, Lan CK. Intra-abdominal hypertension in medical critically ill patients: a narrative review. Shock. 2014;41(3):175–180.
8) Liebling P.D., Jafari B. (2018) Intra-abdominal Hypertension and Abdominal Compartment Syndrome: Consequences for Mechanical Ventilation. In: Esquinas A., Lemyze M. (eds) Mechanical Ventilation in the Critically Ill Obese Patient. Springer, Cham
9) Pelosi P, Quintel M, Malbrain ML. Effect of intra-abdominal pressure on respiratory mechanics. Acta Clin Belg. 2007;62 Suppl 1:78-88.
10) Christensen M, Craft J. The cardio-respiratory effects of intra-abdominal hypertension: Considerations for critical care nursing practice. Intensive Crit Care Nurs. 2018;44:53–58.
11) De Keulenaer BL, De Waele JJ, Powell B, Malbrain ML. What is normal intra-abdominal pressure and how is it affected by positioning, body mass and positive end-expiratory pressure?. Intensive Care Med. 2009;35(6):969–976.
12) Fernández Meré LA, Alvarez Blanco M. Síndrome compartimental abdominal [Abdominal compartment syndrome]. Rev Esp Anestesiol Reanim. 2007;54(6):359–370.
13) Malbrain MLNG. The saga continues: How to set best PEEP in intra-abdominal hypertension?. J Crit Care. 2018;43:387–389.
14) Reintam Blaser A, Parm P, Kitus R, Starkopf J. Risk factors for intra-abdominal hypertension in mechanically ventilated patients [published correction appears in Acta Anaesthesiol Scand. 2011 Oct;55(9):1153. Blaser, A Reintam [corrected to Reintam Blaser, A]; Par, P [corrected to Parm, P]]. Acta Anaesthesiol Scand. 2011;55(5):607–614.
15) Malbrain ML, Chiumello D, Pelosi P, et al. Prevalence of intra-abdominal hypertension in critically ill patients: a multicentre epidemiological study. Intensive Care Med. 2004;30(5):822–829.
16) Soler Morejón Cde D, Tamargo Barbeito TO. Effect of mechanical ventilation on intra-abdominal pressure in critically ill patients without other risk factors for abdominal hypertension: an observational multicenter epidemiological study. Ann Intensive Care. 2012;2 Suppl 1(Suppl 1):S22.
17) Krebs J, Pelosi P, Tsagogiorgas C, Alb M, Luecke T. Effects of positive end-expiratory 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(5):R160.
18) Acute Respiratory Distress Syndrome Network, Brower RG, Matthay MA, et al. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med. 2000;342(18):1301–1308.
19) Gattinoni L, Pelosi P, Suter PM, Pedoto A, Vercesi P, Lissoni A. Acute respiratory distress syndrome caused by pulmonary and extrapulmonary disease. Different syndromes?. Am J Respir Crit Care Med. 1998;158(1):3–11.
20) Kirkpatrick AW, Pelosi P, De Waele JJ, et al. Clinical review: Intra-abdominal hypertension: does it influence the physiology of prone ventilation?.Crit Care. 2010;14(4):232.
21) Verzilli D, Constantin JM, Sebbane M, et al. Positive end-expiratory pressure affects the value of intra-abdominal pressure in acute lung injury/acute respiratory distress syndrome patients: a pilot study. Crit Care. 2010;14(4):R137.
22) Regli A, De Keulenaer BL, Palermo A, van Heerden PV. Positive end-expiratory pressure adjusted for intra-abdominal pressure - A pilot study. J Crit Care. 2018;43:390–394.
23) Yang Y, Li Y, Liu SQ, et al. Positive end expiratory pressure titrated by transpulmonary pressure improved oxygenation and respiratory mechanics in acute respiratory distress syndrome patients with intra-abdominal hypertension. Chin Med J (Engl). 2013;126(17):3234–3239.
24) Amato MB, Meade MO, Slutsky AS, et al. Driving pressure and survival in the acute respiratory distress syndrome. N Engl J Med. 2015;372(8):747–755.
25) Cheatham ML, De Waele JJ, De Laet I, et al. The impact of body position on intra-abdominal pressure measurement: a multicenter analysis. Crit Care Med. 2009;37(7):2187–2190.
26) McBeth PB, Zygun DA, Widder S, et al. Effect of patient positioning on intra-abdominal pressure monitoring. Am J Surg. 2007;193(5):644–647.
27) Sturini E, Saporito A, Sugrue M, Parr MJ, Bishop G, Braschi A. Respiratory variation of intra-abdominal pressure: indirect indicator of abdominal compliance?. Intensive Care Med. 2008;34(9):1632–1637.
28) Hering R, Wrigge H, Vorwerk R, et al. The effects of prone positioning on intraabdominal pressure and cardiovascular and renal function in patients with acute lung injury. Anesth Analg. 2001;92(5):1226–1231.
29) Chiumello D, Cressoni M, Racagni M, et al. Effects of thoraco-pelvic supports during prone position in patients with acute lung injury/acute respiratory distress syndrome: a physiological study. Crit Care. 2006;10(3):R87.
30) Stephen J. Fletcher (2006) The effect of prone ventilation on intra-abdominal pressure. Clinical Intensive Care, 17:3-4, 109-112
31) Pelosi P, Tubiolo D, Mascheroni D, et al. Effects of the prone position on respiratory mechanics and gas exchange during acute lung injury. Am J Respir Crit Care Med. 1998;157(2):387–393.
32) Sánchez-Miralles A, Castellanos G, Badenes R, Conejero R. Síndrome compartimental abdominal y síndrome de distrés intestinal agudo [Abdominal compartment syndrome and acute intestinal distress syndrome]. Med Intensiva. 2013;37(2):99–109.
2) Malbrain ML, Cheatham ML. Definitions and pathophysiological implications of intra-abdominal hypertension and abdominal compartment syndrome. Am Surg. 2011 Jul;77 Suppl1:S6-11.
3) Malbrain ML, De Laet IE, De Waele JJ, Kirkpatrick AW. Intra-abdominal hypertension: definitions, monitoring, interpretation and management. Best Pract Res ClinAnaesthesiol. 2013;27(2):249–270.
4) Malbrain ML, Chiumello D, Cesana BM, et al. A systematic review and individual patient data meta-analysis on intra-abdominal hypertension in critically ill patients: the wake-up project. World initiative on Abdominal Hypertension Epidemiology, a Unifying Project (WAKE-Up!). Minerva Anestesiol. 2014;80(3):293–306.
5) Pelosi P, Luecke T, Rocco PR. Chest wall mechanics and abdominal pressure during general anaesthesia in normal and obese individuals and in acute lung injury. Curr Opin Crit Care. 2011;17(1):72–79.
6) Regli A, Pelosi P, Malbrain MLNG. Ventilation in patients with intra-abdominal hypertension: what every critical care physician needs to know. Ann Intensive Care. 2019;9(1):52.
7) Ortiz-Diaz E, Lan CK. Intra-abdominal hypertension in medical critically ill patients: a narrative review. Shock. 2014;41(3):175–180.
8) Liebling P.D., Jafari B. (2018) Intra-abdominal Hypertension and Abdominal Compartment Syndrome: Consequences for Mechanical Ventilation. In: Esquinas A., Lemyze M. (eds) Mechanical Ventilation in the Critically Ill Obese Patient. Springer, Cham
9) Pelosi P, Quintel M, Malbrain ML. Effect of intra-abdominal pressure on respiratory mechanics. Acta Clin Belg. 2007;62 Suppl 1:78-88.
10) Christensen M, Craft J. The cardio-respiratory effects of intra-abdominal hypertension: Considerations for critical care nursing practice. Intensive Crit Care Nurs. 2018;44:53–58.
11) De Keulenaer BL, De Waele JJ, Powell B, Malbrain ML. What is normal intra-abdominal pressure and how is it affected by positioning, body mass and positive end-expiratory pressure?. Intensive Care Med. 2009;35(6):969–976.
12) Fernández Meré LA, Alvarez Blanco M. Síndrome compartimental abdominal [Abdominal compartment syndrome]. Rev Esp Anestesiol Reanim. 2007;54(6):359–370.
13) Malbrain MLNG. The saga continues: How to set best PEEP in intra-abdominal hypertension?. J Crit Care. 2018;43:387–389.
14) Reintam Blaser A, Parm P, Kitus R, Starkopf J. Risk factors for intra-abdominal hypertension in mechanically ventilated patients [published correction appears in Acta Anaesthesiol Scand. 2011 Oct;55(9):1153. Blaser, A Reintam [corrected to Reintam Blaser, A]; Par, P [corrected to Parm, P]]. Acta Anaesthesiol Scand. 2011;55(5):607–614.
15) Malbrain ML, Chiumello D, Pelosi P, et al. Prevalence of intra-abdominal hypertension in critically ill patients: a multicentre epidemiological study. Intensive Care Med. 2004;30(5):822–829.
16) Soler Morejón Cde D, Tamargo Barbeito TO. Effect of mechanical ventilation on intra-abdominal pressure in critically ill patients without other risk factors for abdominal hypertension: an observational multicenter epidemiological study. Ann Intensive Care. 2012;2 Suppl 1(Suppl 1):S22.
17) Krebs J, Pelosi P, Tsagogiorgas C, Alb M, Luecke T. Effects of positive end-expiratory 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(5):R160.
18) Acute Respiratory Distress Syndrome Network, Brower RG, Matthay MA, et al. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med. 2000;342(18):1301–1308.
19) Gattinoni L, Pelosi P, Suter PM, Pedoto A, Vercesi P, Lissoni A. Acute respiratory distress syndrome caused by pulmonary and extrapulmonary disease. Different syndromes?. Am J Respir Crit Care Med. 1998;158(1):3–11.
20) Kirkpatrick AW, Pelosi P, De Waele JJ, et al. Clinical review: Intra-abdominal hypertension: does it influence the physiology of prone ventilation?.Crit Care. 2010;14(4):232.
21) Verzilli D, Constantin JM, Sebbane M, et al. Positive end-expiratory pressure affects the value of intra-abdominal pressure in acute lung injury/acute respiratory distress syndrome patients: a pilot study. Crit Care. 2010;14(4):R137.
22) Regli A, De Keulenaer BL, Palermo A, van Heerden PV. Positive end-expiratory pressure adjusted for intra-abdominal pressure - A pilot study. J Crit Care. 2018;43:390–394.
23) Yang Y, Li Y, Liu SQ, et al. Positive end expiratory pressure titrated by transpulmonary pressure improved oxygenation and respiratory mechanics in acute respiratory distress syndrome patients with intra-abdominal hypertension. Chin Med J (Engl). 2013;126(17):3234–3239.
24) Amato MB, Meade MO, Slutsky AS, et al. Driving pressure and survival in the acute respiratory distress syndrome. N Engl J Med. 2015;372(8):747–755.
25) Cheatham ML, De Waele JJ, De Laet I, et al. The impact of body position on intra-abdominal pressure measurement: a multicenter analysis. Crit Care Med. 2009;37(7):2187–2190.
26) McBeth PB, Zygun DA, Widder S, et al. Effect of patient positioning on intra-abdominal pressure monitoring. Am J Surg. 2007;193(5):644–647.
27) Sturini E, Saporito A, Sugrue M, Parr MJ, Bishop G, Braschi A. Respiratory variation of intra-abdominal pressure: indirect indicator of abdominal compliance?. Intensive Care Med. 2008;34(9):1632–1637.
28) Hering R, Wrigge H, Vorwerk R, et al. The effects of prone positioning on intraabdominal pressure and cardiovascular and renal function in patients with acute lung injury. Anesth Analg. 2001;92(5):1226–1231.
29) Chiumello D, Cressoni M, Racagni M, et al. Effects of thoraco-pelvic supports during prone position in patients with acute lung injury/acute respiratory distress syndrome: a physiological study. Crit Care. 2006;10(3):R87.
30) Stephen J. Fletcher (2006) The effect of prone ventilation on intra-abdominal pressure. Clinical Intensive Care, 17:3-4, 109-112
31) Pelosi P, Tubiolo D, Mascheroni D, et al. Effects of the prone position on respiratory mechanics and gas exchange during acute lung injury. Am J Respir Crit Care Med. 1998;157(2):387–393.
32) Sánchez-Miralles A, Castellanos G, Badenes R, Conejero R. Síndrome compartimental abdominal y síndrome de distrés intestinal agudo [Abdominal compartment syndrome and acute intestinal distress syndrome]. Med Intensiva. 2013;37(2):99–109.
Published
2020-12-01
How to Cite
1.
Vicente A, Virgilio SA, Tocalini P, . Influence of intra-abdominal hypertension on the respiratory mechanics of critically ill adult patients with invasive mechanical ventilation. Rev Fac Cien Med Univ Nac Cordoba [Internet]. 2020 Dec. 1 [cited 2024 Jul. 17];77(4):339-44. Available from: https://revistas.unc.edu.ar/index.php/med/article/view/28148
Issue
Section
Literature Reviews
License
Copyright (c) 2020 Universidad Nacional de Córdoba
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The Faculty of Medical Sciences Journal (RFCM) subscribes to the Open Access policy and does not charge authors fees for publishing, nor does it charge readers fees for accessing published articles (APC).
