Abstract
BackgroundMechanical ventilation (MV) is considered a predisposing factor for increased intra-abdominal pressure (IAP), especially when positive end-expiratory pressure (PEEP) is applied or in the presence of auto-PEEP. So far, no prospective data exists on the effect of MV on IAP. The study aims to look on the effects of MV on IAP in a group of critically ill patients with no other risk factors for intra-abdominal hypertension (IAH).MethodsAn observational multicenter study was conducted on a total of 100 patients divided into two groups: 50 patients without MV and 50 patients with MV. All patients were admitted to the intensive care units of the Medical and Surgical Research Centre, the Carlos J. Finlay Hospital, the Julio Trigo University Hospital, and the Calixto García Hospital, in Havana, Cuba between July 2000 and December 2004. The IAP was measured twice daily on admission using a standard transurethral technique. IAH was considered if IAP was greater than 12 mmHg. Correlations were made between IAP and body mass index (BMI), diagnostic category, gender, age, and ventilatory parameters.ResultsThe mean IAP in patients on MV was 6.7 ± 4.1 mmHg and significantly higher than in patients without MV (3.6 ± 2.4 mmHg, p < 0.0001). This difference was maintained regardless of gender, age, BMI, and diagnosis. The use of MV and BMI were independent predictors for IAH for the whole population, while male gender, assisted ventilation mode, and the use of PEEP were independent factors associated with IAH in patients on MV.ConclusionsIn this study, MV was identified as an independent predisposing factor for the development of IAH. Critically ill patients, which are on MV, present with higher IAP values on admission and should be monitored very closely, especially if PEEP is applied, even when they have no other apparent risk factors for IAH.
Highlights
Mechanical ventilation (MV) is considered a predisposing factor for increased intra-abdominal pressure (IAP), especially when positive end-expiratory pressure (PEEP) is applied or in the presence of auto-PEEP
The situation turns more complicated when the patient at risk for intra-abdominal hypertension (IAH) is being mechanically ventilated because under analgosedation and/or muscle relaxation, the typical signs and symptoms of complications such as abscesses or intra-abdominal fluid collections, hematomas, or even diffuse peritonitis could be masked. These conditions, that can be very deleterious through the wellknown effects of IAH on hemodynamics, respiratory and renal function, hepatosplanchnic perfusion and, for the whole body [2,6,7] could be aggravated by the use of MV per se
The aim of the present study is to look on the effects of MV on baseline IAP values in critically ill patients
Summary
Mechanical ventilation (MV) is considered a predisposing factor for increased intra-abdominal pressure (IAP), especially when positive end-expiratory pressure (PEEP) is applied or in the presence of auto-PEEP. The situation turns more complicated when the patient at risk for IAH is being mechanically ventilated because under analgosedation and/or muscle relaxation, the typical signs and symptoms of complications such as abscesses or intra-abdominal fluid collections, hematomas, or even diffuse peritonitis could be masked. These conditions, that can be very deleterious through the wellknown effects of IAH on hemodynamics, respiratory and renal function, hepatosplanchnic perfusion and, for the whole body [2,6,7] could be aggravated by the use of MV per se
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