Abstract
Intra-abdominal hypertension is frequent in surgical and medical critically ill patients. Intra-abdominal hypertension has a serious impact on the function of respiratory as well as peripheral organs. In the presence of alveolar capillary damage, which occurs in acute respiratory distress syndrome (ARDS), intra-abdominal hypertension promotes lung injury as well as edema, impedes the pulmonary lymphatic drainage, and increases intra-thoracic pressures, leading to atelectasis, airway closure, and deterioration of respiratory mechanics and gas exchange. The optimal setting of mechanical ventilation and its impact on respiratory function and hemodynamics in ARDS associated with intra-abdominal hypertension are far from being assessed. We suggest that the optimal ventilator management of patients with ARDS and intra-abdominal hypertension would include the following: (a) intra-abdominal, esophageal pressure, and hemodynamic monitoring; (b) ventilation setting with protective tidal volume, recruitment maneuver, and level of positive end-expiratory pressure set according to the 'best' compliance of the respiratory system or the lung; (c) deep sedation with or without neuromuscular paralysis in severe ARDS; and (d) open abdomen in selected patients with severe abdominal compartment syndrome.
Highlights
Intra-abdominal hypertension is frequent in surgical and medical critically ill patients
The study by Regli and colleagues [1] in the previous issue of Critical Care reports the effects of different levels of positive end-expiratory pressure (PEEP) on respiratory function and hemodynamics in an animal model of acute respiratory distress syndrome (ARDS) associated with intra-abdominal hypertension (IAH)
Regli and colleagues [1] reported an increase of endexpiratory lung volume and gas exchange, with a reduction of pulmonary shunt and dead space fraction when intra-abdominal pressure (IAP)-matching PEEP was applied
Summary
Intra-abdominal hypertension is frequent in surgical and medical critically ill patients. The study by Regli and colleagues [1] in the previous issue of Critical Care reports the effects of different levels of positive end-expiratory pressure (PEEP) on respiratory function and hemodynamics in an animal model of acute respiratory distress syndrome (ARDS) associated with intra-abdominal hypertension (IAH). In the presence of alveolar capillary membrane damage, IAH promotes lung injury [3] as well as edema and increases intra-thoracic pressures, leading to atelectasis, airway closure, and deterioration of gas exchange [4].
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