Intra-abdominal Pressure Values Research Articles

Noninvasive Assessment of Intra-Abdominal Pressure Using Ultrasound-Guided Tonometry: A Proof-of-Concept Study.

Intra-abdominal hypertension jeopardizes abdominal organ perfusion and venous return. Contemporary recognition of elevated intra-abdominal pressure (IAP) plays a crucial role in reducing mortality and morbidity. We evaluated ultrasound-guided tonometry in this context hypothesizing that the vertical chamber diameter of this device inversely correlates with IAP. IAP was increased in six 5 mmHg steps to 40 mmHg by instillation of normal saline into the peritoneal cavity of eight anesthetized pigs. Liver and renal blood flows (ultrasound transit time), intravesical, intraperitoneal, and end-inspiratory plateau pressures were recorded. For ultrasound-based assessment of IAP (ultrasound-guided tonometry), a pressure-transducing, compressible chamber was fixed at the tip of a linear ultrasound probe, and the system was applied on the abdominal wall using different predetermined levels of external pressure. At each IAP level (reference: intravesical pressure), two investigators measured the vertical diameter of this chamber. All abdominal flows decreased (by 39%-58%), and end-inspiratory plateau pressure increased from 15 mbar (14-17 mbar) to 38 mbar (33-42 mbar) (median, range) with increasing IAP (all P < 0.01). Vertical chamber diameter decreased from 14.9 (14.6-15.2) mm to12.8 (12.4-13.4) mm with increasing IAP. Coefficients of variations between and within observers regarding change of the vertical tonometry chamber diameter were small (all <4%), and the results were independent of the externally applied pressure level on the ultrasound probe. Correlation of IAP and vertical pressure chamber distance was highly significant (r = -1, P = 0.0004). Ultrasound-guided tonometry could discriminate between normal (baseline) pressure and 15 mmHg, between 15 and 25 mmHg) and between 25 and 40 mmHg IAP (all P ≤ 0.18). Similar results were obtained for end-inspiratory plateau pressures. In our model, values obtained by ultrasound-guided tonometry correlated significantly with IAPs. The method was able to discriminate between normal, moderately, and markedly increased IAP values.

IMPROVEMENT OF TECHNOLOGIES OF DIAGNOSTICS AND TREATMENT OF INTRA-ABDOMINAL HYPERTENSION IN ACUTE SURGICAL PATHOLOGY OF ABDOMINAL CAVITY

Relevance. The article is devoted to the problem of diagnosis and treatment of intra-abdominal hypertension (IAH) in acute abdominal pathology. Acute surgical diseases and abdominal injuries are accompanied by an increase in intra-abdominal pressure (IAP) in 83.6% of cases, and cause an abdominal compartment syndrome (ACS) in 16.8% of the observations.&#x0D; Objective. This review seeks to improve the results of treatment of patients with acute abdominal pathology by improving the methods of diagnosis, prevention and treatment of IAH.&#x0D; Materials and methods. The results of treatment of 187 patients with acute pathology of abdominal organs, which was accompanied by high IAP, were analyzed. Among the 187 patients, 98 (52.4%) were men, 89 (47.6%) women. The patients were divided into two groups depending on the diagnostic and therapeutic tactics chosen: the comparison group (85 (45.5%) persons) and the main group (102 (54.5%) persons). The treatment of them were carried out in accordance with our harmonized diagnostic and treatment algorithm of the correction of IAH. 149 (79.7%) patients were operated: 82 patients in the main group and 67 persons in comparison group. Our own method for the long-term determination of IAP by measuring it in the bladder was used for long-term diagnostics of IAP. Advanced laparolifting system was used in the complex conservative treatment of patients with acute pancreatitis accompanied by IAH. Methods for predicting the possibility of performing laparoscopic intervention in urgent surgery and postoperative pain after laparoscopic surgery were improved.&#x0D; Results. Implementation of the improved method of measuring IAP through prolonged monitoring of BP allowed to timely select and start the necessary therapeutic tactics, aimed to overcome intra-abdominal hypertension, and to avoid the development of abdominal compartment syndrome (sensitivity of the technique was 95.2%, specificity - 85.7%). The use of our advanced diagnostic and treatment algorithm for the prevention and treatment of IAH allowed to limit the measures to the first level in 67,6% of cases, to the second level - in 22,5% and to avoid the decompression laparostomy. At the same time, the need for such intervention arose in 11.1% of patients who had conservative treatment.&#x0D; Use of the proposed laparolifting system in the complex conservative treatment of IAH of patients with acute pancreatitis allowed to normalize IAP in the vast majority of patients, preventing the occurrence of ACS by reducing the frequency of complications associated with IAH, from 52.9% to 16.7% (p = 0.03 ), as well as overall mortality - from 35.3% to 5.6% (p = 0.03). Implementation into clinical practice the method of predicting the possibility of performing laparoscopic intervention in the conditions of urgent surgery by registering the initial values ​​of IAP, allowed to expand the indications for the implementation of this type of surgery in treatment of acute surgical pathology of the abdominal cavity organs (sensitivity of the technique was 85.7%, specificity - 95.5%). Local use of stereoselective NSAIDs (original dexketoprofen) at the end of the laparoscopic intervention followed by their intramuscular administration has a higher analgesic effect in comparison with other classes of analgesic agents, which is reliably confirmed by pain assessment indicators (visual analogue scales, blood plasma cortisol and external respiration function) (p &lt;0.0001), and has a significantly higher degree of safety (p &lt;0.001). Application of the proposed diagnostic and treatment algorithm in the complex treatment of patients with acute surgical pathology of the abdominal cavity, which is accompanied by IAH, allowed to achieve the intended goal for improving the treatment results of this category of patients by reducing the incidence of systemic complications from 54.1% to 11.8% ( p &lt;0.0001), total mortality from 21.2% to 1.96% (p &lt;0.0001), and postoperative lethality from 22.4% to 2.4% (p = 0.0001).&#x0D; Conclusions. The method of measuring IAP by prolonged monitoring of BP is effective and practical (sensitivity of the technique was 95.2%, specificity - 85.7%). The use of the laparolifting system in patients with acute pancreatitis accompanied by IAH allowed to reduce the frequency of complications from 52.9% to 16.7% (p = 0.03), and the overall mortality - from 35.3% to 5.6% (p = 0,03). The introduced method of predicting the possibility of performing laparoscopic intervention in urgent surgery demonstrates high sensitivity (85.7%) and specificity (95.5%). The local use of stereoslective NSAIDs at the end of the laparoscopic intervention has a high analgesic effect and has a significantly higher safety degree (p &lt;0.001). The use of the advanced diagnostic and treatment algorithm for treatment of IAH allows to apply only the first level measures in 67,6% of cases, the second level measures in 22,5%, to avoid the implementation of decompression laparostomy and to reduce the incidence of systemic complications from 54,1% to 11,8% (p &lt;0.0001), to reduce total mortality from 21.2% to 1.96% (p &lt;0.0001) and postoperative lethality from 22.4% to 2.4% (p = 0.0001).

Intraabdominal pressure in women during CrossFit exercises and the effect of age and parity

ABSTRACTTo determine intraabdominal pressure (IAP) in women during CrossFit and to determine whether parity, age, or CrossFit experience affects IAP during CrossFit exercises, we evaluated 10 women: 5 experienced and active CrossFitters and 5 who were not regularly engaged in CrossFit. A Laborie urodynamics abdominal pressure probe with the Goby wireless system measured IAP during 10 repetitions of 13 different CrossFit exercises. Women had a mean age of 36 years. A significant difference was found between mean peak IAP of the 5 parous vs the 5 nulliparous women (P = 0.009). Experience with CrossFit did not affect mean peak IAP achieved with exercise. In some exercises, there was a significant change in IAP as participants progressed through repetitions (P = 0.003 for back squats and 0.04 for sit-ups). Participants achieved IAP values that were markedly higher than those previously published.

Correlation of Procalcitonin and C-Reactive Protein with Intra-Abdominal Hypertension in Intra-Abdominal Infections: Their Predictive Role in the Progress of the Disease.

AIM:To analyse the correlation of procalcitonin (PCT) and C-reactive protein (CRP) values with increased intra-abdominal pressure and to evaluate their predictive role in the progression of Intra-abdominal infections.MATERIALS AND METHODS:A non-randomized prospective study conducted in the group of 80 patients. We have measured the PCT, CRP and intra-abdominal pressure (IAP).RESULTS:According to IAH grades (G), there was a significant difference of PCT values: G I 3.6 ± 5.1 ng/ml, G II 10.9 ± 22.6 ng/ml, G III 15.2 ± 30.2 ng/ml (p = 0.045) until: CRP values were increased in all IAH groups but without distinction between the groups: GI 183 ± 64.5, GII 196 ± 90.2, GIII 224 ± 96.3 (p = 0.17). According to the severity of the infection, we yielded increased values of PCT, IAP and CRP in septic shock, severe sepsis and SIRS/sepsis resulting in significant differences of PCT and IAP.CONCLUSION:Based on the results of our research, we conclude that the correlation of PCT values with IAH grades is quite significant while the CRP results remain high in IAH but without significant difference between the different grades of IAH.

Liver function assessment by indocyanine green plasma disappearance rate in patients with intra-abdominal hypertension after “non-hepatic” abdominal surgery

Background and objective: Liver function assessment in patients with intra-abdominal hypertension (IAH) after major abdominal surgery is complex and often confounding. Elevated intra-abdominal pressure (IAP) often occurs after major abdominal surgery, and is associated with decreased abdominal blood flow and organ dysfunction, and it could cause abdominal compartment syndrome (ACS), which is a life-threatening condition. Plasma disappearance rate (PDR) of indocyanine green (ICG) and ICG retention rate after 15 min (R15) were used to evaluate liver function and as a prognostic parameter after major abdominal surgery.Methods: In this prospective/observational study, 51 patients were followed in the surgical intensive care unit after major abdominal surgery (operation of the small and large intestine, stomach, pancreas, spleen, or resection of the abdominal aorta), 29 had IAH. The PDR-ICG and R15 were analyzed 24 h after surgery concurrently with IAP, APP, bilirubin, AST, ALT, prothrombin time, albumin, cardiac index, arterial lactate, oxygen delivery, MAP (mean arterial pressure), APACHE II (acute physiology and chronic health evaluation), SOFA (sequential organ failure assessment), and SAPS II (simplified acute physiology score). IAH has been defined as a peak intra-abdominal pressure (IAP) value of ≥12 mmHg, at a minimum, as two standardized measurements obtained 1–6 h apart.Results: The PDR-ICG measured 24 h after surgery was not different among groups (20.95% [SD = 10.34] vs 25.40% [SD = 7.42]), p = .094. ICG R15 was significantly higher in patients with IAH, 11.10% [SD = 13.82] vs 8.30 [SD = 11.46], p < .05, respectively. The PDR/ICG value was significantly lower in non-survivors than survivors (16.82 [SD = 10.87] vs 24.35 [SD = 8.48], p < .05).Conclusions: The results suggest that PDR/ICG and ICG R15 are useful dynamic tests for evaluation of complex liver function and survival prediction after major abdominal surgery in patients with IAH.

The effect of crystalloid infusion on body water content and intra-abdominal pressure in patients undergoing orthopedic surgery under spinal anesthesia.

Crystalloids are frequently used for the correction of spinal anesthesia-induced hypotension, intraoperative bleeding, or vaporisation from surgical wounds. The aim of this study was to observe the effect of perioperative crystalloid infusion on intraabdominal pressure (IAP), volume excess (VE), total body water (TBW), and extracellular body water (ECW) in patients undergoing elective orthopedic surgery under spinal anesthesia. Adult patients undergoing hip or knee replacement were studied. Changes in VE, TBW, ECW, and IAP were observed in patients who received restrictive fluid therapy (group R) and in patients who received liberal fluid therapy (group L). IAP was measured in the urinary bladder. All parameters were measured at 4 points in time: just before anesthesia (baseline value, A); just after surgery (B); 3 h after surgery (C); and on the morning of postoperative day 1 (D). Additionally, IAP was measured after anesthesia, just before surgery (A1). The mean baseline values of IAP, ECW, TBW, and VE were comparable between groups L and R. The induction of anesthesia reduced IAP in both groups (p < 0.001). IAP and VE increased in both groups after surgery. Significantly higher values of IAP, however, were noted in group L at time points B, C, and D. TBW and ECW increased after surgery in group L. In group R, ECW slightly increased only at time point C. IAP strongly correlated with ECW in group L (p < 0.001, r = 0.62). Spinal anesthesia reduces IAP. A perioperative increase in body water content and IAP mainly depends on the volume of the infused crystalloids.

Neutrophil Gelatinase-Associated Lipocalin as a Marker for Renal Dysfunction Detection in Critically Ill Patients with Increased Intraabdominal Pressure.

IntroductionElevated intraabdominal pressure (IAP) it is known to have an impact on renal function trough the pressure transmitted from the abdominal cavity to the vasculature responsible for the renal blood flow. Intraabdominal pressure is found to be frequent in intensive care patients and also to be a predictor of mortality. Intra-abdominal high pressure is an entity that can have serious impact on intensive care admitted patients, studies concluding that if this condition progresses to abdominal compartment syndrome mortality is as high as 80%.AimThe aim of this study was to observe if a link between increased intraabdominal pressure and modification in renal function exists (NGAL, creatinine clearance).Material and MethodThe study enrolled 30 critically ill patients admitted in the Intensive Care Unit of SCJU TîrguMures between November 2015 and August 2016. The study enrolled adult, hemodynamically stable patients admitted in intensive critical care - defined by a normal blood pressure maintained without any vasopressor or inotropic support, invasive monitoring using PICCO device and abdominal pressure monitoring.ResultsThe patients were divided into two groups based on the intraabdominal pressure values: normal intraabdominal pressure group= 52 values and increased intraabdominal group= 35 values. We compared the groups in the light of NGAL values, 24 hours diuresis, GFR and creatinine clearance. The groups are significantly different when compared in the light of NGAL values and GFR values. We obtained a statistically significant correlation between NGAL value and 24 hour diuresis. No other significant correlations were encountered between the studied items.ConclusionsNGAL values are increased in patients with high intraabdominal pressure which may suggest its utility as a cut off marker for patients with increased intraabdominal pressure. There is a significant decreased GFR in patient with elevated intraabdominal pressure, observation which can help in early detection of renal injury in patients due to high intraabdominal pressure. No correlation was found between creatinine clearance and increased intraabdominal pressure.

Intra-abdominal pressure and procalcitonin are valid prognostic markers of acute pancreatitis severity (intra-abdominal pressure and procalcitonin)

Introduction. Early assessment of the severity and etiology of acute pancreatitis is very important for further treatment procedures. The aim of the study was to investigate the association between intra-abdominal pressure (IAP) and procalcitonin as an indicator of severity of acute pancreatitis. Method. The IAP is measured every 12 hours through the urinary catheter placed in the bladder, in 65 patients with acute pancreatitis. Procalcitonin is measured within 24 hours of receipt of the patient, after 48 hours and after 78 hours. These values of procalcitonin and IAP were compared to each other and in relation to the Acute Physiology, Age and Chronic Health Evaluation II (APACHE II) scoring system. Patients with APACHE II score > 8 are defined with moderate and severe acute pancreatitis. Results. The values of IAP (18,1 ± 4,5 mmHg vs 8,9 ± 2,67 mmHg; p = 0,01 ), procalcitonin (15,43 + 2,25 ng/ml vs 3,14 + 1,12 ng/ml; p =0,031) and APACHE II scoring system (17,3 ± 6,24 vs 6,5 ± 1,0; p = 0,013) were significantly higher in patients with moderate and severe acute pancreatitis. The increase in the value of IAP was accompanied by an increase in the value of procalcitonin (r = 0,581, p = 0,01). The sensitivity in the prediction of severe acute pancreatitis after 24 hours of receiving the patient is 91,7% for the IAP, 87,8% for procalcitonin and 84,9% for APACHE II scoring system. Conclusion. The increase in the value of the IAP is accompanied by an increase in the values of procalcitonin, also patients with higher values of APACHE II scoring sys­tem have higher values of IAP and procalcitonin. The values of IAP and procalcitonin can be used as markers of acute pancreatitis severity.

The influence of intraabdominal pressure on the mortality rate of patients with acute pancreatitis.

Intraabdominal hypertension (IAH) is a common clinical finding in patients with acute pancreatitis and is associated with poor prognosis. This study aimed to determine the impact of intraabdominal pressure (IAP) on the mortality rate in patients with acute pancreatitis in an intensive care unit. A total of 50 patients with acute pancreatitis were included in this prospective cohort study. Based on the obtained values of IAP, the patients were divided into two groups: those with normal IAP (n = 14) and increased IAP (n = 36). Mean values of IAP were compared with examined variables. The mortality rate of the study group was 40%. Comparing the IAP and treatment outcomes, it was proved that there were statistically highly significant differences (P = 0.012). Increasing the value of IAP increased the mortality rate. Deceased patients in the IAH group had greater statistical significance of APACHE II score (P = 0.016), abdominal perfusion pressure (P = 0.048), lactate (P = 0.049), hematocrit (P = 0.039), Ranson's criteria on admission (P = 0.017), Ranson's criteria after 48 h (P = 0.010), Sequential Organ Failure Assessment score (P = 0.014), and body mass index (P = 0.012) compared to the surviving patients. IAP has an impact on the increase of mortality rates in patients with acute pancreatitis.

Can femoral venous pressure be used as an estimate for standard vesical intra-abdominal pressure measurement?

Intra-abdominal hypertension (IAH) is highly prevalent in critically ill patients admitted to the intensive care unit and is associated with an increased morbidity and mortality. The present study investigated whether femoral venous pressure (FVP) can be used as a surrogate parameter for intra-abdominal pressure (IAP) measured via the bladder in IAH grade II (IAP <20 mmHg) or grade III (IAP ≥20 mmHg). This was a single-centre prospective study carried out in a tertiary adult intensive care unit. IAP was measured via the bladder with a urinary catheter with simultaneous recording of the FVP via a femoral central line. If the IAP was <20 mmHg external weight to a maximum of 10 kg was applied to the abdomen with subsequent measurements of IAP and FVP. Eleven patients were enrolled into the study. IAH (IAP >12 mmHg) was identified in five patients (42%) and abdominal compartment syndrome (ACS, IAP >20 mmHg with new onset organ failure) in two (18%) with all-cause study mortality of 18%. The mean Acute Physiology and Chronic Health Evaluation (APACHE) II score was 21 ± 5, Simplified Acute Physiology (SAPS 2) score 49 ± 8, and Sequential Organ Failure Assessment (SOFA) score 9 ± 3. At baseline the bias between IAP and FVP was 3.2 with a precision of 3.63 mmHg (limits of agreement [LA] -4.1, 10.4). At 5 kg and 10 kg, the bias was 2.5 with a precision of 3.92 mmHg (LA -5.4, 10.3) and 2.26 mmHg (LA -2.1, 7.0) respectively. A receiver operating characteristic analysis for FVP to predict IAH showed an area under the curve of 0.87 (95% confidence interval 0.74-0.94, P=0.0001). FVP cannot be recommended as a surrogate measure for IAP even at IAP values above 20 mmHg. However, an elevated FVP was a good predictor of IAH.

How central obesity influences intra-abdominal pressure: a prospective, observational study in cardiothoracic surgical patients.

BackgroundIntra-abdominal hypertension (IAH) is frequently present in critically ill patients and is an independent predictor for mortality. Better recognition of clinically important thresholds is necessary. Increased intra-abdominal pressure (IAP) is associated with renal dysfunction, and renal failure is one of the most consistently described organ dysfunctions associated with IAH. Obesity is also associated with kidney injury. The underlying mechanisms are not yet fully understood. Increased IAP may be a link in this association. The aim of this study was firstly to find the range in values of intra-abdominal pressure (IAP) in cardiothoracic surgery patients a secondly to investigate the relationship between central obesity, body mass index (BMI) and IAP and thirdly to investigate the relationship between IAP, inflammation and renal function in this population.MethodsConsecutive adult patients admitted to the cardiothoracic unit of the intensive care unit (ICU) after undergoing elective cardiothoracic surgery were included in this prospective, observational study. C-reactive protein (CRP) as a marker of inflammation and serum creatinine as a marker of renal function were measured pre- and postoperatively. Estimated glomerular filtration rates were calculated pre- and postoperatively. BMI was calculated. Waist circumference (WC), hip circumference (HC) and transvesical IAP were measured once directly after admission to the ICU postoperatively. Waist/hip ratio (WHR) was calculated (WC divided by HC). Three definitions of central obesity were used. Central obesity was defined according to WC, WHR or median WHR.ResultsIn total, 186 patients undergoing cardiothoracic surgery were included. Mean IAP was 9.1 mmHg (SD 4.4). IAP ≥ 12 mmHg was observed in 50 patients (26.9 %). IAP > 20 mmHg was measured in 4 patients (2.2 %). There was a positive correlation between IAP and BMI (r 2 = 0.05, p = 0.003). Correlations between IAP and WC (r 2 = 0.02, p = 0.054) and between IAP and WHR (r 2 = 0.01, p = 0.173) were not significant. There were no correlations between pre- or postoperative CRP and IAP (r 2 = 2.3 × 10−4, p = 0.839 and r 2 = 0.013, p = 0.117, respectively). In obese patients postoperative CRP was significantly higher than in non-obese patients (p = 0.034). There were no correlations between pre-operative serum creatinine and IAP (r 2 = 3.3 × 10−5, p = 0.938) or postoperative serum creatinine and IAP (r 2 = 0.003, p = 0.491).ConclusionsThe range in IAP in patients undergoing cardiothoracic surgery was wide. There was a positive correlation between IAP and BMI. Correlations between IAP and indices for central obesity were not significant. In a multiple regression model BMI was a better predictor of IAP than WHR in this population. There were no correlations between pre- or postoperative CRP and IAP. Furthermore, this study did not find evidence for a relation between IAP and pre- and postoperative serum creatinine.Electronic supplementary materialThe online version of this article (doi:10.1186/s13613-016-0195-8) contains supplementary material, which is available to authorized users.

Low Transmission of Airway Pressures to the Abdomen in Mechanically Ventilated Patients With or Without Acute Respiratory Failure and Intra-Abdominal Hypertension.

Intra-abdominal pressure, measured at end expiration, may depend on ventilator settings and transmission of intrathoracic pressure. We determined the transmission of positive intrathoracic pressure during mechanical ventilation at inspiration and expiration into the abdominal compartment. We included 9 patients after uncomplicated cardiac surgery and 9 with acute respiratory failure. Intravesical pressures were measured thrice (reproducibility of 1.8%) and averaged, at the end of each inspiratory and expiratory hold maneuvers of 5 seconds. Transmission, the change in intra-abdominal over intrathoracic pressures from end inspiration to end expiration, was about 8%. End-expiratory intra-abdominal pressure was lower than "total" intra-abdominal pressure over the entire respiratory cycle by 0.34 cm H2O. It was 0.73 cm H2O higher than "true" intra-abdominal pressure over the entire respiratory cycle, taking transmission into account. The percentage error was 3% for total and 10% for true pressure. Results did not differ among patients with or without acute respiratory failure and decreased respiratory compliance or between those with (≥12 mm Hg, n = 5) or without intra-abdominal hypertension. Transmitted airway pressure only slightly affects intra-abdominal pressure in mechanically ventilated patients, irrespective of respiratory compliance and baseline intra-abdominal pressure values. End-expiratory measurements referenced against atmospheric pressure may suffice for clinical practice.

3D finite element modeling of pelvic organ prolapse

Objectives: The purpose of this study is to develop a validated 3D finite element model of the pelvic floor system which can offer insights into the mechanics of anterior vaginal wall prolapse and have the ability to assess biomedical device treatment methods. The finite element results should accurately mimic the clinical findings of prolapse due to intra-abdominal pressure (IAP) and soft tissues impairment conditions. Methods: A 3D model of pelvic system was created in Creo Parametric 2.0 based on MRI Images, which included uterus, cervix, vagina, cardinal ligaments, uterosacral ligaments, and a simplified levator plate and rectum. The geometrical model was imported into ANSYS Workbench 14.5. Mechanical properties of soft tissues were based on experimental data of tensile test results from current literature. Studies were conducted for IAP loadings on the vaginal wall and uterus, increasing from lowest to extreme values. Results: Anterior vaginal wall collapse occurred at an IAP value corresponding to maximal valsalva and showed similar collapsed shape as clinical findings. Prolapse conditions exhibited high sensitivity to vaginal wall stiffness, whereas healthy tissues was found to support the vagina against prolapse. Ligament impairment was found to have only a secondary effect on prolapse.

Intra-abdominal Pressure Monitoring in Open Abdomen Management with Dynamic Abdominal Closure.

The importance of elevated intra-abdominal pressure (IAP) and abdominal compartment syndrome (ACS) have been recognized in critical care for its potential damaging effects. But, quantification of IAP values may be useful as a clinical tool for determining efficacy of coughing and straining for functional recovery of OA patients. We would like to evaluate IAP generated in an OA patient and the effect of negative pressure therapy (NPT) and dynamic abdominal closure systems (ABRA) on the IAP values at rest and during coughing and straining and compare those with IAP measurements of closed abdomen after standard open elective colorectal surgery (non-OA). Eight OA and eight non-OA patients were included in this study. OA patient with NPT and ABRA (OA + NA), OA patient without NPT and ABRA completely unbraced (OA-NA) (NA stands for NPT and ABRA), and non-OA patients underwent IAP measurements at rest, during coughing, and during straining via transurethral catheter. There was no difference in the mean of IAP measurement at rest in OA-NA (6.1mmHg), OA + NA (6.5mmHg), and non-OA (6.0mmHg) patients. During coughing, IAP of OA-NA, OA + NA, and non-OA patients were 11.5, 19.1, and 22.0mmHg and during straining, IAP of OA-NA, OA + NA, and non-OA patients were 11.5, 17.5, and 23.5mmHg, respectively. Application of NPT in conjunction with ABRA did not increase IAP at rest but provided significant IAP increase in OA + NA patients, when compared to OA-NA patients during coughing and straining. NPT in conjunction with ABRA offers the advantage of increase of IAP during coughing and straining.

Features of respiratory support during laparoscopic correction of inguinal hernias in children.

IntroductionThe objectives were to study the changes in the mechanics of respiration in children undergoing surgery depending on the value of intra-abdominal pressure (IAP) during laparoscopic procedures, and to compare the effects of different mechanical ventilation modes – pressure controlled (PCV) and volume controlled (VCV) ventilation – on the mechanics of respiration considering carboxyperitoneum conditions (CP).AimTo study the changes in the mechanics of respiration in operated children depending on the value of intra-abdominal pressure during laparoscopic procedures.Material and methodsFifty-two children aged 1–12 years undergoing laparoscopic surgery on inguinal hernias were randomly allocated to receive mechanical ventilation using either VCV (n = 24) or PCV (n = 28) mode. Respiratory mechanics were measured before application of carboxyperitoneum (initial data) and after the gas had been pumped into the abdominal cavity, at the following intra-abdominal pressure values: 6 mm Hg, 8 mm Hg, 10 mm Hg, 12 mm Hg, 14 mm Hg.ResultsElevation of intra-abdominal pressure due to carboxyperitoneum conditions had a negative effect on the mechanics of respiration. Changes in the respiratory mechanics were restrictive in nature in both groups. The patients who were receiving pressure controlled ventilation showed a decrease in tidal volume, exhaled minute volume, and dynamic lung compliance, which affected the gas exchange at intra-abdominal pressure values ≥ 12 mm Hg. Patients who were receiving volume controlled ventilation showed an increase in peak inspiratory pressure and mean airway pressure and a decrease in dynamic lung compliance in response to higher intra-abdominal pressure. A significant increase of concentration of exhaled carbon dioxide (etCO2) was registered at IAP ≥ 12 mm Hg.ConclusionsApplication of carboxyperitoneum causes increased intra-abdominal pressure and restrictive disorders in respiratory mechanics. Intra-abdominal pressure readings within 8–12 mm Hg allow laparoscopic procedures to be performed without significant gas exchange disorders in children older than 1 year.

The Pathophysiological Hypothesis of Kidney Damage during Intra-Abdominal Hypertension.

The Pathophysiological Hypothesis of Kidney Damage during Intra-Abdominal Hypertension.

Transvesical Intra-Abdominal Pressure Measurement in Newborn: What Is the Optimal Saline Volume Instillation?

To determine the optimal saline volume bladder instillation to measure intravesical pressure in critically ill newborns weighing less than 4.5 kg, and to establish a reference of intra-abdominal pressure value in this population. Prospective monocentric study. Neonatal ICU and PICU. Newborns, premature or not, weighing less than 4.5 kg who required a urethral catheter. Patients were classified into two groups according to whether they presented a risk factor for intra-abdominal hypertension. Nine intravesical pressure measures per patient were performed after different volume saline instillation. The first one was done without saline instillation and then by increments of 0.5 mL/kg to a maximum of 4 mL/kg. Linear models for repeated measurements of intravesical pressure with unstructured covariance were used to analyze the variation of intravesical pressure measures according to the conditions of measurement (volume instilled). Pairwise comparisons of intravesical pressure adjusted mean values between instillation volumes were done using Tukey tests, corrected for multiple testing to determine an optimal instillation volume. Forty-seven patients with completed measures (nine instillations volumes) were included in the analysis. Mean intravesical pressure values were not significantly different when measured after instillation of 0.5, 1, or 1.5 mL/kg, whereas measures after instillation of 2 mL/kg or more were significantly higher. The median intravesical pressure value in the group without intra-abdominal hypertension risk factor after instillation of 1 mL/kg was 5 mm Hg (2-6 mm Hg). The optimal saline volume bladder instillation to measure intra-abdominal pressure in newborns weighing less than 4.5 kg was 1 mL/kg. Reference intra-abdominal pressure in this population was found to be 5 mm Hg (2-6 mm Hg).

Biophysical Validation of Intra- Abdominal Pressure and Transurethral Method

Biophysical Validation of Intra- Abdominal Pressure and Transurethral Method Objective: The increase in intra-abdominal pressure (IAP) is a well-documented phenomenon, directly associated with pathophysiological changes in all organic systems, increasing morbidity and mortality. The gold standard for its determination is the transurethral method (TM), which still today is surrounded by controversy. The purpose of the study is to, through physical principles, demonstrate IAP, validate TM and explain the variables that influence IAP. Materials and Methods: Development of a biophysical formulation, based on mechanics of fluids, to explain IAP, TM and its variables. Validation of the principles formulated in a non-living animal model, where all components that generate the IAP were determined. Determination of: IAP by TM, intragastric and direct method; gastric, bladder and abdominal areas and volumes; weight of all abdominal structures. Results: IAP values obtained by the several methods are within the limits described for the species with average values between 2.31 and 7.14 mmHg. Determination of the areas and strength of all anatomical structures allowed the replacement of values in the biophysical formulation and calculation of IAP. The mathematically calculation of IAP confirms the theoretical definition of IAP. This value when compared with the direct readings per sensor showed no statistical differences (P<0.05). IAP determination by direct method also showed no differences in the five body positions (P=0.765). Indirect methods revealed statistically significant differences from the direct method only in the Trendelenburg and reverse Trendelenburg. Breathing, muscle contraction, body position and water manometer position influence IAP measurement by indirect methods. Using digital treatment of images and using pixels analysis algorithms, it is also possible to determine bladder and gastric surface area, in average 6.17*10-3 ± 5.05*103 m2 and 3.55*10-2 ± 1.65*10-2 m2 respectively. Conclusion: This study improves the knowledge of the application of the direct and indirect methods to accesses IAP. The biophysical principles explain the formation of IAP and prove the accuracy of TM, explaining the variables which affect it.

Intra-abdominal pressure and possible ways of its drug correction after emergency laparotomy

Intra-abdominal pressure and possible ways of its drug correction after emergency laparotomy

Inverted U-Shaped Relationship between Central Venous Pressure and Intra-Abdominal Pressure in the Early Phase of Severe Acute Pancreatitis: A Retrospective Study.

ObjectiveMany studies have indicated that intra-abdominal pressure (IAP) is positively correlated with central venous pressure (CVP) in severe cases. However, although elevated IAP is common in patients with severe acute pancreatitis (SAP), its relationship with CVP remains unclear. Our study aimed to investigate the association of IAP with CVP in early-phase SAP patients.MethodsIn total, 116 SAP patients were included in this retrospective study. On the first day of hospitalization, blood samples were collected for biochemical examination and cytokine concentration monitoring. Additionally, a urinary catheter and right subclavian vein catheter were inserted for IAP and CVP measurement, respectively. Other routine clinical data were also recorded.ResultsWithin 24 hours after hospitalization, CVP fluctuated and increased with increasing IAP up to 15.7 mmHg (P = 0.054) but decreased with increasing IAP when the IAP was > 15.7 mmHg (P < 0.001). After adjusting for abdominal perfusion pressure (APP) and mean arterial pressure (MAP), a similar distribution was observed. An inverted U-shaped trend between IAP and CVP was also present in the groups classified according to the patient’s sex, local complications, ascites, and serum amylase levels.ConclusionsCVP and IAP have an inverted U-shaped relationship, with a peak at an IAP of 15.7 mmHg in the early phase of SAP. After this peak, CVP decreases as IAP increases. These results have crucial implications for clinical fluid resuscitation in SAP patients. In particular, because one CVP value might be correlated with different IAP values in patients with the same CVP, the volume of fluid needed might be different.