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Experimental intra-abdominal hypertension influences airway pressure limits for lung protective mechanical ventilation

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dc.creatorCortes-Puentes, Gustavo A.spa
dc.creatorCortes-Puentes, Luis A.spa
dc.creatorAdams, Alexander B.spa
dc.creatorAnderson, Christopher P.spa
dc.creatorMarini, John J.spa
dc.creatorDries, David J.spa
dc.date.accessioned2020-05-25T23:56:41Z
dc.date.available2020-05-25T23:56:41Z
dc.date.created2013spa
dc.description.abstractBACKGROUND: Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) may complicate monitoring of pulmonary mechanics owing to their impact on the respiratory system. However, recommendations for mechanical ventilation of patients with IAH/ACS and the interpretation of thoracoabdominal interactions remain unclear. Our study aimed to characterize the influence of elevated intra-abdominal pressure (IAP) and positive end-expiratory pressure (PEEP) on airway plateau pressure (PPLAT) and bladder pressure (PBLAD). METHODS: Nine deeply anesthetized swineweremechanically ventilated via tracheostomy: volume-controlled mode at tidal volume (VT) of 10mL/kg, frequency of 15, inspiratory-expiratory ratio of 1:2, and PEEP of 1 and 10 cm H2O (PEEP1 and PEEP10, respectively). A tracheostomy tube was placed in the peritoneal cavity, and IAP levels of 5, 10, 15, 20, and 25 mm Hg were applied, using a continuous positive airway pressure system. At each IAP level, PBLAD and airway pressure measurements were performed during both PEEP1 and PEEP10. RESULTS: PBLAD increased as experimental IAP rose (y = 0.83x + 0.5; R2 = 0.98; p G 0.001 at PEEP1). Minimal underestimation of IAP by PBLAD was observed (j2.5 T 0.8 mm Hg at an IAP of 10-25 mm Hg). Applying PEEP10 did not significantly affect the correlation between experimental IAP and PBLAD. Approximately 50% of the PBLAD (in cm H2O) was reflected by changes in P PLAT, regardless of the PEEP level applied. Increasing IAP did not influence hemodynamics at any level of IAP generated. CONCLUSION: With minimal underestimation, PBLAD measurements closely correlated with experimentally regulated IAP, independent of the PEEP level applied. For each PEEP level applied, a constant proportion (approximately 50%) of measured PBLAD (in cm H2O) was reflected in PPLAT. A higher safety threshold for PPLAT should be considered in the setting of IAH/ACS as the clinician considers changes in VT. A strategy of reducing V T to cap PPLAT at widely recommended values may not be warranted in the setting of increased IAP. Copyright © 2013 Lippincott Williams and amp; Wilkins.eng
dc.format.mimetypeapplication/pdf
dc.identifier.doihttps://doi.org/10.1097/TA.0b013e31829243a7
dc.identifier.issn21630755
dc.identifier.issn21630763
dc.identifier.urihttps://repository.urosario.edu.co/handle/10336/22487
dc.language.isoengspa
dc.relation.citationEndPage1473
dc.relation.citationIssueNo. 6
dc.relation.citationStartPage1468
dc.relation.citationTitleJournal of Trauma and Acute Care Surgery
dc.relation.citationVolumeVol. 74
dc.relation.ispartofJournal of Trauma and Acute Care Surgery, ISSN:21630755, 21630763, Vol.74, No.6 (2013); pp. 1468-1473spa
dc.relation.urihttps://www.scopus.com/inward/record.uri?eid=2-s2.0-84880126229&doi=10.1097%2fTA.0b013e31829243a7&partnerID=40&md5=54ec0dc779a26a7a5c13e0619899d8c6spa
dc.rights.accesRightsinfo:eu-repo/semantics/openAccess
dc.rights.accesoAbierto (Texto Completo)spa
dc.source.instnameinstname:Universidad del Rosariospa
dc.source.reponamereponame:Repositorio Institucional EdocURspa
dc.subject.keywordWaterspa
dc.subject.keywordAbdominal compartment syndromespa
dc.subject.keywordAirway pressurespa
dc.subject.keywordAnimal experimentspa
dc.subject.keywordArticlespa
dc.subject.keywordArtificial ventilationspa
dc.subject.keywordHemodynamicsspa
dc.subject.keywordIntraabdominal hypertensionspa
dc.subject.keywordNonhumanspa
dc.subject.keywordPeritoneal cavityspa
dc.subject.keywordPositive end expiratory pressurespa
dc.subject.keywordPriority journalspa
dc.subject.keywordTidal volumespa
dc.subject.keywordTracheostomyspa
dc.subject.keywordTracheostomy tubespa
dc.subject.keywordAbdominal cavityspa
dc.subject.keywordAnimalsspa
dc.subject.keywordContinuous positive airway pressurespa
dc.subject.keywordDisease modelseng
dc.subject.keywordIntra-abdominal hypertensionspa
dc.subject.keywordRespiratory systemspa
dc.subject.keywordSwinespa
dc.subject.keywordAbdominal compartment syndromespa
dc.subject.keywordIntra-abdominal hypertensionspa
dc.subject.keywordPigsspa
dc.subject.keywordPlateau airway pressurespa
dc.subject.keywordPositive end-expiratory pressurespa
dc.titleExperimental intra-abdominal hypertension influences airway pressure limits for lung protective mechanical ventilationspa
dc.typearticleeng
dc.type.hasVersioninfo:eu-repo/semantics/publishedVersion
dc.type.spaArtículospa
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