Relationship between Abdominal Pressure, Pulmonary Compliance, and Cardiac Preload in a Porcine Model
Rationale. Elevated intra-abdominal pressure (IAP) may compromise respiratory and cardiovascular function by abdomino-thoracic pressure transmission. We aimed (1) to study the effects of elevated IAP on pleural pressure, (2) to understand the implications for lung and chest wall compliances and (3)...
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| Format: | Article |
| Language: | English |
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Wiley
2012-01-01
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| Series: | Critical Care Research and Practice |
| Online Access: | http://dx.doi.org/10.1155/2012/763181 |
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| _version_ | 1832568371454935040 |
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| author | Joost Wauters Piet Claus Nathalie Brosens Myles McLaughlin Greet Hermans Manu Malbrain Alexander Wilmer |
| author_facet | Joost Wauters Piet Claus Nathalie Brosens Myles McLaughlin Greet Hermans Manu Malbrain Alexander Wilmer |
| author_sort | Joost Wauters |
| collection | DOAJ |
| description | Rationale. Elevated intra-abdominal pressure (IAP) may compromise respiratory and cardiovascular function by abdomino-thoracic pressure transmission. We aimed (1) to study the effects of elevated IAP on pleural pressure, (2) to understand the implications for lung and chest wall compliances and (3) to determine whether volumetric filling parameters may be more accurate than classical pressure-based filling pressures for preload assessment in the setting of elevated IAP. Methods. In eleven pigs, IAP was increased stepwise from 6 to 30 mmHg. Hemodynamic, esophageal, and pulmonary pressures were recorded. Results. 17% (end-expiratory) to 62% (end-inspiratory) of elevated IAP was transmitted to the thoracic compartment. Respiratory system compliance decreased significantly with elevated IAP and chest wall compliance decreased. Central venous and pulmonary wedge pressure increased with increasing IAP and correlated inversely (r=-0.31) with stroke index (SI). Global end-diastolic volume index was unaffected by IAP and correlated best with SI (r=0.52). Conclusions. Increased IAP is transferred to the thoracic compartment and results in a decreased respiratory system compliance due to decreased chest wall compliance. Volumetric filling parameters and transmural filling pressures are clearly superior to classical cardiac filling pressures in the assessment of cardiac preload during elevated IAP. |
| format | Article |
| id | doaj-art-7c3e2d1e03d147478eb1f94f23e6cb97 |
| institution | Kabale University |
| issn | 2090-1305 2090-1313 |
| language | English |
| publishDate | 2012-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Critical Care Research and Practice |
| spelling | doaj-art-7c3e2d1e03d147478eb1f94f23e6cb972025-02-03T00:59:13ZengWileyCritical Care Research and Practice2090-13052090-13132012-01-01201210.1155/2012/763181763181Relationship between Abdominal Pressure, Pulmonary Compliance, and Cardiac Preload in a Porcine ModelJoost Wauters0Piet Claus1Nathalie Brosens2Myles McLaughlin3Greet Hermans4Manu Malbrain5Alexander Wilmer6Medical Intensive Care Unit, University Hospital Gasthuisberg, Herestraat 49, 3000 Leuven, BelgiumCardiac Imaging, University Hospital Gasthuisberg, 3000 Leuven, BelgiumMedical Intensive Care Unit, University Hospital Gasthuisberg, Herestraat 49, 3000 Leuven, BelgiumCardiac Imaging, University Hospital Gasthuisberg, 3000 Leuven, BelgiumMedical Intensive Care Unit, University Hospital Gasthuisberg, Herestraat 49, 3000 Leuven, BelgiumIntensive Care Unit, Ziekenhuis Netwerk Antwerpen, Campus Stuivenberg, 2060 Antwerpen, BelgiumMedical Intensive Care Unit, University Hospital Gasthuisberg, Herestraat 49, 3000 Leuven, BelgiumRationale. Elevated intra-abdominal pressure (IAP) may compromise respiratory and cardiovascular function by abdomino-thoracic pressure transmission. We aimed (1) to study the effects of elevated IAP on pleural pressure, (2) to understand the implications for lung and chest wall compliances and (3) to determine whether volumetric filling parameters may be more accurate than classical pressure-based filling pressures for preload assessment in the setting of elevated IAP. Methods. In eleven pigs, IAP was increased stepwise from 6 to 30 mmHg. Hemodynamic, esophageal, and pulmonary pressures were recorded. Results. 17% (end-expiratory) to 62% (end-inspiratory) of elevated IAP was transmitted to the thoracic compartment. Respiratory system compliance decreased significantly with elevated IAP and chest wall compliance decreased. Central venous and pulmonary wedge pressure increased with increasing IAP and correlated inversely (r=-0.31) with stroke index (SI). Global end-diastolic volume index was unaffected by IAP and correlated best with SI (r=0.52). Conclusions. Increased IAP is transferred to the thoracic compartment and results in a decreased respiratory system compliance due to decreased chest wall compliance. Volumetric filling parameters and transmural filling pressures are clearly superior to classical cardiac filling pressures in the assessment of cardiac preload during elevated IAP.http://dx.doi.org/10.1155/2012/763181 |
| spellingShingle | Joost Wauters Piet Claus Nathalie Brosens Myles McLaughlin Greet Hermans Manu Malbrain Alexander Wilmer Relationship between Abdominal Pressure, Pulmonary Compliance, and Cardiac Preload in a Porcine Model Critical Care Research and Practice |
| title | Relationship between Abdominal Pressure, Pulmonary Compliance, and Cardiac Preload in a Porcine Model |
| title_full | Relationship between Abdominal Pressure, Pulmonary Compliance, and Cardiac Preload in a Porcine Model |
| title_fullStr | Relationship between Abdominal Pressure, Pulmonary Compliance, and Cardiac Preload in a Porcine Model |
| title_full_unstemmed | Relationship between Abdominal Pressure, Pulmonary Compliance, and Cardiac Preload in a Porcine Model |
| title_short | Relationship between Abdominal Pressure, Pulmonary Compliance, and Cardiac Preload in a Porcine Model |
| title_sort | relationship between abdominal pressure pulmonary compliance and cardiac preload in a porcine model |
| url | http://dx.doi.org/10.1155/2012/763181 |
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