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Respiratory variation of intra-abdominal pressure: indirect indicator of abdominal compliance?

Abstract

Objective

To assess if the observed respiratory cycle-related variation in intra-abdominal pressure is reliably quantifiable and a possible indirect indicator of abdominal compliance. Secondary issues were to assess the roles played by respiratory parameters in determining this oscillation and by patients’ position in increasing their intra-abdominal pressure.

Design and setting

Prospective observational study in a 26-bed medical-surgical intensive care unit.

Patients

Sixteen consecutive patients admitted to intensive care for at least 24 h, requiring mechanical ventilation and intra-abdominal pressure monitoring.

Measurements and results

Intra-abdominal pressure was measured with a modified Kron technique; its waveform was recorded and inspiratory and expiratory values were measured during five consecutive respiratory cycles for 5 days, both in the supine and the 30° head-up position. Inspiratory values were significantly higher than expiratory values (p = 0.001) and a correlation was found between their difference and intra-abdominal pressure basal values (p = 0.025). A positive linear relationship was shown between intra-abdominal pressure and the amplitude of its oscillation (r = 0.4), particularly in the subgroup of patients with intra-abdominal hypertension (r = 0.9). Intra-abdominal pressure was lower in patients supine than in the 30° head-up position (p = 0.001).

Conclusions

Respiratory cycle-related variations in intra-abdominal pressure were specifically investigated, quantified and shown as linearly increasing with end-expiratory intra-abdominal pressure; this phenomenon could be explained by patients’ abdominal compliance status. Supine posture should be an important consideration in specific patients affected by intra-abdominal hypertension.

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Correspondence to Evelina Sturini.

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Sturini, E., Saporito, A., Sugrue, M. et al. Respiratory variation of intra-abdominal pressure: indirect indicator of abdominal compliance?. Intensive Care Med 34, 1632–1637 (2008). https://doi.org/10.1007/s00134-008-1155-z

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Keywords

  • Intra-abdominal pressure
  • Respiratory variation
  • Mechanical ventilation
  • Intra-abdominal hypertension
  • Abdominal compliance
  • Intensive care unit