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Effects of continuous negative extra-abdominal pressure on cardiorespiratory function during abdominal hypertension: an experimental study

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Abstract

Objective

To investigate whether negative extra-abdominal pressure (NEXAP) improves respiratory function and induces a blood shift from the intrathoracic compartment and to assess whether these effects are influenced by abdominal pressure.

Design and setting

Prospective, randomized, controlled trial in the animal laboratory of a university hospital.

Subjects

Eight sedated and paralyzed pigs (19.6±3.4 kg).

Interventions

Application of NEXAP (−20 cmH2O).

Measurements and results

Airway, esophageal, gastric and central venous pressures were recorded simultaneously. Intrathoracic blood volume was assessed by PiCCO. The effects of NEXAP were assessed with and without abdominal hypertension by intraperitoneal insufflation of helium. NEXAP caused a lasting drop of gastric (1.97±2.26 mmHg) and esophageal (1.21±0.67 mmHg) pressures, while end-expiratory airway pressure was similar, hence transpulmonary pressure increased. Intrathoracic blood volume dropped from 358±47 to 314±47 ml. The fall was associated with a decrease in central venous pressure (R2=0.820). When peritoneal pressure was raised (24.7±5.5 mmHg), the effects were less marked. However, the difference between negative pressure around the abdomen and the pressure inside the abdomen (effective NEXAP) was correlated with the proportional changes in intrathoracic blood volume (R2=0.648), being greater with more negative effective NEXAP. NEXAP improved chest wall elastance during abdominal hypertension (from 0.067±0.023 to 0.056±0.021 cmH2O/ml).

Conclusions

NEXAP increases lung volume and causes a shift of blood from the intrathoracic compartment. It needs to be tailored against abdominal pressure to be effective

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Acknowledgements

The authors thank Fabio Ambrosini and Valeria De Barba for generous technical and logistical support.

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Authors and Affiliations

  1. Istituto di Anestesia e Rianimazione, Ospedale Maggiore di Milano-Istituto di Ricovero e Cura a Carattere Scientifico, Università degli Studi di Milano, Via F. Sforza 35, 20122, Milan, Italy

    Franco Valenza, Manuela Irace, Massimiliano Guglielmi, Nicola Bottino, Cecilia Tedesco, Micol Maffioletti, Patrizia Maccagni, Tommaso Fossali, Gabriele Aletti & Luciano Gattinoni

  2. Istituto di Chirurgia Sperimentale e dei Trapianti, Ospedale Maggiore di Milano-Istituto di Ricovero e Cura a Carattere Scientifico, Università degli Studi di Milano, Via F. Sforza 35, 20122, Milan, Italy

    Stefano Gatti

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  1. Franco Valenza
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  2. Manuela Irace
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  3. Massimiliano Guglielmi
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  4. Stefano Gatti
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  5. Nicola Bottino
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  6. Cecilia Tedesco
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  7. Micol Maffioletti
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  8. Patrizia Maccagni
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  9. Tommaso Fossali
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  10. Gabriele Aletti
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  11. Luciano Gattinoni
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Corresponding author

Correspondence to Luciano Gattinoni.

Additional information

This study was funded by Ospedale Maggiore di Milano-IRCCS

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Valenza, F., Irace, M., Guglielmi, M. et al. Effects of continuous negative extra-abdominal pressure on cardiorespiratory function during abdominal hypertension: an experimental study. Intensive Care Med 31, 105–111 (2005). https://doi.org/10.1007/s00134-004-2483-2

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  • DOI: https://doi.org/10.1007/s00134-004-2483-2

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