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Intra-abdominal Pressure and Chest Wall Interaction

  • M. Del Turco
  • F. Giunta
  • V. M. Ranieri

Abstract

Acute lung injury (ALI) is characterized by of a reduction in functional residual capacity (FRC) and an increase in static elastance of the respiratory system [1]. Such increase in static elastance of the respiratory system is mostly due to alterations in the mechanical properties of the lung because of the leading role of the underlying pulmonary injury. However, recent studies [2, 3] have reported that chest wall elastance may also be increased in patients with ALI probably through the increase in abdominal pressure. This chapter will
  • discuss the physiology of the abdomen-chest wall interaction

  • describe the gold standard technique to measure intra-thoracic and abdominal pressures, and

  • discuss the mechanisms and potential clinical implications of increased intra-abdominal pressure (IAP).

Keywords

Acute Lung Injury Abdominal Distension Pulmonary Capillary Wedge Pressure Abdominal Compartment Syndrome Intraabdominal Pressure 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Marini JJ (1990) Lung mechanics in the adult respiratory distress syndrome. Clin Chest Med 11: 673–690PubMedGoogle Scholar
  2. 2.
    Ranieri VM, Brienza M, Santostasi S, et al (1997) Impairment of lung and chest wall mechanics in patients with acute respiratory distress syndrome. Role of abdominal distension. Am J Respir Crit Care Med 156: 1082–1091Google Scholar
  3. 3.
    Gattinoni L, Pelosi P, Suter PM, Pedoto A, Vercesi P, Lissoni A (1998) Acute respiratory distress syndrome caused by pulmonary and extrapulmonary disease. Different syndromes? Am J Respir Crit Care Med 158: 3–11PubMedCrossRefGoogle Scholar
  4. 4.
    Agostoni E (1986) Static behavior of the respiratory system. In: Macklem PT, Mead J (eds) Handbook of Physiology. Sect. 3: The Respiratory System. Vol 3: Mechanics of Breathing. Part 1. American Physiology Society, Bethesda, pp 113–130Google Scholar
  5. 5.
    Agostoni E (1986) Passive Mechanical properties of the chest wall. In: Macklem PT, Mead J (eds) Handbook of Physiology. Sect. 3: The Respiratory System. Vol 3: Mechanics of brething. Part 2. American Physiology Society, Bethesda, pp 429–442Google Scholar
  6. 6.
    Mutoh T, Lamm WJ, Embree LJ, Hildebrandt J, Albert PK (1991) Abdominal distension alters regional pleural pressures and chest wall mechanics in pigs in vivo. J Appl Physiol 70 (6): 2611–2618PubMedGoogle Scholar
  7. 7.
    Mutoh T, Lmm WJ, Embree LJ, Hildebrandt J, Albert PK (1992) Volume infusion produces abdominal distension, lung compression, and chest wall stiffening in pigs. J Appl Physiol 72 (2): 575–582PubMedCrossRefGoogle Scholar
  8. 8.
    Iberti TJ, Kelly KM, Gentili DR, Hirsch S, Benjamin E (1987) A simple technique to accurately determine intra-abdominal pressure. Crit Care Med 15: 1140–1142PubMedCrossRefGoogle Scholar
  9. 9.
    Lacey SR, Bruce J, Brooks SP, et al (1987) The different merits of various method of indirect measurement of intaabdominal pressure as a guide to closure of abdominal wall defect. J Pediatr Surg 22: 1207–1211PubMedCrossRefGoogle Scholar
  10. 10.
    Sugrue M, Buist MD, Lee A, Sanchez DJ, Hillman KM (1994) Intra-abdominal pressure measurement using a modified nasogastric tube: description and validation of a new technique. Intensive Care Med 20: 588–590PubMedCrossRefGoogle Scholar
  11. 11.
    Cheathman ML, Safcsak K (1998) Intraabdominal pressure: a revised method for measurement. J Am Coll Surg 186: 594–595CrossRefGoogle Scholar
  12. 12.
    Kron JL, Harman PK, Nolan SP (1984) The measurement of intra-abdominal pressure as a criteriion for abdominal re-exploration. Ann Surg 199: 28–30PubMedCrossRefGoogle Scholar
  13. 13.
    Iberti TJ, Liber CE, Banjamin E (1989) Determination of intra-abdominal pressure using a transurethral bladder catheter: clinical validation of the technique. Anesthesiology 70: 4750CrossRefGoogle Scholar
  14. 14.
    Baydur A, Behrakis PK, Zin WA, Jaeger M, Milic-Emili J (1982) A simple method for assessing the validity of the esophageal balloon technique. Am J Respir Crit Care 126: 788–791Google Scholar
  15. 15.
    Bradley SE (1947) The effect of increased intra-abdominal pressure on renal function in man. J Clin Invest 26: 1010PubMedCrossRefGoogle Scholar
  16. 16.
    Ivatury RR (1996) Intra-abdominal hypertension: the abdominal compartment syndrome. In: Ivatury RR, Cayten CG (eds) The Textbook of Penetrating Tauma. Williams and Wilkins, Baltimore, pp 939–951Google Scholar
  17. 17.
    Simon RJ (1994) Intra-abdominal hypertension in patients with catastrophic abdominal trauma: the benefit of prophylaxis and aggressive control. Crit Care Med 22: A72 (Abst)Google Scholar
  18. 18.
    Morris JA, Eddy VA, Blinman TA, Rutherford EJ, Sharp KW (1993) The staged laparotomy for trauma: issues in unpacking and reconstruction. Ann Surg 217: 576–586PubMedCrossRefGoogle Scholar
  19. 19.
    Diebel NL, Dulchaysky SA, Brown WJ (1997) Splanchnic ischemia and bacterial translocation in the abdominal compartment syndrome. J Trauma 43: 852–855PubMedCrossRefGoogle Scholar
  20. 20.
    Diebel LN, Wilson RF, Dulchaysky SA, Saxe J (1992) Effect of increased intra-abdominal pressure on hepatic arterial, portal venous, and hepatic microcirculatory blood flow. J Trauma 33: 279–283PubMedCrossRefGoogle Scholar
  21. 21.
    Ivatury RR, Porter JM, Simon RJ, et al (1998) Intra-abdominal hypertensiion after lifethreathening penetrating abdominal trauma: prophylaxis, incidence, and clinical relevance to gastric mucosal PH and abdominal compartment syndrome. J Trauma 44: 1016–1023PubMedCrossRefGoogle Scholar
  22. 22.
    Burch JM, Moore EE, Moore FA, Franciose R (1996) The abdominal compartment syndrome. Surg Clin North Am 76: 833–842PubMedCrossRefGoogle Scholar
  23. 23.
    Saggi BH, Sugarman HJ, Ivatury RR, Bloomfield GL (1998) Abdominal compartment syndrome. J Trauma 45: 597–609PubMedCrossRefGoogle Scholar
  24. 24.
    Cheatham ML, White MW, Sagraves SG, Johnson JL, Block EF (2000) Abdominal perfusion pressure: a superior parameter in the assessment of intra-abdominal hypertension. J Trauma 49: 621–627PubMedCrossRefGoogle Scholar
  25. 25.
    Pelosi P, Croci M, Ravagnan I, et al (1997) Respiratory system mechanics in sedated, paralyzed, morbidly obese patients. J Appl Physiol 82 (3): 811–818PubMedGoogle Scholar
  26. 26.
    Froese AB, Bryan AC (1974) Effects of anesthesia and paralysis on diaphragmatic mechanics in man. Anesthesiology 41: 242–255PubMedCrossRefGoogle Scholar
  27. 27.
    Fahy BG, Barnas GM, Flowers JL, Nagle SE, Njoku MJ (1995) The effects of increased abdominal pressure on lung and chest wall mechanics during laparoscopic surgery. Anesth Analg 81: 744–750PubMedGoogle Scholar
  28. 28.
    Cullen DJ, Coyle JP, Teplick R, Long MC (1989) Cardiovascular, pulmonary, and renal effects of massively increased intra-abdominal pressure in critically ill patients. Crit Care Med 17: 118–121PubMedCrossRefGoogle Scholar
  29. 29.
    Ridings PC, Bloomfield GL, Blocher GR, Sugerman HJ (1995) Cardiopulmonary effects of raised intra-abdominal pressure before and after intravascular volume expansion. J Trauma 39: 1071–1075PubMedCrossRefGoogle Scholar
  30. 30.
    Robotham IL, Wise RA, Bromberger-Barnea B (1985) Effects of changes in abdominal pressure on left ventricular performance and regional blood flow. Crit Care Med 13: 803–808PubMedCrossRefGoogle Scholar
  31. 31.
    Kelman GR (1972) Cardiac output and arterial blood-gas tension during laparoscopy. Br J Anaesth 44: 1155–1161PubMedCrossRefGoogle Scholar
  32. 32.
    Cheatham ML, Safcsak K, Block EF, Nelson LD (1999) Preload assessment in patients with an open abdomen. J Trauma 46: 16–22PubMedCrossRefGoogle Scholar
  33. 33.
    Bloomfield GL, Blocher GR, Falchry IF, Sica DA, Surgerman HJ (1997) Elevated intra-abdominal pressure increases plasma renin activity and aldosterone levels. J Trauma 42: 997 1003Google Scholar
  34. 34.
    Cheatham ML (1999) Intra-abdominal hypertension and compartment syndrome. New Horiz 2: 96–115Google Scholar
  35. 35.
    Bloomfield GL, Ridings PC, Blocher GR, Marmarou A, Sugerman JH (1997) A proposed relationship between increased intraabdominal, intrathoracic, and intracranial pressure. Crit Care Med 25: 496–503PubMedCrossRefGoogle Scholar
  36. 36.
    Saggi BH, Bloomfield Gl, Sugarman JH, et al (1999) Treatment of intracranial hypertension using nonsurgical abdominal decompression. J Trauma 46: 646–651PubMedCrossRefGoogle Scholar
  37. 37.
    Sugerman HJ, DeMaia EJ, Felton WL 3rd, Nakatsuka M, Sismarnis A (1997) Increased intra-abdominal pressure and cardiac filling pressure in obesity associated pseudotumor cerebri. Neurology 49: 507–511PubMedCrossRefGoogle Scholar
  38. 38.
    Sugerman HJ, Bloomfield GL, Saagi BW (1999) Multisystem organ failure secondary to increased intraabdominal pressure. Infection 27: 61–66PubMedCrossRefGoogle Scholar
  39. 39.
    Sugrue M, Jones F, Lee A, et al (1996) Intraabdominal pressure and gastric intramucosal pH: is there an association? World J Surg 20: 988–991PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2002

Authors and Affiliations

  • M. Del Turco
  • F. Giunta
  • V. M. Ranieri

There are no affiliations available

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