Skip to main content
SpringerLink
Log in

Einfluss einer Volumenzunahme auf den intraabdominellen Druck

Influence of volume increase on intra-abdominal pressure

  • Medizin aktuell
  • Published:
Der Anaesthesist Aims and scope Submit manuscript

Zusammenfassung

Ziel dieser Übersicht ist die Zusammenfassung physiologischer und pathologischer Aspekte der Beziehung zwischen intraabdomineller Volumenzunahme und Steigerung des intraabdominellen Drucks („intra-abdominal pressure“, IAP). Ein Kapillarleck infolge von Trauma oder Entzündung kann eine Volumenverschiebung ins Abdomen verursachen. Der IAP-Anstieg wird durch die „compliance“ beeinflusst, die durch erhöhte Druck- und Volumenzunahme sowie durch aufrechte Körperposition und erhöhten Body-Mass-Index (BMI) vermindert wird. Eine pathologische Steigerung des IAP (>12 mmHg) hängt von der Menge und Art des verabreichten Flüssigkeitsersatzes ab und bedingt eine erhöhte Morbidität und Mortalität. Kolloide oder hypertone Lösungen können den IAP verringern, jedoch ist die Datengrundlage noch unzureichend. Therapeutische Optionen sind daher IAP-Monitoring und Dekompression.

Abstract

The aim of this review is to summarize the physiological and pathological aspects of the relationship between volume and intra-abdominal pressure (IAP). A capillary leak following trauma or inflammation can induce a volume shift into the abdomen. An increase of the IAP depends on the abdominal compliance, which is reduced by increases in intra-abdominal volume and pressure as well as by an upright body position and obesity. A pathological increase of IAP (>12 mmHg) depends on the amount and type of resuscitation volume and is known to cause increased morbidity und mortality. Colloids or hypertensive solutions can reduce IAP however, current data are still insufficient. Therapeutic options are IAP monitoring and decompression.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2

Literatur

  1. Abu-Rafea B, Vilos GA, Vilos AG et al (2006) Effect of body habitus and parity on insufflated CO2 volume at various intraabdominal pressures during laparoscopic access in women. J Minim Invasive Gynecol 13:205–210

    Article  PubMed  Google Scholar 

  2. Balogh Z, McKinley BA, Cocanour CS et al (2003) Supranormal trauma resuscitation causes more cases of abdominal compartment syndrome. Arch Surg 138:637–643

    Article  PubMed  Google Scholar 

  3. Cala SJ, Edyvean J, Engel LA (1993) Abdominal compliance, parasternal activation and chest wall motion. J Appl Physiol 74:1398–1405

    Article  PubMed  CAS  Google Scholar 

  4. Cheatham ML, Malbrain ML, Kirkpatrick A et al (2007) Results from the International Conference of Experts on Intra-Abdominal Hypertension and Abdominal Compartment Syndrome. II. Recommendations. Intensive Care Med 33:951–962

    Article  PubMed  Google Scholar 

  5. Cohen D, Timbs AE, Dalton KJ (1986) Measurement of compliance of the maternal abdominal wall in pregnancy. Eur J Obstet Gynecol Reprod Biol 23:267–272

    Article  PubMed  CAS  Google Scholar 

  6. Cotton BA, Guy JS, Morris JA Jr, Abumrad NN (2006) The cellular, metabolic and systemic consequences of aggressive fluid resuscitation strategies. Shock 26:115–121

    Article  PubMed  CAS  Google Scholar 

  7. Daugherty EL, Hongyan L, Taichman D et al (2007) Abdominal compartment syndrome is common in medical intensive care unit patients receiving large-volume resuscitation. J Intensive Care Med 22:294–299

    Article  PubMed  Google Scholar 

  8. De Laet I, Malbrain ML (2007) ICU management of the patient with intra-abdominal hypertension: what to do, when and to whom? Acta Clin Belg Suppl 1:190–199

    Google Scholar 

  9. De Waele JJ, Hoste EA, Malbrain ML (2006) Decompressive laparotomy for abdominal compartment syndrome – a critical analysis. Crit Care 10:R51

    Article  Google Scholar 

  10. Eleftheriadis E, Kotzampassi K, Botsios D et al (1996) Splanchnic ischemia during laparoscopic cholecystectomy. Surg Endosc 10:324–326

    Article  PubMed  CAS  Google Scholar 

  11. Fietsam R, Villalba M, Glover JL, Clark K (1989) Intra-abdominal compartment syndrome as a complication of ruptured abdominal aortic aneurysm repair. Am Surg 55:396–402

    PubMed  Google Scholar 

  12. Gilroy RJ Jr, Lavietes MH, Loring SH et al (1985) Respiratory mechanical effects of abdominal distension. J Appl Physiol 58:1997–2003

    PubMed  Google Scholar 

  13. Kashtan J, Green JF, Parsons EQ, Holcroft JW (1981) Hemodynamic effect of increased abdominal pressure. J Surg Res 30:249–255

    Article  PubMed  CAS  Google Scholar 

  14. Kirkpatrick AW, Balogh Z, Ball CG et al (2006) The secondary abdominal compartment syndrome: iatrogenic or unavoidable? J Am Coll Surg 202:668–679

    Article  PubMed  Google Scholar 

  15. Kirkpatrick AW, Colistro R, Laupland KB et al (2006) Renal arterial resistive index response to intraabdominal hypertension in a porcine model. Crit Care Med 35:207–213

    Article  Google Scholar 

  16. Malbrain ML, Chiumello D, Pelosi P et al (2005) Incidence and prognosis of intraabdominal hypertension in a mixed population of critically ill patients: a multiple-center epidemiological study. Crit Care Med 33:315–322

    Article  PubMed  Google Scholar 

  17. Malbrain ML, Chiumello D, Pelosi P et al (2004) Prevalence of intra-abdominal hypertension in critically ill patients: a multicentre epidemiological study. Intensive Care Med 30:822–829

    Article  PubMed  Google Scholar 

  18. Malbrain ML, Wilmer A (2007) The polycompartment syndrome: towards an understanding of the interactions between different compartments! Intensive Care Med 33:1869–1872

    Article  PubMed  Google Scholar 

  19. McDougall EM, Figenshau RS, Clayman RV et al (1994) Laparoscopic pneumoperitoneum: impact of body habitus. J Laparoendosc Surg 4:385–391

    PubMed  CAS  Google Scholar 

  20. O’Mara MS, Slater H, Goldfarb IW, Caushaj PF (2005) A prospective, randomized evaluation of intra-abdominal pressures with crystalloid and colloid resuscitation in burn patients. J Trauma 58:1011–1018

    Article  Google Scholar 

  21. Oda J, Ueyama M, Yamashita K et al (2006) Hypertonic lactated saline resuscitation reduces the risk of abdominal compartment syndrome in severely burned patients. J Trauma 60:64–71

    Article  PubMed  CAS  Google Scholar 

  22. Reed SF, Britt RC, Collins J et al (2006) Aggressive surveillance and early catheter-directed therapy in the management of intra-abdominal hypertension. J Trauma 61:1359–1363

    Article  PubMed  Google Scholar 

  23. Schachtrupp A, Jansen M, Bertram P et al (2006) Abdominal compartment syndrome: significance, diagnosis and treatment. Anaesthesist 55:660–667

    Article  PubMed  CAS  Google Scholar 

  24. Schachtrupp A, Lawong G, Afify M et al (2005) Fluid resuscitation preserves cardiac output but cannot prevent organ damage in a porcine model during 24 h of intraabdominal hypertension. Shock 24:153–158

    Article  PubMed  Google Scholar 

  25. Sugrue M, Jones F, Deane SA et al (1999) Intra-abdominal hypertension is an independent cause of postoperative renal impairment. Arch Surg 134:1082–1085

    Article  PubMed  CAS  Google Scholar 

  26. World Society of the Abdominal Compartment Syndrome (WSACS) (2007) Consensus definitions and recommendations. http://www.wsacs.org/

Download references

Interessenkonflikt

Der Autor ist außerplanmäßige Lehrkraft der Chirurgischen Universitätsklinik und Poliklinik der RWTH Aachen und Mitarbeiter der B.Braun-AG in Melsungen. Die B.Braun-AG vertreibt keine Produkte, die speziell zur Prävention, Diagnostik oder Therapie des abdominellen Drucks zugelassen sind. Es besteht kein Interessenkonflikt.

Author information

Authors and Affiliations

  1. Stabsabteilung Medizinische Wissenschaft, B. Braun- Melsungen AG, Carl- Braun Str. 1, 34243, Melsungen, Deutschland

    A. Schachtrupp

Authors
  1. A. Schachtrupp
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. Schachtrupp.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Schachtrupp, A. Einfluss einer Volumenzunahme auf den intraabdominellen Druck. Anaesthesist 58, 532–536 (2009). https://doi.org/10.1007/s00101-009-1534-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00101-009-1534-z

Schlüsselwörter

Keywords

Search

Navigation