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

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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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Authors and Affiliations

  1. Intensive Care Unit, Liverpool Hospital, University of New South Wales, Elizabeth St, Liverpool, Sydney, NSW, 1871, Australia

    Evelina Sturini, Andrea Saporito, Michael J. A. Parr & Gillian Bishop

  2. Trauma Department, Liverpool Hospital, University of New South Wales, Elizabeth St, Liverpool, Sydney, NSW, 1871, Australia

    Michael Sugrue

  3. Cattedra di Anestesia e Rianimazione, Università degli Studi di Pavia, IRCCS Policlinico San Matteo, P.zzale Golgi 2, 27100, Pavia, Italy

    Antonio Braschi

  4. via 26 Aprile 2, 27040, Verrua Po, PV, Italy

    Evelina Sturini

Authors
  1. Evelina Sturini
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  2. Andrea Saporito
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  3. Michael Sugrue
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  4. Michael J. A. Parr
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  5. Gillian Bishop
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  6. Antonio Braschi
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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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  • DOI: https://doi.org/10.1007/s00134-008-1155-z

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