Increased intra-abdominal pressure affects respiratory variations in arterial pressure in normovolaemic and hypovolaemic mechanically ventilated healthy pigs

To evaluate the effect of increased intra-abdominal pressure (IAP) on the systolic and pulse pressure variations induced by positive pressure ventilation in a porcine model. Experimental study in a research laboratory. Seven mechanically ventilated and instrumented pigs prone to normovolaemia and hy...

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Published in:Intensive care medicine Vol. 33; no. 1; pp. 163 - 171
Main Authors: Duperret, Serge, Lhuillier, Franck, Piriou, Vincent, Vivier, Emmanuel, Metton, Olivier, Branche, Patricia, Annat, Guy, Bendjelid, Karim, Viale, Jean Paul
Format: Journal Article
Language:English
Published: Heidelberg Springer 01.01.2007
Berlin Springer Nature B.V
Subjects:
Abdomen
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Anesthesiology
Animals
Biological and medical sciences
Blood Pressure
Catheters
Emergency and intensive respiratory care
Hogs
Hypovolemia - physiopathology
Injuries of the thorax. Foreign bodies. Diseases due to physical agents
Intensive care
Intensive care medicine
Medical sciences
Positive-Pressure Respiration
Pressure
Respiration
Swine
Traumas. Diseases due to physical agents
Ultrasonic imaging
Ventilators
France
Hypertension
Systolic pressure
Intensive care
Echocardiography
Cardiovascular disease
Pig
Intra-abdominal hypertension
Vertebrata
Mammalia
Arterial pressure
Artiodactyla
Hemodynamics
Systolic pressure variations
Ungulata
Resuscitation
ISSN:0342-4642, 1432-1238
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Summary:To evaluate the effect of increased intra-abdominal pressure (IAP) on the systolic and pulse pressure variations induced by positive pressure ventilation in a porcine model. Experimental study in a research laboratory. Seven mechanically ventilated and instrumented pigs prone to normovolaemia and hypovolaemia by blood withdrawal. Abdominal banding gradually increased IAP in 5-mmHg steps up to 30 mmHg. Variations in systolic pressure, pulse pressure, inferior vena cava flow, and pleural and transmural (LVEDPtm) left-ventricular end-diastolic pressure were recorded at each step. Systolic pressure variations were 6.1+/-3.1%, 8.5+/-3.6% and 16.0+/-5.0% at 0, 10, and 30 mmHg IAP in normovolaemic animals (mean+/-SD; p<0.01 for IAP effect). They were 12.7+/-4.6%, 13.4+/-6.7%, and 23.4+/-6.3% in hypovolaemic animals (p<0.01 vs normovolaemic group) for the same IAP. Fluctuations of the inferior vena cava flow disappeared as the IAP increased. Breath cycle did not induce any variations of LVEDPtm for 0 and 30 mmHg IAP. In this model, the systolic pressure and pulse pressure variations, and inferior vena cava flow fluctuations were dependent on IAP values which caused changes in pleural pressure swing, and this dependency was more marked during hypovolaemia. The present study suggests that dynamic indices are not exclusively related to volaemia in the presence of increased IAP. However, their fluid responsiveness predictive value could not be ascertained as no fluid challenge was performed.
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ISSN:0342-4642
1432-1238
DOI:10.1007/s00134-006-0412-2