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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Vydané v:	Intensive care medicine Ročník 33; číslo 1; s. 163 - 171
Hlavní autori:	Duperret, Serge, Lhuillier, Franck, Piriou, Vincent, Vivier, Emmanuel, Metton, Olivier, Branche, Patricia, Annat, Guy, Bendjelid, Karim, Viale, Jean Paul
Médium:	Journal Article
Jazyk:	English
Vydavateľské údaje:	Heidelberg Springer 01.01.2007 Berlin Springer Nature B.V
Predmet:	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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Abstract	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.
AbstractList	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. 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. 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.OBJECTIVETo 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.DESIGN AND SETTINGExperimental study in a research laboratory.Seven mechanically ventilated and instrumented pigs prone to normovolaemia and hypovolaemia by blood withdrawal.SUBJECTSSeven 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.INTERVENTIONAbdominal 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.MEASUREMENTS AND MAIN RESULTSVariations 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.CONCLUSIONSIn 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.
Author	Lhuillier, Franck Duperret, Serge Metton, Olivier Bendjelid, Karim Vivier, Emmanuel Branche, Patricia Piriou, Vincent Annat, Guy Viale, Jean Paul
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Keywords	Hypertension Systolic pressure Intensive care Echocardiography Cardiovascular disease Pig Intra-abdominal hypertension Vertebrata Mammalia Arterial pressure Artiodactyla Hemodynamics Systolic pressure variations Ungulata Resuscitation
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Snippet	To evaluate the effect of increased intra-abdominal pressure (IAP) on the systolic and pulse pressure variations induced by positive pressure ventilation in a...
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SubjectTerms	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
Title	Increased intra-abdominal pressure affects respiratory variations in arterial pressure in normovolaemic and hypovolaemic mechanically ventilated healthy pigs
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