Document Detail


Effects of abdominal decompression on cardiopulmonary function and visceral perfusion in patients with intra-abdominal hypertension.
MedLine Citation:
PMID:  9529169     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Increased intra-abdominal pressure (IAP) compromises cardiopulmonary function and visceral perfusion. Our goal was to characterize acute changes in these subsystems associated with operative abdominal decompression. PATIENT POPULATION: A series of 11 consecutive injured patients monitored with a pulmonary artery catheter and nasogastric tonometer in whom operative decompression was performed. Indications for decompression included oliguria or progressive acidosis despite aggressive resuscitation in the presence of elevated IAP (>25 mm Hg). MAIN OUTCOME MEASURES: Studied hemodynamic variables included pulmonary artery occlusion pressure (PAOP), right ventricular end-diastolic volume index (RVEDVI), and cardiac index (CI). Pulmonary variables included shunt fraction (Qs/Qt) and dynamic compliance (Cdyn). Visceral perfusion was assessed using hourly urine output 4 hours before and after decompression (UOP) and gastric intramucosal pH (pHi). Mean values before and after decompression were compared using the paired t test. Linear regression and Fisher's z transformation were used to evaluate the relationships between RVEDVI, PAOP, CI, and IAP. IAP was transduced via bladder pressures. Significance was defined as p < 0.05. Data are expressed as means+/-SD. RESULTS: IAP decreased with decompression (49+/-11 to 19+/-6.8 mm Hg; p < 0.0001). RVEDVI improved independent of CI and correlated better (p < 0.01) with CI (r =0.49, p=0.04) than PAOP did (r=-0.36, p=0.09). PAOP correlated significantly with IAP (r=0.45, p=0.04). Decompression resulted in significant improvements in Qs/Qt, Cdyn, UOP, and pHi. CONCLUSION: Abdominal decompression in patients with increased IAP improves preload, pulmonary function, and visceral perfusion. Elevated IAP has important effects on PAOP, which makes the PAOP an unreliable index of preload in these patients.
Authors:
M C Chang; P R Miller; R D'Agostino; J W Meredith
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Publication Detail:
Type:  Clinical Trial; Controlled Clinical Trial; Journal Article    
Journal Detail:
Title:  The Journal of trauma     Volume:  44     ISSN:  0022-5282     ISO Abbreviation:  J Trauma     Publication Date:  1998 Mar 
Date Detail:
Created Date:  1998-04-09     Completed Date:  1998-04-09     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0376373     Medline TA:  J Trauma     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  440-5     Citation Subset:  AIM; IM; S    
Affiliation:
Department of General Surgery, The Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA.
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MeSH Terms
Descriptor/Qualifier:
Abdominal Injuries / complications*
Adolescent
Adult
Female
Hemodynamics
Humans
Hypertension / etiology,  physiopathology*,  therapy*
Linear Models
Lower Body Negative Pressure*
Lung Compliance
Male
Middle Aged
Prospective Studies
Pulmonary Circulation
Resuscitation / methods
Viscera / blood supply

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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