| Sonographic assessment of abdominal vein dimensional and hemodynamic changes induced in human volunteers by a model of abdominal hypertension. | |
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MedLine Citation:
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PMID: 21099427 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: In patients affected by intra-abdominal hypertension, bladder or gastric pressure measurement may be usefully integrated by ultrasounds in order to detect early hemodynamic impairment. The purpose of this study was to search for changes in abdominal vein size and flow induced by intra-abdominal hypertension. DESIGN: Physiologic study. SETTING: Postoperative intensive care unit of a university hospital. SUBJECTS: Sixteen healthy volunteers. INTERVENTIONS: Four echographic assessments of vessel sizes and blood velocities were randomly performed in the following settings: 1) baseline, 2) intra-abdominal hypertension simulated by a tight pelvic stabilizer around the waist, 3) noninvasive ventilation with a facial mask, and 4) intra-abdominal hypertension plus noninvasive ventilation. MEASUREMENTS AND MAIN RESULTS: The model of intra-abdominal hypertension was validated in eight subjects by measuring gastric pressure. During intra-abdominal hypertension, 1) the inferior vena cava was compressed (significant decrease of both anteroposterior and lateral diameters) and deformed (decreased anteroposterior/lateral diameter ratio), and deformation, but not compression, was attenuated by noninvasive ventilation associated with intra-abdominal hypertension; 2) the portal vein was also compressed (decreased diameter); and 3) blood velocities did not change significantly in the inferior vena cava, portal vein, right suprahepatic vein, or right external iliac vein. In the receiver operating characteristic curve analysis, an inferior vena cava section area (normalized for body surface) of lower than 1 cm²/m² discriminated between intra-abdominal hypertension presence and absence with a sensitivity of 65.6% and a specificity of 87.5% (p = .0001). Noninvasive ventilation alone did not significantly affect vein sizes and velocities. The resistive index, calculated by pulse wave Doppler signal from segmental branches of the right renal artery, increased slightly, but significantly, during intra-abdominal hypertension alone, suggesting an increase of intrarenal pressure. CONCLUSIONS: Simulated intra-abdominal hypertension was associated with decreased inferior vena cava section area and increased resistive index in renal arteries. Further studies are now needed to investigate whether these changes may be of value to integrate bladder or gastric pressure measurement in clinical practice. |
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Authors:
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Franco Cavaliere; Alessandro Cina; Daniele Biasucci; Roberta Costa; Maurizio Soave; Riccardo Gargaruti; Lorenzo Bonomo; Rodolfo Proietti |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Critical care medicine Volume: 39 ISSN: 1530-0293 ISO Abbreviation: Crit. Care Med. Publication Date: 2011 Feb |
Date Detail:
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Created Date: 2011-01-20 Completed Date: 2011-03-04 Revised Date: 2011-09-02 |
Medline Journal Info:
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Nlm Unique ID: 0355501 Medline TA: Crit Care Med Country: United States |
Other Details:
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Languages: eng Pagination: 344-8 Citation Subset: AIM; IM |
Affiliation:
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Institute of Anaesthesia and Intensive Care, Catholic University of Sacred Heart, Rome, Italy. f.cavaliere@rm.unicatt.it |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Abdomen
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blood supply Abdominal Cavity* Adult Compartment Syndromes / ultrasonography* Female Hemodynamics / physiology Humans Hypertension / physiopathology Intensive Care Units Male Middle Aged Models, Anatomic Models, Cardiovascular Reference Values Sampling Studies Ultrasonography, Doppler / methods Veins / physiopathology, ultrasonography* Young Adult |
| Comments/Corrections | |
Comment In:
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Crit Care Med. 2011 Aug;39(8):2017; author reply 2017
[PMID:
21768818
]
Crit Care Med. 2011 Feb;39(2):411-2 [PMID: 21248527 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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