%0 Journal Article
%T Interaction between intra-abdominal pressure and positive-end expiratory pressure
%A Torquato
%A Jamili Anbar
%A Lucato
%A Jeanette Janaina Jaber
%A Antunes
%A Telma
%A Barbas
%A Carmen Valente
%J Clinics
%D 2009
%I Faculdade de Medicina / USP
%R 10.1590/S1807-59322009000200007
%X objective: the aim of this study was to quantify the interaction between increased intra-abdominal pressure and positive-end expiratory pressure. methods: in 30 mechanically ventilated icu patients with a fixed tidal volume, respiratory system plateau and abdominal pressure were measured at a positive-end expiratory pressure level of zero and 10 cm h2o. the measurements were repeated after placing a 5 kg weight on the patients' belly. results: after the addition of 5 kg to the patients' belly at zero positive-end expiratory pressure, both intra-abdominal pressure (p<0.001) and plateau pressures (p=0.005) increased significantly. increasing the positive-end expiratory pressure levels from zero to 10 cm h2o without weight on the belly did not result in any increase in intra-abdominal pressure (p=0.165). however, plateau pressures increased significantly (p< 0.001). increasing positive-end expiratory pressure from zero to 10 cm h2o and adding 5 kg to the belly increased intra-abdominal pressure from 8.7 to 16.8 (p<0.001) and plateau pressure from 18.26 to 27.2 (p<0.001). maintaining positive-end expiratory pressure at 10 cm h2o and placing 5 kg on the belly increased intra-abdominal pressure from 12.3 +/- 1.7 to 16.8 +/- 1.7 (p<0.001) but did not increase plateau pressure (26.6+/-1.2 to 27.2 +/-1.1 -p=0.83). conclusions: the addition of a 5kg weight onto the abdomen significantly increased both iap and the airway plateau pressure, confirming that intra-abdominal hypertension elevates the plateau pressure. however, plateau pressure alone cannot be considered a good indicator for the detection of elevated intra-abdominal pressure in patients under mechanical ventilation using peep. in these patients, the intra-abdominal pressure must also be measured.
%K respiratory mechanics
%K end-positive airway pressure
%K plateau pressures
%K intra-abdominal pressure
%K positive pressure mechanical ventilation.
%U http://www.scielo.br/scielo.php?script=sci_abstract&pid=S1807-59322009000200007&lng=en&nrm=iso&tlng=en