Changes in visceral blood flow with elevated intraabdominal pressure

Caldwell, Christopher B.; Ricotta, John J.

doi:10.1016/0883-9441(88)90051-2

Cited by 53 publications

(84 citation statements)

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“…At a P IA of 15·mmHg (a pressure achieved during treadmill exercise in V. exanthematicus) gastrointestinal blood flow was reduced by 20-40% in anesthetised neonatal lambs (Masey et al, 1985). Similar reductions in gastrointestinal blood flow were found in anesthetised dogs at P IA between 20 and 40·mmHg (Barnes et al, 1985;Caldwell and Ricotta, 1987).…”

supporting

confidence: 61%

“…However, high P IA (>10·mmHg) decreases inferior vena cava blood flow resulting in a decrease in venous return (Barnes et al, 1985;Diamant et al, 1978;Ivankovich et al, 1975;Kashtan et al, 1981;Lynch et al, 1974;Richardson and Trinkle, 1976). A reduction in blood flow to the abdominal organs (renal, superior mesenteric and celiac vasculatures) has also been demonstrated in response to elevated P IA (Barnes et al, 1985;Caldwell and Ricotta, 1987;Masey et al, 1985). At a P IA of 15·mmHg (a pressure achieved during treadmill exercise in V. exanthematicus) gastrointestinal blood flow was reduced by 20-40% in anesthetised neonatal lambs (Masey et al, 1985).…”

mentioning

confidence: 92%

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Elevated intra-abdominal pressure limits venous return during exercise inVaranus exanthematicus

Munns

Hartzler

Bennett

et al. 2004

Journal of Experimental Biology

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supporting

confidence: 61%

mentioning

confidence: 92%

Elevated intra-abdominal pressure limits venous return during exercise inVaranus exanthematicus

Munns

Hartzler

Bennett

et al. 2004

Journal of Experimental Biology

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“…They found that the rise in pressure had multiple effects that reduced vascular flow: i) direct mechanical pressure on the splanchnic vein, ii) triggering of myogenic reflexes within the walls of the splanchnic vein, and iii) mesenteric vasoconstriction due to release of vasoactive hormones. The hepatic perfusion and microvascular blood flow are all affected by elevated IAP (19,20). Increased IAP can reduce mesenteric blood flow (20), and thereby reduce arterial perfusion (19) and venous flow in the stomach, duodenum, small intestine, pancreas and spleen.…”

Section: Discussionmentioning

confidence: 99%

“…The hepatic perfusion and microvascular blood flow are all affected by elevated IAP (19,20). Increased IAP can reduce mesenteric blood flow (20), and thereby reduce arterial perfusion (19) and venous flow in the stomach, duodenum, small intestine, pancreas and spleen. The resulting intestinal ischemia creates free oxygen radicals.…”

Section: Discussionmentioning

confidence: 99%

Clinical significance of intestinal type fatty acid binding protein in patients undergoing coronary artery bypass surgery

Camkiran¹,

Dönmez²,

Aldemir³

et al. 2011

Anadolu Kardiyol Derg

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ÖZETAmaç: Çalışmamızın amacı, kardiyopulmoner baypas (KPB) uygulanan ve uygulanmayan (OPCAB) hastalarda intestinal iskemi ile intestinal yağ asidi bağlayıcı protein (I-FABP) arasında ilişki olup olmadığını belirlemektir. Yöntemler: Çalışma prospektif, gözlemsel olarak planlandı. Elektif koroner arter baypas greftleme cerrahisi uygulanacak 50-70 yaşları arasında hastalar ardışık olarak çalışmaya alındı. Kardiyopulmoner baypas uygulanan 35 hasta birinci grup (CPB), uygulanmayan 16 hasta ikinci grup (OPCAB) olarak kabul edildi. Gruplar arası ve grup içi karşılaştırmalar Student's t, Mann-Whitney U, Friedman ve Wilcoxon testleri ile analiz edildi. Bulgular: Kardiyopulmoner baypas uygulanan grubun I-FABP düzeylerinde operasyon sonunda, başlangıca göre anlamlı yükselme olurken (p<0.005), postoperatif 12. ve 24. saatlerde operasyon bitişine göre anlamlı düşme görüldü (sırasıyla p<0.001, p<0.001). Kardiyopulmoner baypas uygulanmayan grupta ise operasyon sonunda operasyon başlangıcına göre yükselme görülürken (p<0.001), postoperatif 24. saatte operasyon başlangıcına göre anlamlı düşme görüldü (p<0.001). Her iki grubun I-FABP düzeyleri cerrahi bitiminde preoperatif değerlere göre anlamlı şekilde yükseldi. Sonuç: Çalışmamız sırasında hiçbir hastamızda intestinal iskemi görülmezken, I-FABP düzeylerindeki değişiklik bize açık kalp cerrahisi geçiren hastalarda intestinal iskemi monitörizasyonunda I-FABP'nin kullanılabileceğini düşündürdü. ABSTRACTObjective: The aim of this study was to determine whether serum levels of intestinal type fatty acid binding protein (I-FABP) are related to intestinal ischemia in patients undergoing coronary bypass surgery. Methods: The study was planned as prospective, observational. Elective coronary artery bypass candidate patients between ages of 50 and 70 were consecutively included in the study. Thirty-five patients scheduled for cardiopulmonary bypass (CPB) were identified as the CPB group and 16 patients not scheduled for CPB were identified as the off-pump coronary artery bypass surgery (OPCAB) group. The variables between and within the groups were analyzed with Student's t, Mann-Whitney U, Friedman and Wilcoxon tests respectively. Results: In both CPB and OPCAB groups, I-FABP level at the end of the operation was significantly higher than that noted at the beginning of the operation (p<0.005). In the CPB group, there was a significant drop in I-FABP from the end of the operation to each of the postoperative time points (12 th hour and 24 th hour) (respectively p<0.001, p<0.001). In the OPCAB group, the I-FABP levels at both postoperative time points were lower than that at the end of the operation (p<0.001), and the level at 24-hour post-surgery was significantly lower than at both the end-of-operation I-FABP value (p<0.001) and the 12-hour post-surgery I-FABP value. Conclusion: Since we have not observed any intestinal ischemia through our research, slight changes of I-FABP measurements make us believe that I-FABP would be a valuable way to monitor for intestinal ischemia in patients w...

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“…It has also been proposed, that the use of a moderate level of PEEP might efficiently reduce the increase in ventricular afterload [37,40,76,77].…”

Section: Improvement Of Afterloadmentioning

confidence: 99%

What every ICU clinician needs to know about the cardiovascular effects caused by abdominal hypertension

Malbrain

Waele²,

Keulenaer³

2015

Anaesthesiol Intensive Ther

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The effects of increased intra-abdominal pressure (IAP) on cardiovascular function are well recognized and include a combined negative effect on preload, afterload and contractility. The aim of this review is to summarize the current knowledge on this topic. The presence of intra-abdominal hypertension (IAH) erroneously increases barometric filling pressures like central venous (CVP) and pulmonary artery occlusion pressure (PAOP) (since these are zeroed against atmospheric pressure). Transmural filling pressures (calculated by subtracting the pleural pressure from the end-expiratory CVP value) may better reflect the true preload status but are difficult to obtain at the bedside. Alternatively, since pleural pressures are seldom measured, transmural CVP can also be estimated by subtracting half of the IAP from the end-expiratory CVP value, since abdominothoracic transmission is on average 50%. Volumetric preload indicators, such as global and right ventricular end-diastolic volumes or the left ventricular end-diastolic area, also correlate better with true preload. When using functional hemodynamic monitoring parameters like stroke volume variation (SVV) or pulse pressure variation (PPV) one must bear in mind that increased IAP will increase these values (via a concomitant increase in intrathoracic pressure). The passive leg raising test may be a false negative in IAH. Calculation of the abdominal perfusion pressure (as mean arterial pressure minus IAP) has been shown to be a better resuscitation endpoint than IAP alone. Finally, it is re-assuring that transpulmonary thermodilution techniques have been validated in the setting of IAH and abdominal compartment syndrome. In conclusion, the clinician must be aware of the different effects of IAH on cardiovascular function in order to assess the volume status accurately and to optimize hemodynamic performance.

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Changes in visceral blood flow with elevated intraabdominal pressure

Cited by 53 publications

References 0 publications

Elevated intra-abdominal pressure limits venous return during exercise inVaranus exanthematicus

Elevated intra-abdominal pressure limits venous return during exercise inVaranus exanthematicus

Clinical significance of intestinal type fatty acid binding protein in patients undergoing coronary artery bypass surgery

What every ICU clinician needs to know about the cardiovascular effects caused by abdominal hypertension

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