Effect of Positive End-Expiratory Pressure on Intra-Abdominal Pressure

Sussman, Anthony; Boyd, Carl; Williams, Judith V.; DiBenedetto, Robert J.

doi:10.1097/00132586-199204000-00004

Cited by 6 publications

(8 citation statements)

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“…On the other hand, the beneficial effects of PEEP ventilation for such patients, including improved oxygenation, increased functional residual capacity, and decreased intrapulmonary vascular shunting, have been established, although it is known that high levels of PEEP can result in diminished cardiac output, decreased venous return, and transient ischemia to the abdominal viscera. [10][11][12] The results of this study confirmed the negative influence of PEEP on splanchnic hemodynamics, even at a level as low as 5 cmH 2 O, being a pressure very often used in mechanically ventilated patients. At the level of 10 cmH 2 O of PEEP the intestinal and hepatic perfusion was found to be fully disturbed and splanchnic hypoxia became apparent.…”

Section: Discussionsupporting

confidence: 79%

Deterioration of Visceral Perfusion Caused by Intra-Abdominal Hypertension in Pigs Ventilated with Positive End-Expiratory Pressure

2000

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Experimental studies and clinical experience suggest that the combination of positive end-expiratory pressure (PEEP) ventilation and intra-abdominal hypertension might alter splanchnic hemodynamics to a significantly greater degree than the effect of either of them alone. Therefore, we assessed the intestinal and hepatic hemodynamics in two steps of PEEP ventilation, adding tense pneumoperitoneum in a pig model. The hepatic artery, portal vein, and superior mesenteric artery blood flow, as well as the hepatic and intestinal mucosal microcirculation, and the hepatic pO2 and intestinal mucosal pH, were assessed before, then with 5 cmH2O and 10 cmH2O PEEP alone, and in combination with a 12-mmHg pneumoperitoneum, in ten domestic pigs. Statistical analysis of the hepatic and intestinal measurements revealed a significant decrease (P = 0.001) in all parameters in relation to the baseline, during the 5-cmH2O and 10-mmH2O PEEP ventilation period. The addition of 12 mmHg intra-abdominal pressure led to an extreme deterioration in all parameters (P = 0.001), in relation to both the baseline and the 10-cmH2O PEEP measurement. These findings demonstrate that PEEP and intra-abdominal hypertension act cumulatively on the abdominal viscera, producing conditions of extremely low hypoperfusion and ischemia.

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Section: Discussionsupporting

confidence: 79%

Deterioration of Visceral Perfusion Caused by Intra-Abdominal Hypertension in Pigs Ventilated with Positive End-Expiratory Pressure

2000

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“…In another study that examined the effects of PEEP on IAP, Ferrer et al (18) observed that there was an increase in IAP with PEEP, which is similar to the results we obtained in this study. However, Sussman et al (19) reported that 15 cm H2O or less PEEP values did not have any effects on IAP. In the present study of ours, we determined that elevated PEEP values increased IAP.…”

Section: Discussionmentioning

confidence: 93%

Effects of increasing Positive End-Expiratory Pressure (PEEP) values on intraabdominal pressure and hemodynamics: A prospective clinical study

Dumanlidağ¹,

Yüzkat²,

Soyalp³

et al. 2019

Eastern J Med

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The most common reason for admission of patients to Intensive Care Units is respiratory insufficiency. In respiratory insufficiency treatment, mostly mechanical ventilation support is applied to patients. Positive End-Expiratory Pressure (PEEP) is an important parameter of mechanical ventilation. PEEP increases the pressure that occurs in the respiratory system during mechanical ventilation, and also contributes to oxygenation of the blood by improving the pulmonary oxygen exchange by opening the collapsed or fluid-filled alveoli (1-4). Although PEEP frequently saves lives, it also brings with it several hemodynamic complications. At times, the potential negative outcomes of high-level PEEP might be more than their benefits (5,6). PEEP also has impacts on the cardiovascular system according to the cardiovascular status, compliance with the respiratory system and its level. PEEP increases the airway and intrathoracic pressure, and reduces the venous return of the heart, which causes a reduction in the pre-load of the heart. This leads to a decrease in the cardiac pulse volume and average arterial pressure (7,8). In addition, it was also reported in several studies that PEEP decreases the mesenteric blood-flow (9). For this reason, it is recommended that the PEEP level is considered when interpreting the Intra-Abdominal Pressure (IAP) values in patients who receive mechanical ventilation (10-12). Both invasive and non-invasive methods are employed in the follow-up of patients in Intensive Care Units. The IAP follow-up is not carried out routinely because measurement methods are frequently considered to be invasive. For this reason, there must be a clear indication for measurement, which is the case in other invasive procedures. Normal Intra-Abdominal Pressure (IAP) has been ABSTRACT In the present study, the purpose was to compare the effects of Positive End-Expiratory Pressure (PEEP), which is applied to intensive care patients, on Intraabdominal Pressure (IAP) and hemodynamic parameters. The patients were selected from among the patients who received mechanical ventilator support and PEEP at various levels in Intensive Care Unit, who were between 18-80 years of age, who did not have abdominal surgery. In the present study, a total of 64 patients were divided into 3 groups. Those who had PEEP value at 4 cmH2O were included as Group 4, those with PEEP value between 5-8 cmH2O were included in Group 8, and those with PEEP value between 9-12 cmH2O were included in Group 12. The intraabdominal pressures, central venous and arterial blood press ures, heart rates, peripheral oxygen saturation values, body temperatures, fluid balances and urine volumes were measured at 0, 6, 12, 18 and 24 th hours. The Intra-Bladder Pressure Measurement Method was employed to measure the intra-abdominal pressure. The lowest IAP values were measured in Group 4, and the highest values were measured in Group 12. The IAP values that were measured in Group 12 were higher than the other groups at a significant level. The intra and inter-group b...

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“…6 Sussman et al found that PEEP up to 15 cm H 2 O did not affect IAP in 15 patients after laparotomy on mechanical ventilation. 13 Gattinoni et al 8 found about 10% transmission of PEEP in pulmonary ARDS (n ¼ 12) and 14% in extrapulmonary ARDS (n ¼ 9) with decreased chest wall compliance. Intra-abdominal hypertension was associated with a decreased chest wall compliance.…”

Section: Discussionmentioning

confidence: 98%

“…10,11 In small series of animals and humans (up to n ¼ 30), some of them reported in abstracts or personal communications only, transmission of PEEP to the abdomen has been reported to vary between 0% and 57%, particularly when baseline IAP is elevated above 12 mm Hg, and abdominal compliance is thus relatively low. [5][6][7][8][11][12][13] If the latter 57% would also apply to inspiratory airway pressure, IAP would be severely underestimated if measured at end expiration only.…”

Section: Introductionmentioning

confidence: 99%

Low Transmission of Airway Pressures to the Abdomen in Mechanically Ventilated Patients With or Without Acute Respiratory Failure and Intra-Abdominal Hypertension

Heijnen

Man

Groeneveld

2016

J Intensive Care Med

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Effect of Positive End-Expiratory Pressure on Intra-Abdominal Pressure

Cited by 6 publications

References 0 publications

Deterioration of Visceral Perfusion Caused by Intra-Abdominal Hypertension in Pigs Ventilated with Positive End-Expiratory Pressure

Deterioration of Visceral Perfusion Caused by Intra-Abdominal Hypertension in Pigs Ventilated with Positive End-Expiratory Pressure

Effects of increasing Positive End-Expiratory Pressure (PEEP) values on intraabdominal pressure and hemodynamics: A prospective clinical study

Low Transmission of Airway Pressures to the Abdomen in Mechanically Ventilated Patients With or Without Acute Respiratory Failure and Intra-Abdominal Hypertension

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