Adrian Regli1, Bart Leon De Keulenaer2, Annamaria Palermo3, Peter Vernon van Heerden4. 1. Intensive Care Unit, Fremantle Hospital, Alma Street, Fremantle, WA 6160, Australia; Intensive Care Unit, Fiona Stanley Hospital, 102-118 Murdoch Drive, Murdoch, WA 6150, Australia; School of Medicine and Pharmacology, The University of Western Australia, Sterling Highway, Crawley, (Perth) WA 6009, Australia; Medical School, The Notre Dame University, Henry Road, Fremantle, WA 6160, Australia. Electronic address: adrian.regli@gmail.com. 2. Intensive Care Unit, Fremantle Hospital, Alma Street, Fremantle, WA 6160, Australia; Intensive Care Unit, Fiona Stanley Hospital, 102-118 Murdoch Drive, Murdoch, WA 6150, Australia; School of Surgery, The University of Western Australia, Sterling Highway, Crawley, (Perth) WA 6009, Australia. Electronic address: bdekeul@hotmail.com. 3. Intensive Care Unit, Fremantle Hospital, Alma Street, Fremantle, WA 6160, Australia; Intensive Care Unit, Fiona Stanley Hospital, 102-118 Murdoch Drive, Murdoch, WA 6150, Australia. Electronic address: anna.palermo@health.wa.gov.au. 4. School of Medicine and Pharmacology, The University of Western Australia, Sterling Highway, Crawley, (Perth) WA 6009, Australia; General Intensive Care Unit, Hadassah University Hospital, Kiryat Hadassah, Jerusalem 91120, Israel. Electronic address: vernon@hadassah.org.il.
Abstract
PURPOSE: Intra-abdominal hypertension (IAH) is associated with impaired respiratory function. Animal data suggest that positive end-expiratory pressure (PEEP) levels adjusted to intra-abdominal pressure (IAP) levels may counteract IAH-induced respiratory dysfunction. In this pilot study, our aim was to assess whether PEEP adjusted for IAP can be applied safely in patients with IAH. MATERIALS AND METHODS: We included patients on mechanical ventilation and with IAH. Patients were excluded with severe cardiovascular dysfunction or severe hypoxemia or if the patient was in imminent danger of dying. Following a recruitment manoeuvre, the following PEEP levels were randomly applied: PEEP of 5cmH2O (baseline), PEEP=50% of IAP, and PEEP=100% of IAP. After a 30min equilibration period we measured arterial blood gases and cardio-respiratory parameters. RESULTS: Fifteen patients were enrolled. Six (41%) patients did not tolerate PEEP=100% IAP due to hypoxemia, hypotension or endotracheal cuff leak. PaO2/FiO2 ratios were 234 (68), 271 (99), and 329 (107) respectively. The differences were significant (p=0.009) only between baseline and PEEP=100% IAP. CONCLUSIONS: PEEP=100% of IAP was not well-tolerated and only marginally improved oxygenation in ventilated patients with IAH.
PURPOSE: Intra-abdominal hypertension (IAH) is associated with impaired respiratory function. Animal data suggest that positive end-expiratory pressure (PEEP) levels adjusted to intra-abdominal pressure (IAP) levels may counteract IAH-induced respiratory dysfunction. In this pilot study, our aim was to assess whether PEEP adjusted for IAP can be applied safely in patients with IAH. MATERIALS AND METHODS: We included patients on mechanical ventilation and with IAH. Patients were excluded with severe cardiovascular dysfunction or severe hypoxemia or if the patient was in imminent danger of dying. Following a recruitment manoeuvre, the following PEEP levels were randomly applied: PEEP of 5cmH2O (baseline), PEEP=50% of IAP, and PEEP=100% of IAP. After a 30min equilibration period we measured arterial blood gases and cardio-respiratory parameters. RESULTS: Fifteen patients were enrolled. Six (41%) patients did not tolerate PEEP=100% IAP due to hypoxemia, hypotension or endotracheal cuff leak. PaO2/FiO2 ratios were 234 (68), 271 (99), and 329 (107) respectively. The differences were significant (p=0.009) only between baseline and PEEP=100% IAP. CONCLUSIONS: PEEP=100% of IAP was not well-tolerated and only marginally improved oxygenation in ventilated patients with IAH.