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

Bram G.A.D.H. Heijnen, Angelique M.E. Spoelstra-De Man, A. B.Johan Groeneveld

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Purpose: Intra-abdominal pressure, measured at end expiration, may depend on ventilator settings and transmission of intrathoracic pressure. We determined the transmission of positive intrathoracic pressure during mechanical ventilation at inspiration and expiration into the abdominal compartment. Methods and Results: We included 9 patients after uncomplicated cardiac surgery and 9 with acute respiratory failure. Intravesical pressures were measured thrice (reproducibility of 1.8%) and averaged, at the end of each inspiratory and expiratory hold maneuvers of 5 seconds. Transmission, the change in intra-abdominal over intrathoracic pressures from end inspiration to end expiration, was about 8%. End-expiratory intra-abdominal pressure was lower than "total" intra-abdominal pressure over the entire respiratory cycle by 0.34 cm H2O. It was 0.73 cm H2O higher than "true" intra-abdominal pressure over the entire respiratory cycle, taking transmission into account. The percentage error was 3% for total and 10% for true pressure. Results did not differ among patients with or without acute respiratory failure and decreased respiratory compliance or between those with (≥12 mm Hg, n = 5) or without intra-abdominal hypertension. Conclusions: Transmitted airway pressure only slightly affects intra-abdominal pressure in mechanically ventilated patients, irrespective of respiratory compliance and baseline intra-abdominal pressure values. End-expiratory measurements referenced against atmospheric pressure may suffice for clinical practice.

Original languageEnglish
Pages (from-to)218-222
Number of pages5
JournalJournal of Intensive Care Medicine
Volume32
Issue number3
DOIs
Publication statusPublished - 2017

Cite this

@article{ec4d70960c324a33a0fe88044910655a,
title = "Low Transmission of Airway Pressures to the Abdomen in Mechanically Ventilated Patients with or Without Acute Respiratory Failure and Intra-Abdominal Hypertension",
abstract = "Purpose: Intra-abdominal pressure, measured at end expiration, may depend on ventilator settings and transmission of intrathoracic pressure. We determined the transmission of positive intrathoracic pressure during mechanical ventilation at inspiration and expiration into the abdominal compartment. Methods and Results: We included 9 patients after uncomplicated cardiac surgery and 9 with acute respiratory failure. Intravesical pressures were measured thrice (reproducibility of 1.8{\%}) and averaged, at the end of each inspiratory and expiratory hold maneuvers of 5 seconds. Transmission, the change in intra-abdominal over intrathoracic pressures from end inspiration to end expiration, was about 8{\%}. End-expiratory intra-abdominal pressure was lower than {"}total{"} intra-abdominal pressure over the entire respiratory cycle by 0.34 cm H2O. It was 0.73 cm H2O higher than {"}true{"} intra-abdominal pressure over the entire respiratory cycle, taking transmission into account. The percentage error was 3{\%} for total and 10{\%} for true pressure. Results did not differ among patients with or without acute respiratory failure and decreased respiratory compliance or between those with (≥12 mm Hg, n = 5) or without intra-abdominal hypertension. Conclusions: Transmitted airway pressure only slightly affects intra-abdominal pressure in mechanically ventilated patients, irrespective of respiratory compliance and baseline intra-abdominal pressure values. End-expiratory measurements referenced against atmospheric pressure may suffice for clinical practice.",
keywords = "abdominal compliance, acute respiratory distress syndrome, acute respiratory failure, intra-abdominal hypertension, positive end-expiratory pressures, respiratory compliance",
author = "Heijnen, {Bram G.A.D.H.} and {Spoelstra-De Man}, {Angelique M.E.} and Groeneveld, {A. B.Johan}",
year = "2017",
doi = "10.1177/0885066615625180",
language = "English",
volume = "32",
pages = "218--222",
journal = "Journal of Intensive Care Medicine",
issn = "0885-0666",
publisher = "SAGE Publications Inc.",
number = "3",

}

Low Transmission of Airway Pressures to the Abdomen in Mechanically Ventilated Patients with or Without Acute Respiratory Failure and Intra-Abdominal Hypertension. / Heijnen, Bram G.A.D.H.; Spoelstra-De Man, Angelique M.E.; Groeneveld, A. B.Johan.

In: Journal of Intensive Care Medicine, Vol. 32, No. 3, 2017, p. 218-222.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Low Transmission of Airway Pressures to the Abdomen in Mechanically Ventilated Patients with or Without Acute Respiratory Failure and Intra-Abdominal Hypertension

AU - Heijnen, Bram G.A.D.H.

AU - Spoelstra-De Man, Angelique M.E.

AU - Groeneveld, A. B.Johan

PY - 2017

Y1 - 2017

N2 - Purpose: Intra-abdominal pressure, measured at end expiration, may depend on ventilator settings and transmission of intrathoracic pressure. We determined the transmission of positive intrathoracic pressure during mechanical ventilation at inspiration and expiration into the abdominal compartment. Methods and Results: We included 9 patients after uncomplicated cardiac surgery and 9 with acute respiratory failure. Intravesical pressures were measured thrice (reproducibility of 1.8%) and averaged, at the end of each inspiratory and expiratory hold maneuvers of 5 seconds. Transmission, the change in intra-abdominal over intrathoracic pressures from end inspiration to end expiration, was about 8%. End-expiratory intra-abdominal pressure was lower than "total" intra-abdominal pressure over the entire respiratory cycle by 0.34 cm H2O. It was 0.73 cm H2O higher than "true" intra-abdominal pressure over the entire respiratory cycle, taking transmission into account. The percentage error was 3% for total and 10% for true pressure. Results did not differ among patients with or without acute respiratory failure and decreased respiratory compliance or between those with (≥12 mm Hg, n = 5) or without intra-abdominal hypertension. Conclusions: Transmitted airway pressure only slightly affects intra-abdominal pressure in mechanically ventilated patients, irrespective of respiratory compliance and baseline intra-abdominal pressure values. End-expiratory measurements referenced against atmospheric pressure may suffice for clinical practice.

AB - Purpose: Intra-abdominal pressure, measured at end expiration, may depend on ventilator settings and transmission of intrathoracic pressure. We determined the transmission of positive intrathoracic pressure during mechanical ventilation at inspiration and expiration into the abdominal compartment. Methods and Results: We included 9 patients after uncomplicated cardiac surgery and 9 with acute respiratory failure. Intravesical pressures were measured thrice (reproducibility of 1.8%) and averaged, at the end of each inspiratory and expiratory hold maneuvers of 5 seconds. Transmission, the change in intra-abdominal over intrathoracic pressures from end inspiration to end expiration, was about 8%. End-expiratory intra-abdominal pressure was lower than "total" intra-abdominal pressure over the entire respiratory cycle by 0.34 cm H2O. It was 0.73 cm H2O higher than "true" intra-abdominal pressure over the entire respiratory cycle, taking transmission into account. The percentage error was 3% for total and 10% for true pressure. Results did not differ among patients with or without acute respiratory failure and decreased respiratory compliance or between those with (≥12 mm Hg, n = 5) or without intra-abdominal hypertension. Conclusions: Transmitted airway pressure only slightly affects intra-abdominal pressure in mechanically ventilated patients, irrespective of respiratory compliance and baseline intra-abdominal pressure values. End-expiratory measurements referenced against atmospheric pressure may suffice for clinical practice.

KW - abdominal compliance

KW - acute respiratory distress syndrome

KW - acute respiratory failure

KW - intra-abdominal hypertension

KW - positive end-expiratory pressures

KW - respiratory compliance

UR - http://www.scopus.com/inward/record.url?scp=85011685063&partnerID=8YFLogxK

U2 - 10.1177/0885066615625180

DO - 10.1177/0885066615625180

M3 - Article

VL - 32

SP - 218

EP - 222

JO - Journal of Intensive Care Medicine

JF - Journal of Intensive Care Medicine

SN - 0885-0666

IS - 3

ER -