Format

Send to

Choose Destination
See comment in PubMed Commons below
Arch Surg. 1995 May;130(5):544-7; discussion 547-8.

Increases in intra-abdominal pressure affect pulmonary compliance.

Author information

  • 1Department of Surgery, Henry Ford Hospital, Detroit, Mich, USA.

Abstract

OBJECTIVES:

To determine the effect of increased intra-abdominal pressure (IAP) on pulmonary compliance and to determine an effective means to measure IAP.

DESIGN:

A prospective study.

SETTING:

An urban tertiary care hospital.

PATIENTS:

Twenty-six adult patients undergoing laparoscopic cholecystectomy.

INTERVENTIONS:

Intra-operative management of laparoscopic cholecystectomy requiring endotracheal intubation with general anesthesia, nasogastric and urinary bladder catheters, and position changes. Additional interventions included use of a rectal manometer and a respiratory pressure module inserted within the ventilator circuit.

MAIN OUTCOME MEASURES:

Correlation of changes in IAP with changes in dynamic pulmonary compliance, measured as tidal volume/(end inspiratory pressure--end expiratory pressure) and comparison of three different measurement techniques (bladder, rectal, and gastric) with a standard technique (insufflation pressure) in three different positions (supine, Trendelenburg's, and reverse Trendelenburg's).

RESULTS:

Compliance was significantly related to insufflation pressure (P < .001) by analysis of variance. In the gas insufflation model, the mean increment in bladder pressure reflected most closely the IAP increment in the supine position (5.7 vs 6 mm Hg) but not in the Trendelenburg (2.1 vs 6 mm Hg) and reverse Trendelenburg positions (3.4 vs 6 mm Hg). Rectal and gastric pressures were also position dependent and technically less reliable.

CONCLUSIONS:

Increased IAP has a major influence on pulmonary compliance (50% decrease at 16 mm Hg). Measurements of IAP by intraorgan manometry are position dependent and may not accurately reflect the intraperitoneal pressure.

PMID:
7748095
[PubMed - indexed for MEDLINE]
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Silverchair Information Systems
    Loading ...
    Write to the Help Desk