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Effects of continuous negative extra-abdominal pressure on cardiorespiratory function during abdominal hypertension: an experimental study

Authors
  • Valenza, Franco1
  • Irace, Manuela1
  • Guglielmi, Massimiliano1
  • Gatti, Stefano2
  • Bottino, Nicola1
  • Tedesco, Cecilia1
  • Maffioletti, Micol1
  • Maccagni, Patrizia1
  • Fossali, Tommaso1
  • Aletti, Gabriele1
  • Gattinoni, Luciano1
  • 1 Università degli Studi di Milano, Istituto di Anestesia e Rianimazione, Ospedale Maggiore di Milano-Istituto di Ricovero e Cura a Carattere Scientifico, Via F. Sforza 35, Milan, 20122, Italy , Milan
  • 2 Università degli Studi di Milano, Istituto di Chirurgia Sperimentale e dei Trapianti, Ospedale Maggiore di Milano-Istituto di Ricovero e Cura a Carattere Scientifico, Via F. Sforza 35, Milan, 20122, Italy , Milan
Type
Published Article
Journal
Intensive Care Medicine
Publisher
Springer-Verlag
Publication Date
Oct 26, 2004
Volume
31
Issue
1
Pages
105–111
Identifiers
DOI: 10.1007/s00134-004-2483-2
Source
Springer Nature
Keywords
License
Yellow

Abstract

ObjectiveTo investigate whether negative extra-abdominal pressure (NEXAP) improves respiratory function and induces a blood shift from the intrathoracic compartment and to assess whether these effects are influenced by abdominal pressure.Design and settingProspective, randomized, controlled trial in the animal laboratory of a university hospital.SubjectsEight sedated and paralyzed pigs (19.6±3.4 kg).InterventionsApplication of NEXAP (−20 cmH2O).Measurements and resultsAirway, esophageal, gastric and central venous pressures were recorded simultaneously. Intrathoracic blood volume was assessed by PiCCO. The effects of NEXAP were assessed with and without abdominal hypertension by intraperitoneal insufflation of helium. NEXAP caused a lasting drop of gastric (1.97±2.26 mmHg) and esophageal (1.21±0.67 mmHg) pressures, while end-expiratory airway pressure was similar, hence transpulmonary pressure increased. Intrathoracic blood volume dropped from 358±47 to 314±47 ml. The fall was associated with a decrease in central venous pressure (R2=0.820). When peritoneal pressure was raised (24.7±5.5 mmHg), the effects were less marked. However, the difference between negative pressure around the abdomen and the pressure inside the abdomen (effective NEXAP) was correlated with the proportional changes in intrathoracic blood volume (R2=0.648), being greater with more negative effective NEXAP. NEXAP improved chest wall elastance during abdominal hypertension (from 0.067±0.023 to 0.056±0.021 cmH2O/ml).ConclusionsNEXAP increases lung volume and causes a shift of blood from the intrathoracic compartment. It needs to be tailored against abdominal pressure to be effective

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