What every ICU clinician needs to know about the cardiovascular effects caused by abdominal hypertension.
نویسندگان
چکیده
The effects of increased intra-abdominal pressure (IAP) on cardiovascular function are well recognized and include a combined negative effect on preload, afterload and contractility. The aim of this review is to summarize the current knowledge on this topic. The presence of intra-abdominal hypertension (IAH) erroneously increases barometric filling pressures like central venous (CVP) and pulmonary artery occlusion pressure (PAOP) (since these are zeroed against atmospheric pressure). Transmural filling pressures (calculated by subtracting the pleural pressure from the end-expiratory CVP value) may better reflect the true preload status but are difficult to obtain at the bedside. Alternatively, since pleural pressures are seldom measured, transmural CVP can also be estimated by subtracting half of the IAP from the end-expiratory CVP value, since abdominothoracic transmission is on average 50%. Volumetric preload indicators, such as global and right ventricular end-diastolic volumes or the left ventricular end-diastolic area, also correlate better with true preload. When using functional hemodynamic monitoring parameters like stroke volume variation (SVV) or pulse pressure variation (PPV) one must bear in mind that increased IAP will increase these values (via a concomitant increase in intrathoracic pressure). The passive leg raising test may be a false negative in IAH. Calculation of the abdominal perfusion pressure (as mean arterial pressure minus IAP) has been shown to be a better resuscitation endpoint than IAP alone. Finally, it is re-assuring that transpulmonary thermodilution techniques have been validated in the setting of IAH and abdominal compartment syndrome. In conclusion, the clinician must be aware of the different effects of IAH on cardiovascular function in order to assess the volume status accurately and to optimize hemodynamic performance.
منابع مشابه
What every pediatrician should know about liver transplantation
Liver transplantation is the treatment of choice for children with end-stage liver disease. Improvement in outcomes (allograft and patient survival) has led to widespread use of pediatric LT worldwide. This success is due to improvement in patient selection, transplant surgery, anesthesia/postoperative care and immunosuppression management. This review will focus on different aspects of LT whi...
متن کاملAssociation of serum melatonin and albumin with cardiovascular disease
Cardiovascular diseases are a major cause of death worldwide. Endothelial dysfunction, inflammatory conditions, and oxidative stress at the forefront of the onset and progression of most cardiovascular diseases specificaly coronary heart disease and heart failure. Melatonin is a type of indole neuroendocrine hormone. It was first found that the regulation of the sleep-wake cycle is regulated...
متن کاملHypertensive disorders of pregnancy: what the physician needs to know
Hypertension developing during pregnancy may be caused by a variety of different pathophysiological mechanisms. The occurrence of proteinuric hypertension during the second half of pregnancy identifies a group of women whose hypertensive disorder is most likely to be caused by the pregnancy itself and for whom the risk of complications, including maternal mortality, is highest. Physicians ident...
متن کاملDiseases of the Lacrimal System and Third Eyelid What Every Clinician Must Know about Diagnosis & Therapy
متن کامل
Risk Factors and Prognostic Factors of Acute Renal Failure in Patients Admitted to an Intensive Care Unit, Tehran-Iran
Acute renal failure (ARF) is defined as a sudden and continuous decrease of glomerular function associated with azotemia, and may be followed by decreased urinary output. There is a high incidence of ARF in ICU patients with a high mortality rate. Many factors can promote ARF development or influence its outcome. This study was done to assess the incidence, risk factors, outcome and treatme...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
عنوان ژورنال:
- Anaesthesiology intensive therapy
دوره 47 4 شماره
صفحات -
تاریخ انتشار 2015