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Báo cáo y học: "Positive end-expiratory pressure affects the value of intra-abdominal pressure in acute lung injury/ acute respiratory distress syndrome patients: a pilot study"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học quốc tế cung cấp cho các bạn kiến thức về ngành y đề tài: Positive end-expiratory pressure affects the value of intra-abdominal pressure in acute lung injury/ acute respiratory distress syndrome patients: a pilot study. | Verzilli et al. Critical Care 2010 14 R137 http ccforum.eom content 14 4 R137 c CRITICAL CARE RESEARCH Open Access Positive end-expiratory pressure affects the value of intra-abdominal pressure in acute lung injury acute respiratory distress syndrome patients a pilot study 1 2 111 Daniel Verzilli Jean-Michel Constantin Mustapha Sebbane Gérald Chanques Boris Jung Pierre-Frangois Perrigault1 Manu Malbrain3 Samir Jaber1 Abstract Introduction To examine the effects of positive end-expiratory pressure PEEP on intra-abdominal pressure IAP in patients with acute lung injury ALI . Methods Thirty sedated and mechanically ventilated patients with ALI or acute respiratory distress syndrome ARDS admitted to a sixteen-bed surgical medical ICU were included. All patients were studied with sequentially increasing PEEP 0 6 and 12 cmH2O during a PEEP-trial. Results Age was 55 17 years weight was 70 17 kg SAPS II was 44 14 and PaO2 FO2 was 192 53 mmHg. The IAP was 12 5 mmHg at PEEP 0 zero end-expiratory pressure ZEEP 13 5 mmHg at PEEP 6 and 15 6 mmHg at PEEP 12 P 0.05 vs ZEEP . In the patients with intra-abdominal hypertension defined as IAP 12 mmHg n 15 IAP significantly increased from 15 3 mmHg at ZEEP to 20 3 mmHg at PEEP 12 P 0.01 . Whereas in the patients with IAP 12 mmHg n 15 IAP did not significantly change from ZEEP to PEEP 12 8 2 vs 10 3 mmHg . In the 13 patients in whom cardiac output was measured increase in PEEP from 0 to 12 cmH2O did not significantly change cardiac output nor in the 8 out of 15 patients of the high-IAP group. The observed effects were similar in both ALI n 17 and ARDS n 13 patients. Conclusions PEEP is a contributing factor that impacts IAP values. It seems necessary to take into account the level of PEEP whilst interpreting IAP values in patients under mechanical ventilation. Introduction Patients with primary acute lung injury ALI or acute respiratory distress syndrome ARDS may develop secondary abdominal pathologies associated with increased .