Positive end-expiratory pressure affects the value of intra-abdominal pressure in acute lung injuryacute respiratory distress syndrome patients a pilot study 英文参考文献.docVIP
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Positive end-expiratory pressure affects the value of intra-abdominal pressure in acute lung injuryacute respiratory distress syndrome patients a pilot study 英文参考文献
Verzillietal.CriticalCare2010,14:R137
/content/14/4/R137
RESEARCH
OpenAccess
Positiveend-expiratorypressureaffectsthevalue
ofintra-abdominalpressureinacutelunginjury/
acuterespiratorydistresssyndromepatients:a
pilotstudy
DanielVerzilli1,Jean-MichelConstantin2,MustaphaSebbane1,GéraldChanques1,BorisJung1,
Pierre-Fran?oisPerrigault1,ManuMalbrain3,SamirJaber1*
Abstract
Introduction:Toexaminetheeffectsofpositiveend-expiratorypressure(PEEP)onintra-abdominalpressure(IAP)
inpatientswithacutelunginjury(ALI).
Methods:ThirtysedatedandmechanicallyventilatedpatientswithALIoracuterespiratorydistresssyndrome
(ARDS)admittedtoasixteen-bedsurgicalmedicalICUwereincluded.Allpatientswerestudiedwithsequentially
increasingPEEP(0,6and12cmH2O)duringaPEEP-trial.
Results:Agewas55±17years,weightwas70±17kg,SAPSIIwas44±14andPaO2/FIO2 was192±53mmHg.
TheIAPwas12±5mmHgatPEEP0(zeroend-expiratorypressure,ZEEP),13±5mmHgatPEEP6and15±6
mmHgatPEEP12(P0.05vsZEEP).Inthepatientswithintra-abdominalhypertensiondefinedasIAP≥12
mmHg(n=15),IAPsignificantlyincreasedfrom15±3mmHgatZEEPto20±3mmHgatPEEP12(P0.01).
WhereasinthepatientswithIAP12mmHg(n=15),IAPdidnotsignificantlychangefromZEEPtoPEEP12
(8±2vs10±3mmHg).Inthe13patientsinwhomcardiacoutputwasmeasured,increaseinPEEPfrom0to12
cmH2Odidnotsignificantlychangecardiacoutput,norinthe8outof15patientsofthehigh-IAPgroup.The
observedeffectsweresimilarinbothALI(n=17)andARDS(n=13)patients.
Conclusions:PEEPisacontributingfactorthatimpactsIAPvalues.Itseemsnecessarytotakeintoaccountthe
levelofPEEPwhilstinterpretingIAPvaluesinpatientsundermechanicalventilation.
Introduction
surgical pneumoperitoneum) and multiple pathological
Patients with primary acute lung injury (ALI) or acute situations (eg, abdominal trauma, pancreatitis, liver
respiratorydistresssyndrome(ARDS)maydevelopsec- transplantation) [2,4]. Apersistent increase of IAP can
ondaryabdominalpathologiesassociatedwithincreased produce multiple adverse effects, involving both intra-
intra-abdominalp
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