Effect of intra-abdominal pressure on respiratory function in patients undergoing ventral hernia repair

• 作者: Alexey A Smetkin Alexey Y Teterin Ayyaz Hussain Elena N Raibuzhis Konstantin M Gaidukov Manu LNG Malbrain Mikhail Y Kirov Vsevolod V Kuzkov
• 来源期刊: 世界重症医学杂志
• 学科: 医学
• 关键词: INTRA-ABDOMINAL PRESSURE Gastric PRESSURE BLADDER PRESSURE INTRA-ABDOMINAL hypertension HERNIA OXYGENATION RESPIRATORY function
• 年，卷（期）: 2013,（2）
• 页码范围: 9-16
• 页数: 8页
• 分类号: R

摘要

AIM:To determine the influence of intra-abdominal pressure(IAP)on respiratory function after surgical repair of ventral hernia and to compare two different methods of IAP measurement during the perioperative period.METHODS:Thirty adult patients after elective repair of ventral hernia were enrolled into this prospective study.IAP monitoring was performed via both a balloontipped nasogastric probe[intragastric pressure(IGP),CiMON,Pulsion Medical Systems,Munich,Germany]and a urinary catheter[intrabladder pressure(IBP),UnoMeterAbdo-Pressure Kit,UnoMedical,Denmark]on five consecutive stages:(1)after tracheal intubation(AI);(2)after ventral hernia repair;(3)at the end of surgery;(4)during spontaneous breathing trial through the endotracheal tube;and(5)at 1 h after tracheal extubation.The patients were in the complete supine position during all study stages.RESULTS:The IAP(measured via both techniques)increased on average by 12%during surgery compared to AI(P<0.02)and by 43%during spontaneous breathing through the endotracheal tube(P<0.01).In parallel,the gradient betweenРаСО2 and EtCO2[Р(а-et)CO2]rose significantly,reaching a maximum during the spontaneous breathing trial.The PаO2/FiO2 decreased by 30%one hour after tracheal extubation(P=0.02).The dynamic compliance of respiratory system reduced intraoperatively by 15%-20%(P<0.025).At all stages,we observed a significant correlation between IGP and IBP(r=0.65-0.81,P<0.01)with a mean bias varying from-0.19 mmHg(2SD 7.25 mmHg)to-1.06 mm Hg(2SD 8.04 mmHg)depending on the study stage.Taking all paired measurements together(n=133),the median IGP was 8.0(5.5-11.0)mmHg and the median IBP was 8.8(5.8-13.1)mmHg.The overall r 2 value(n=30)was 0.76(P<0.0001).Bland and Altman analysis showed an overall bias for the mean values per patient of 0.6 mmHg(2SD 4.2 mmHg)with percentage error of 45.6%.Looking at changes in IAP between the different study stages,we found an excellent concordance coefficient of 94.9%comparingΔIBP andΔIGP(n=117).CONCLUSION:During ventral hernia repa