The Effect of Body Position on Compartmental Intra-abdominal Pressure Following Liver Transplantation

Overview

Journal Ann Intensive Care

Specialty Critical Care

Date 2012 Aug 10

PMID 22873413

Citations 8

Authors

Adrian B Cresswell

Wayel Jassem

Parthi Srinivasan

Andreas A Prachalias

Elizabeth Sizer

William Burnal

Georg Auzinger

Paolo Muiesan

Mohammed Rela

Nigel D Heaton

Matthew J Bowles

Julia A Wendon

Affiliations

Soon will be listed here.

Abstract

Background: Current assumptions rely on intra-abdominal pressure (IAP) being uniform across the abdominal cavity. The abdominal contents are, however, a heterogeneous mix of solid, liquid and gas, and pressure transmission may not be uniform. The current study examines the upper and lower IAP following liver transplantation.

Methods: IAP was measured directly via intra-peritoneal catheters placed at the liver and outside the bladder. Compartmental pressure data were recorded at 10-min intervals for up to 72 h following surgery, and the effect of intermittent posture change on compartmental pressures was also studied. Pelvic intra-peritoneal pressure was compared to intra-bladder pressure measured via a FoleyManometer.

Results: A significant variation in upper and lower IAP of 18% was observed with a range of differences of 0 to 16 mmHg. A sustained difference in inter-compartmental pressure of 4 mmHg or more was present for 23% of the study time. Head-up positioning at 30° provided a protective effect on upper intra-abdominal pressure, resulting in a significant reduction in all patients. There was excellent agreement between intra-bladder and pelvic pressure.

Conclusions: A clinically significant variation in inter-compartmental pressure exists following liver transplantation, which can be manipulated by changes to body position. The existence of regional pressure differences suggests that IAP monitoring at the bladder alone may under-diagnose intra-abdominal hypertension and abdominal compartment syndrome in these patients. The upper and lower abdomen may need to be considered as separate entities in certain conditions.

Citing Articles

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References

Diebel L, Dulchavsky S, Brown W . Splanchnic ischemia and bacterial translocation in the abdominal compartment syndrome. J Trauma. 1997; 43(5):852-5. DOI: 10.1097/00005373-199711000-00019. View

Diebel L, Wilson R, Dulchavsky S, Saxe J . Effect of increased intra-abdominal pressure on hepatic arterial, portal venous, and hepatic microcirculatory blood flow. J Trauma. 1992; 33(2):279-82; discussion 282-3. DOI: 10.1097/00005373-199208000-00019. View

Risin E, Kessel B, Ashkenazi I, Lieberman N, Alfici R . A new technique of direct intra-abdominal pressure measurement: a preliminary study. Am J Surg. 2006; 191(2):235-7. DOI: 10.1016/j.amjsurg.2005.07.038. View

Malbrain M . Different techniques to measure intra-abdominal pressure (IAP): time for a critical re-appraisal. Intensive Care Med. 2004; 30(3):357-71. DOI: 10.1007/s00134-003-2107-2. View

Cheatham M, De Waele J, De Laet I, De Keulenaer B, Widder S, Kirkpatrick A . The impact of body position on intra-abdominal pressure measurement: a multicenter analysis. Crit Care Med. 2009; 37(7):2187-90. DOI: 10.1097/CCM.0b013e3181a021fa. View

DAngelo E, Pecchiari M, Acocella F, Monaco A, Bellemare F . Effects of abdominal distension on breathing pattern and respiratory mechanics in rabbits. Respir Physiol Neurobiol. 2002; 130(3):293-304. DOI: 10.1016/s0034-5687(02)00008-7. View

Cullen D, Coyle J, Teplick R, Long M . Cardiovascular, pulmonary, and renal effects of massively increased intra-abdominal pressure in critically ill patients. Crit Care Med. 1989; 17(2):118-21. DOI: 10.1097/00003246-198902000-00002. View

McBeth P, Zygun D, Widder S, Cheatham M, Zengerink I, Glowa J . Effect of patient positioning on intra-abdominal pressure monitoring. Am J Surg. 2007; 193(5):644-7. DOI: 10.1016/j.amjsurg.2007.01.013. View

De Laet I, Malbrain M, Jadoul J, Rogiers P, Sugrue M . Renal implications of increased intra-abdominal pressure: are the kidneys the canary for abdominal hypertension?. Acta Clin Belg. 2014; 62 Suppl 1:119-30. DOI: 10.1179/acb.2007.62.s1.015. View

10.

Eleftheriadis E, Kotzampassi K . Hepatic microcirculation after continuous 7-day elevated intra-abdominal pressure in cirrhotic rats. Hepatol Res. 2006; 32(2):96-100. DOI: 10.1016/j.hepres.2005.04.002. View

11.

Bland J, Altman D . Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986; 1(8476):307-10. View

12.

Sugrue M, Jones F, Lee A, Buist M, Deane S, Bauman A . Intraabdominal pressure and gastric intramucosal pH: is there an association?. World J Surg. 1996; 20(8):988-91. DOI: 10.1007/s002689900149. View

13.

Diebel L, Dulchavsky S, Wilson R . Effect of increased intra-abdominal pressure on mesenteric arterial and intestinal mucosal blood flow. J Trauma. 1992; 33(1):45-8; discussion 48-9. DOI: 10.1097/00005373-199207000-00010. View

14.

DOTY J, Saggi B, Blocher C, Fakhry I, Gehr T, Sica D . Effects of increased renal parenchymal pressure on renal function. J Trauma. 2000; 48(5):874-7. DOI: 10.1097/00005373-200005000-00010. View

15.

Sugrue M, Bauman A, Jones F, Bishop G, Flabouris A, Parr M . Clinical examination is an inaccurate predictor of intraabdominal pressure. World J Surg. 2002; 26(12):1428-31. DOI: 10.1007/s00268-002-6411-8. View

16.

Malbrain M, Chiumello D, Pelosi P, Wilmer A, Brienza N, Malcangi V . Prevalence of intra-abdominal hypertension in critically ill patients: a multicentre epidemiological study. Intensive Care Med. 2004; 30(5):822-9. DOI: 10.1007/s00134-004-2169-9. View

17.

Schachtrupp A, Henzler D, Orfao S, Schaefer W, Schwab R, Becker P . Evaluation of a modified piezoresistive technique and a water-capsule technique for direct and continuous measurement of intra-abdominal pressure in a porcine model. Crit Care Med. 2006; 34(3):745-50. DOI: 10.1097/01.CCM.0000198526.04530.36. View

18.

Kirkpatrick A, Brenneman F, McLean R, Rapanos T, Boulanger B . Is clinical examination an accurate indicator of raised intra-abdominal pressure in critically injured patients?. Can J Surg. 2000; 43(3):207-11. PMC: 3695163. View

19.

Sugrue M, Buist M, Lee A, Sanchez D, Hillman K . Intra-abdominal pressure measurement using a modified nasogastric tube: description and validation of a new technique. Intensive Care Med. 1994; 20(8):588-90. DOI: 10.1007/BF01705728. View

20.

Pelosi P, Quintel M, Malbrain M . Effect of intra-abdominal pressure on respiratory mechanics. Acta Clin Belg. 2014; 62 Suppl 1:78-88. DOI: 10.1179/acb.2007.62.s1.011. View