Malbrain Manu L N G
Medical ICU, ACZA Campus Stuivenberg, Antwerpen, Belgium.
Curr Opin Crit Care. 2004 Apr;10(2):132-45. doi: 10.1097/00075198-200404000-00010.
This review focuses on the available literature published in the past 2 years. MEDLINE and PubMed searches were performed using intraabdominal pressure, intraabdominal hypertension, and abdominal compartment as search items. The aim was to find an answer to the question: "Is it wise not to measure or even not to think about intraabdominal hypertension in ICU?"
It is difficult to find a good gold standard for intraabdominal pressure measurement. Bladder pressure can be used as an intraabdominal pressure estimate provided it is measured in a reproducible way. Automated continuous intraabdominal pressure monitoring has recently become available. Key messages are (1). body mass index and fluid resuscitation are independent predictors of intraabdominal hypertension; (2). intraabdominal hypertension increases intrathoracic, intracranial, and intracardiac filling pressures; (3). transmural or transabdominal filling pressures combined with volumetric parameters better reflect preload; (4). volumetric target values need to be corrected for baseline ejection fractions; (5). intraabdominal hypertension decreases left ventricular, chest wall and total respiratory system compliance; (6). best positive end-expiratory pressure can be set to counteract intraabdominal pressure; (7). acute respiratory distress syndrome definitions should take into account best positive end-expiratory pressure and intraabdominal pressure but not wedge pressure; (8). lung protective strategies should aim at deltaPplat (plateau pressure - intraabdominal pressure); (9). intraabdominal hypertension causes atelectasis and increases extravascular lung water; (10). intraabdominal hypertension is an independent predictor of acute renal failure; (11). monitoring of abdominal perfusion pressure can be useful; and (12). intraabdominal hypertension triggers bacterial translocation and multiple organ system failure.
The answer is that it is unwise not to measure intraabdominal pressure in the ICU or even not to think about it.
本综述聚焦于过去两年发表的相关文献。使用腹腔内压力、腹腔内高压和腹腔间隔作为检索词，对MEDLINE和PubMed进行了检索。目的是找到以下问题的答案：“在重症监护病房（ICU）不测量甚至不考虑腹腔内高压是否明智？”
很难找到一个用于测量腹腔内压力的良好金标准。膀胱压力若能以可重复的方式测量，可作为腹腔内压力的估计值。自动连续腹腔内压力监测最近已可用。关键信息包括：（1）体重指数和液体复苏是腹腔内高压的独立预测因素；（2）腹腔内高压会增加胸腔内、颅内和心内充盈压；（3）跨壁或经腹充盈压与容积参数相结合能更好地反映前负荷；（4）容积目标值需要根据基线射血分数进行校正；（5）腹腔内高压会降低左心室、胸壁和全呼吸系统顺应性；（6）最佳呼气末正压可设置为抵消腹腔内压力；（7）急性呼吸窘迫综合征的定义应考虑最佳呼气末正压和腹腔内压力，但不包括楔压；（8）肺保护性策略应针对平台压差值（平台压 - 腹腔内压力）；（9）腹腔内高压会导致肺不张并增加血管外肺水；（10）腹腔内高压是急性肾衰竭的独立预测因素；（11）监测腹腔灌注压可能有用；（12）腹腔内高压会引发细菌移位和多器官系统功能衰竭。
答案是在ICU不测量腹腔内压力甚至不考虑它是不明智的。
