The effect of neuromuscular blockers in patients with intra-abdominal hypertension.

OBJECTIVE

The objective was to prospectively study the effect of neuromuscular blockers on intra-abdominal pressure (IAP) and a number of physiological variables in patients with increased IAP.

DESIGN

Prospective cohort study.

SETTING

Intensive care unit of the Ghent University Hospital.

PATIENTS AND PARTICIPANTS

Ten critically ill patients with intra-abdominal hypertension (IAH).

INTERVENTIONS

An intravenous bolus of cisatracurium at a dose of 0.15 mg/kg was administered, and IAP was measured just before administration and then at 15, 30, 60 and 120 min. The effect of cisatracurium on central venous pressure (CVP), mean arterial pressure (MAP), abdominal perfusion pressure (APP) and heart rate (HR) was also evaluated. Urinary output was recorded prior to administration and after 60 and 120 min.

MEASUREMENTS AND RESULTS

The median age of the patients was 50 years (interquartile range 38-65); five of them were male. APACHE II score on admission was 29 (IQR 14-37). IAH was caused by massive fluid resuscitation without obvious abdominal problem in five patients, by abdominal trauma in three, and by burns and bowel distension in one patient each. Bolus administration of cisatracurium significantly decreased IAP from 18 mmHg (16-20) at baseline to 14 mmHg (12-16) at 15 min (p = 0.01) and to 14 mmHg (13-17) at 30 min (p = 0.02). MAP, APP, CVP and HR remained unchanged. No significant effect on urinary output was observed. In all patients, IAP returned to the baseline level after 2 h.

CONCLUSIONS

Bolus administration of cisatracurium can be used to temporarily reduce IAP in patients with IAH.