da Silva Almeida Juliana Roberta, Machado Fabio Santana, Schettino Guilherme Paula Pinto, Park Marcelo, Azevedo Luciano Cesar Pontes
Intensive Care and Anesthesiology Research Laboratory, Research and Education Institute, Hospital Sirio-Libanes, Bela Vista, São Paulo, Brazil.
J Trauma. 2010 Aug;69(2):375-83. doi: 10.1097/TA.0b013e3181e12b3a.
To evaluate the cardiopulmonary effects of positive end-expiratory pressure (PEEP) equalization to intra-abdominal pressure (IAP) in an experimental model of intra-abdominal hypertension (IAH) and acute lung injury (ALI).
Eight anesthetized pigs were submitted to IAH of 20 mm Hg with a carbon dioxide insufflator for 30 minutes and then submitted to lung lavage with saline and Tween (2.5%). Pressure x volume curves of the respiratory system were performed by a low flow method during IAH and ALI, and PEEP was subsequently adjusted to 27 cm . H2O for 30 minutes.
IAH decreases pulmonary and respiratory system static compliances and increases airway resistance, alveolar-arterial oxygen gradient, and respiratory dead space. The presence of concomitant ALI exacerbates these findings. PEEP identical to AP moderately improved oxygenation and respiratory mechanics; however, an important decline in stroke index and right ventricle ejection fraction was observed.
Simultaneous IAH and ALI produce important impairments in the respiratory physiology. PEEP equalization to AP may improve the respiratory performance, nevertheless with a secondary hemodynamic derangement.
在腹腔高压（IAH）和急性肺损伤（ALI）的实验模型中，评估呼气末正压（PEEP）与腹腔内压力（IAP）平衡对心肺的影响。
八只麻醉猪通过二氧化碳注入器施加20 mmHg的IAH持续30分钟，然后用生理盐水和吐温（2.5%）进行肺灌洗。在IAH和ALI期间，通过低流量法绘制呼吸系统的压力-容积曲线，随后将PEEP调整至27 cmH₂O并维持30分钟。
IAH降低肺和呼吸系统的静态顺应性，增加气道阻力、肺泡-动脉氧梯度和呼吸死腔。同时存在ALI会加剧这些表现。与IAP相等的PEEP适度改善了氧合和呼吸力学；然而，观察到每搏输出指数和右心室射血分数显著下降。
IAH和ALI同时存在会对呼吸生理产生重要损害。PEEP与IAP平衡可能改善呼吸功能，但会继发血流动力学紊乱。
