Internal and Intensive Care Medicine, Intensive Care Unit, Hermanos Ameijeiras Hospital, San Lázaro and Belascoaín, La Habana, CP 10300, Cuba.
Ann Intensive Care. 2012 Dec 20;2 Suppl 1(Suppl 1):S22. doi: 10.1186/2110-5820-2-S1-S22.
Mechanical ventilation (MV) is considered a predisposing factor for increased intra-abdominal pressure (IAP), especially when positive end-expiratory pressure (PEEP) is applied or in the presence of auto-PEEP. So far, no prospective data exists on the effect of MV on IAP. The study aims to look on the effects of MV on IAP in a group of critically ill patients with no other risk factors for intra-abdominal hypertension (IAH).
An observational multicenter study was conducted on a total of 100 patients divided into two groups: 50 patients without MV and 50 patients with MV. All patients were admitted to the intensive care units of the Medical and Surgical Research Centre, the Carlos J. Finlay Hospital, the Julio Trigo University Hospital, and the Calixto García Hospital, in Havana, Cuba between July 2000 and December 2004. The IAP was measured twice daily on admission using a standard transurethral technique. IAH was considered if IAP was greater than 12 mmHg. Correlations were made between IAP and body mass index (BMI), diagnostic category, gender, age, and ventilatory parameters.
The mean IAP in patients on MV was 6.7 ± 4.1 mmHg and significantly higher than in patients without MV (3.6 ± 2.4 mmHg, p < 0.0001). This difference was maintained regardless of gender, age, BMI, and diagnosis. The use of MV and BMI were independent predictors for IAH for the whole population, while male gender, assisted ventilation mode, and the use of PEEP were independent factors associated with IAH in patients on MV.
In this study, MV was identified as an independent predisposing factor for the development of IAH. Critically ill patients, which are on MV, present with higher IAP values on admission and should be monitored very closely, especially if PEEP is applied, even when they have no other apparent risk factors for IAH.
机械通气(MV)被认为是增加腹腔内压(IAP)的一个诱发因素,尤其是在应用呼气末正压(PEEP)或存在自动 PEEP 时。迄今为止,尚无 MV 对 IAP 影响的前瞻性数据。本研究旨在观察一组无其他腹腔高压(IAH)危险因素的危重病患者 MV 对 IAP 的影响。
对 2000 年 7 月至 2004 年 12 月在古巴哈瓦那的医学和外科研究中心、卡洛斯·J·芬利医院、胡里奥·特里戈大学医院和卡利克斯托·加西亚医院重症监护病房住院的 100 例患者进行了一项观察性多中心研究,将患者分为两组:50 例无 MV 患者和 50 例 MV 患者。所有患者入院时均采用标准经尿道技术测量两次 IAP。如果 IAP 大于 12mmHg,则认为存在 IAH。分析 IAP 与体重指数(BMI)、诊断类别、性别、年龄和通气参数之间的相关性。
MV 患者的平均 IAP 为 6.7±4.1mmHg,明显高于无 MV 患者(3.6±2.4mmHg,p<0.0001)。无论性别、年龄、BMI 和诊断如何,这种差异均保持不变。MV 的使用和 BMI 是整个人群发生 IAH 的独立预测因素,而男性、辅助通气模式和 PEEP 的使用是 MV 患者发生 IAH 的独立相关因素。
在这项研究中,MV 被确定为 IAH 发展的一个独立诱发因素。接受 MV 的危重病患者入院时 IAP 值较高,应密切监测,尤其是在应用 PEEP 时,即使他们没有其他明显的 IAH 危险因素。