Intensive Care Unit, Fremantle Hospital, Alma Street, Fremantle, WA 6160, Australia; Intensive Care Unit, Fiona Stanley Hospital, 102-118 Murdoch Drive, Murdoch, WA 6150, Australia; School of Medicine and Pharmacology, The University of Western Australia, Sterling Highway, Crawley, (Perth) WA 6009, Australia; Medical School, The Notre Dame University, Henry Road, Fremantle, WA 6160, Australia.
Intensive Care Unit, Fremantle Hospital, Alma Street, Fremantle, WA 6160, Australia; Intensive Care Unit, Fiona Stanley Hospital, 102-118 Murdoch Drive, Murdoch, WA 6150, Australia; School of Surgery, The University of Western Australia, Sterling Highway, Crawley, (Perth) WA 6009, Australia.
J Crit Care. 2018 Feb;43:390-394. doi: 10.1016/j.jcrc.2017.10.012. Epub 2017 Oct 16.
Intra-abdominal hypertension (IAH) is associated with impaired respiratory function. Animal data suggest that positive end-expiratory pressure (PEEP) levels adjusted to intra-abdominal pressure (IAP) levels may counteract IAH-induced respiratory dysfunction. In this pilot study, our aim was to assess whether PEEP adjusted for IAP can be applied safely in patients with IAH.
We included patients on mechanical ventilation and with IAH. Patients were excluded with severe cardiovascular dysfunction or severe hypoxemia or if the patient was in imminent danger of dying. Following a recruitment manoeuvre, the following PEEP levels were randomly applied: PEEP of 5cmHO (baseline), PEEP=50% of IAP, and PEEP=100% of IAP. After a 30min equilibration period we measured arterial blood gases and cardio-respiratory parameters.
Fifteen patients were enrolled. Six (41%) patients did not tolerate PEEP=100% IAP due to hypoxemia, hypotension or endotracheal cuff leak. PaO/FiO ratios were 234 (68), 271 (99), and 329 (107) respectively. The differences were significant (p=0.009) only between baseline and PEEP=100% IAP.
PEEP=100% of IAP was not well-tolerated and only marginally improved oxygenation in ventilated patients with IAH.
腹腔内高压（IAH）与呼吸功能障碍有关。动物数据表明，根据腹腔内压（IAP）调整呼气末正压（PEEP）水平可能对抗 IAH 引起的呼吸功能障碍。在这项初步研究中，我们的目的是评估根据 IAP 调整的 PEEP 是否可安全应用于 IAH 患者。
我们纳入了接受机械通气和 IAH 的患者。排除严重心血管功能障碍或严重低氧血症的患者，或如果患者有即将死亡的危险。在进行招募操作后，随机应用以下 PEEP 水平：PEEP 为 5cmH2O（基线）、PEEP=IAP 的 50%和 PEEP=IAP 的 100%。在 30 分钟的平衡期后，我们测量了动脉血气和心肺参数。
共纳入 15 例患者。由于低氧血症、低血压或气管套囊泄漏，6 例（41%）患者不能耐受 PEEP=100%IAP。PaO/FiO 比值分别为 234（68）、271（99）和 329（107）。仅在基线和 PEEP=100%IAP 之间差异具有统计学意义（p=0.009）。
PEEP=100%IAP 不能耐受，仅略微改善了 IAH 患者通气时的氧合。
