Universidade Estadual de Campinas (UNICAMP), Hospital das Clínicas, Departamento de Pediatria, Unidade de Terapia Intensiva Pediátrica, Campinas, SP, Brazil.
Universidade Estadual de Campinas (UNICAMP), Hospital das Clínicas, Escola de Enfermagem, Unidade de Terapia Intensiva Pediátrica, Campinas, SP, Brazil.
J Pediatr (Rio J). 2021 Sep-Oct;97(5):564-570. doi: 10.1016/j.jped.2020.11.002. Epub 2020 Dec 21.
To evaluate the influence of intra-abdominal pressure on the cardiac index (CI) at different intra-abdominal hypertension grades achieved when performing an abdominal compression maneuver (ACM). Evaluating the effectiveness of the ACM in distending the left internal jugular vein (LIJV).
Prospective observational study conducted in the PICU of a quaternary care teaching hospital. Participants underwent the ACM and the IAP was measured with an indwelling urinary catheter. At each IAH grade reached during the ACM, the CI was measured by transthoracic echocardiography and the LIJV cross-sectional area (CSA) was determined by ultrasonography.
Twenty-four children were included (median age and weight of 3.5 months and 6.37kg, respectively). The median CI observed at baseline and during IAH grades I, II, III, and IV were 3.65L/min/m (IQR 3.12-4.03), 3.38L/min/m (IQR 3.04-3.73), 3.16L/min/m (IQR 2.70-3.53), 2.89L/min/m (IQR 2.38-3.22), and 2.42L/min/m (IQR 1.91-2.79), respectively. A 25% increase in the LIJV CSA area was achieved in 14 participants (58%) during the ACM.
The ACM significantly increases IAP, causing severe reversible impairment in the cardiovascular system and is effective in distending the LIJV in just over half of the subjects. Even low levels of HIA can result in significant cardiac dysfunction in children. Therefore, health professionals should be aware of the negative hemodynamic repercussions caused by the increased IAP.
评估在实施腹部压迫手法（ACM）时达到不同腹腔内高压（IAH）程度时，腹内压对心指数（CI）的影响。评估 ACM 在充盈左颈内静脉（LIJV）方面的效果。
这是在一家四级保健教学医院的 PICU 进行的前瞻性观察性研究。参与者接受了 ACM 并通过留置导尿管测量 IAP。在 ACM 过程中达到的每个 IAH 程度，通过经胸超声心动图测量 CI，并通过超声测量 LIJV 横截面积（CSA）。
共纳入 24 名儿童（中位数年龄和体重分别为 3.5 个月和 6.37kg）。在基线和 IAH 1 级、2 级、3 级和 4 级时观察到的中位数 CI 分别为 3.65L/min/m（IQR 3.12-4.03）、3.38L/min/m（IQR 3.04-3.73）、3.16L/min/m（IQR 2.70-3.53）、2.89L/min/m（IQR 2.38-3.22）和 2.42L/min/m（IQR 1.91-2.79）。在 ACM 期间，14 名参与者（58%）的 LIJV CSA 面积增加了 25%。
ACM 显著增加 IAP，导致严重的心血管系统可逆性损伤，并且在超过一半的受试者中有效充盈 LIJV。即使 IAH 水平较低，也会导致儿童出现明显的心功能障碍。因此，医护人员应意识到增加 IAP 引起的负面血液动力学影响。
