| Effect of Positive End Expiratory Pressure on Intra-abdominal Pressure and Abdominal Perfusion Pressure at an Increased Intra-abdominal Pressure. |
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Choon Hak Lim, Younsuck Koh, Hye Won Lee, Ji Young Khil, Sung Ok Suh, Young Chol Kim, Hae Ja Lim |
1Department of Anesthesiology and Pain Medicine, Korea University College of Medicine, Seoul, Korea. hyewonmd@unitel.co.kr
2Department of Surgery, Korea University College of Medicine, Seoul, Korea.
3Division of Pulmonary andCritical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. |
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| Abstract |
BACKGROUND
Increased intra-abdominal pressure (IAP) leads to adverse effects on most organ systems and is associated with significant morbidity and mortality in surgical and trauma patients. The purpose of this study was to determine the effect of positive end expiratory pressure (PEEP) on IAP and abdominal perfusion pressure (APP, mean arterial pressure, MAP minus IAP) at normal and increased intra-abdominal pressures.
METHODS
15 patients requiring a laparoscopic cholecystectomy were included. IAP was measured indirectly using a transurethral catheter, and APP was calculated for each patient at 0, 5, 10, 15, and 20 cmH2O of PEEP, while the insufflator pressure was maintained at either 0 or 15 mmHg.
RESULTS
At each insufflator pressure, IAP increased with higher PEEP levels (P < 0.05). At 0 mmHg insufflator pressure state, MAP substantially decreased according to increasing PEEP levels, however, at 15 mmHg insufflator pressure state, MAP substantially increased despite increasing PEEP levels. Meanwhile, APP decreased with increasing PEEP levels at an insufflator pressure of zero while remaining constant at a 15 mmHg insufflator pressure.
CONCLUSIONS
We found that IAP increases in response to higher PEEP levels (10, 15, and 20 cmH2O) at insufflator pressures of both zero and 15 mmHg in patients anesthetized for laparoscopic cholecystectomy. However, APP did not decrease with increasing PEEP levels at a higher intraadominal pressure (15 mmHg). |
| Key Words:
intraabdominal pressure; positive end expiratory pressure |
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