Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Intensive Care Medicine
Published in: Intensive Care Medicine 1/2005

01-01-2005 | Original

Effects of continuous negative extra-abdominal pressure on cardiorespiratory function during abdominal hypertension: an experimental study

Authors: Franco Valenza, Manuela Irace, Massimiliano Guglielmi, Stefano Gatti, Nicola Bottino, Cecilia Tedesco, Micol Maffioletti, Patrizia Maccagni, Tommaso Fossali, Gabriele Aletti, Luciano Gattinoni

Published in: Intensive Care Medicine | Issue 1/2005

Login to get access

Abstract

Objective

To investigate whether negative extra-abdominal pressure (NEXAP) improves respiratory function and induces a blood shift from the intrathoracic compartment and to assess whether these effects are influenced by abdominal pressure.

Design and setting

Prospective, randomized, controlled trial in the animal laboratory of a university hospital.

Subjects

Eight sedated and paralyzed pigs (19.6±3.4 kg).

Interventions

Application of NEXAP (−20 cmH2O).

Measurements and results

Airway, esophageal, gastric and central venous pressures were recorded simultaneously. Intrathoracic blood volume was assessed by PiCCO. The effects of NEXAP were assessed with and without abdominal hypertension by intraperitoneal insufflation of helium. NEXAP caused a lasting drop of gastric (1.97±2.26 mmHg) and esophageal (1.21±0.67 mmHg) pressures, while end-expiratory airway pressure was similar, hence transpulmonary pressure increased. Intrathoracic blood volume dropped from 358±47 to 314±47 ml. The fall was associated with a decrease in central venous pressure (R2=0.820). When peritoneal pressure was raised (24.7±5.5 mmHg), the effects were less marked. However, the difference between negative pressure around the abdomen and the pressure inside the abdomen (effective NEXAP) was correlated with the proportional changes in intrathoracic blood volume (R2=0.648), being greater with more negative effective NEXAP. NEXAP improved chest wall elastance during abdominal hypertension (from 0.067±0.023 to 0.056±0.021 cmH2O/ml).

Conclusions

NEXAP increases lung volume and causes a shift of blood from the intrathoracic compartment. It needs to be tailored against abdominal pressure to be effective
Literature
1.
Valenza F, Bottino N, Canavesi K, Lissoni A, Alongi S, Losappio S, Carlesso E, Gattinoni L (2003) Intra-abdominal pressure may be decreased non-invasively by continuous negative extra-abdominal pressure (NEXAP). Intensive Care Med 29:2063–2067CrossRefPubMed
2.
Baydur A, Behrakis PK, Zin WA, Jaeger M, Milic-Emili J (1982) A simple method for assessing the validity of the esophageal balloon technique. Am Rev Respir Dis 126:788–791PubMed
3.
Harris RS, Hess DR, Venegas JG (2000) An objective analysis of the pressure-volume curve in the acute respiratory distress syndrome. Am J Respir Crit Care Med 161:432–439PubMed
4.
Lichtwarck-Aschoff M, Zeravik J, Pfeiffer UJ (1992) Intrathoracic blood volume accurately reflects circulatory volume status in critically ill patients with mechanical ventilation. Intensive Care Med 18:142–147PubMed
5.
Godje O, Hoke K, Lamm P, Schmitz C, Thiel C, Weinert M, Reichart B (1998) Continuous, less invasive, hemodynamic monitoring in intensive care after cardiac surgery. Thorac Cardiovasc Surg 46:242–249
6.
Bland JM, Altman DG (1995) Calculating correlation coefficient with repeated observations. I.Correlation within subjects. BMJ 310:446PubMed
7.
Nunn J (1987) The wash-in exponential function. In: Nunn, JF (ed) Applied respiratory physiology. Butterworth, London, pp 524–527
8.
9.
Malbrain ML (1999) Abdominal pressure in the critically ill: measurement and clinical relevance. Intensive Care Med 25:1453–1458CrossRefPubMed
10.
Gattinoni L, Pelosi P, Suter PM, Pedoto A, Vercesi P, Lissoni A (1998) Acute respiratory distress syndrome caused by pulmonary and extrapulmonary disease. Different syndromes? Am J Respir Crit Care Med 158:3–11PubMed
11.
Ranieri VM, Brienza N, Santostasi S, Puntillo F, Mascia L, Vitale N, Giuliani R, Memeo V, Bruno F, Fiore T, Brienza A, Slutsky AS (1997) Impairment of lung and chest wall mechanics in patients with acute respiratory distress syndrome: role of abdominal distension. Am J Respir Crit Care Med 156:1082–1091PubMed
12.
Stassen NA, Lukan JK, Dixon MS, Carrillo EH (2002) Abdominal compartment syndrome. Scand J Surg 91:104–108PubMed
13.
Burch JM, Moore EE, Moore FA, Franciose R (1996) The abdominal compartment syndrome. Surg Clin North Am 76:833–842PubMed
14.
Borelli M, Benini A, Denkewitz T, Acciaro C, Foti G, Pesenti A (1998) Effects of continuous negative extrathoracic pressure versus positive end-expiratory pressure in acute lung injury patients. Crit Care Med 26:1025–1031CrossRefPubMed
15.
Adams J, Osiovich H, Goldberg R, Suguihara C, Bancalari E (1992) Hemodynamic effects of continuous negative extrathoracic pressure and continuous positive airway pressure in piglets with normal lungs. Biol Neonate 62:69–75PubMed
16.
Pierce J, Jenkins I, Noyes J, Samuels M, Southall D (1995) The successful use of continuous negative extrathoracic pressure in a child with Glenn shunt and respiratory failure. Intensive Care Med 21:766–768PubMed
17.
Torelli L, Zoccali G, Casarin M, Dalla Zuanna F, Lieta E, Conti G (1995) Comparative evaluation of the haemodynamic effects of continuous negative external pressure (CNEP) and positive end-expiratory pressure (PEEP) in mechanically ventilated trauma patients. Intensive Care Med 21:67–70PubMed
18.
Bloomfield GL, Saggi BH, Blocher C, Sugerman HJ (1999) Physiologic effects of externally applied continuous negative abdominal pressure for intra-abdominal hypertension. J Trauma 46:1009–1014PubMed
19.
Sugerman HJ, Felton III WL3, Sismanis A, Saggi BH, Doty JM, Blocher C, Marmarou A, Makhoul RG (2001) Continuous negative abdominal pressure device for to treat pseudotumor cerebri. Int J Obes Relat Metab Disord 25:486–490CrossRefPubMed
20.
Saggi BH, Bloomfield GL, Sugerman HJ, Blocher CR, Hull JP, Marmarou AP, Bullock MR (1999) Treatment of intracranial hypertension using nonsurgical abdominal decompression. J Trauma 46:646–651PubMed
21.
Ivankovich AD, Miletich DJ, Albrecht RF, Heyman HJ, Bonnet RF (1975) Cardiovascular effects of intraperitoneal insufflation with carbon dioxide and nitrous oxide in the dog. Anesthesiology 42:281–287PubMed
22.
Mutoh T, Lamm WJ, Embree LJ, Hildebrandt J, Albert RK (1991) Abdominal distension alters regional pleural pressures and chest wall mechanics in pigs in vivo. J Appl Physiol 70:2611–2618PubMed
23.
Ridings PC, Bloomfield GL, Blocher CR, Sugerman HJ (1995) Cardiopulmonary effects of raised intra-abdominal pressure before and after intravascular volume expansion. J Trauma 39:1071–1075PubMed
24.
Barnes GE, Laine GA, Giam PY, Smith EE, Granger HJ (1985) Cardiovascular responses to elevation of intra-abdominal hydrostatic pressure. Am J Physiol 248:R208–R213PubMed
25.
Quintel M, Pelosi P, Caironi P, Meinhardt JP, Luecke T, Herrmann P, Taccone P, Rylander C, Valenza F, Carlesso E, Gattinoni L (2004) An increase of abdominal pressure increases pulmonary edema in oleic acid-induced lung injury. Am J Respir Crit Care Med 169:534–541CrossRefPubMed
26.
Cheatham ML, Safcsak K, Block EF, Nelson LD (1999) Preload assessment in patients with an open abdomen. J Trauma 46:16–22PubMed
27.
Schachtrupp A, Graf J, Tons C, Hoer J, Fackeldey V, Schumpelick V (2003) Intravascular volume depletion in a 24-hour porcine model of intra-abdominal hypertension. J Trauma 55:734–740PubMed
28.
Hachenberg T, Ebel C, Czorny M, Thomas H, Wendt M (1998) Intrathoracic and pulmonary blood volume during CO2-pneumoperitoneum in humans. Acta Anaesthesiol Scand 42:794–798PubMed
29.
Andersson L, Wallin CJ, Sollevi A, Odeberg-Wernerman S (1999) Pneumoperitoneum in healthy humans does not affect central blood volume or cardiac output. Acta Anaesthesiol Scand 43:809–814CrossRefPubMed
30.
Hofer CK, Zalunardo MP, Klaghofer R, Spahr T, Pasch T, Zollinger A (2002) Changes in intrathoracic blood volume associated with pneumoperitoneum and positioning. Acta Anaesthesiol Scand 46:303–308CrossRefPubMed
31.
Junghans T, Bohm B, Grundel K, Schwenk W (1997) Effects of pneumoperitoneum with carbon dioxide, argon, or helium on hemodynamic and respiratory function. Arch Surg 132:272–278PubMed
32.
Johannsen G, Andersen M, Juhl B (1989) The effect of general anaesthesia on the haemodynamic events during laparoscopy with CO2-insufflation. Acta Anaesthesiol Scand 33:132–136PubMed
33.
Andersson L, Lagerstrand L, Thorne A, Sollevi A, Brodin LA, Odeberg-Wernerman S (2002) Effect of CO (2) pneumoperitoneum on ventilation-perfusion relationships during laparoscopic cholecystectomy. Acta Anaesthesiol Scand 46:552–560CrossRefPubMed
Metadata
Title
Effects of continuous negative extra-abdominal pressure on cardiorespiratory function during abdominal hypertension: an experimental study
Authors
Franco Valenza
Manuela Irace
Massimiliano Guglielmi
Stefano Gatti
Nicola Bottino
Cecilia Tedesco
Micol Maffioletti
Patrizia Maccagni
Tommaso Fossali
Gabriele Aletti
Luciano Gattinoni
Publication date
01-01-2005
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 1/2005
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-004-2483-2

Other articles of this Issue 1/2005

Intensive Care Medicine 1/2005 Go to the issue

Original

Neither baseline tests of molecular hypercoagulability nor D-dimer levels predict deep venous thrombosis in critically ill medical-surgical patients

Neonatal and Pediatric Intensive Care

Characteristics and immediate outcome of childhood meningitis treated in the pediatric intensive care unit

Original

Prediction of responses to various stimuli during sedation: a comparison of three EEG variables

Original

Risk factors for late-onset ventilator-associated pneumonia in trauma patients receiving selective digestive decontamination

Technical Note

Analysis of blood glucose measurements using capillary and arterial blood samples in intensive care patients

Experimental

Acute hemodynamic changes during lung recruitment in lavage and endotoxin-induced ALI