Skip to main content
Top
Published in: Intensive Care Medicine 11/2005

01-11-2005 | Brief Report

Correlation between intra-abdominal and intracranial pressure in nontraumatic brain injury

Authors: Dries H. Deeren, Hilde Dits, Manu L. N. G. Malbrain

Published in: Intensive Care Medicine | Issue 11/2005

Login to get access

Abstract

Objective

To examine on the basis of a large number of measurements whether increased IAP is associated with increased ICP and decreased CPP in ventilated patients with nontraumatic brain injury.

Design and setting

Observational clinical study in the medical and surgical intensive care unit of a tertiary teaching hospital.

Patients

We included 11 patients with nontraumatic brain injury who had an ICP and an IAP-monitoring device because of ischemic (n=4), hemorrhagic (n=5), and metabolic (n=2) encephalopathy.

Methods

IAP was continuously measured in the stomach, and ICP was continuously measured through an intraventricular catheter; 214 consecutive measurements were compared. Because of repeated measurements in the patients we used analysis of covariance to control for the variation in ICP and CPP between patients.

Measurements and results

Patients’ mean IAP was 3.8–11.8 mmHg, ICP 6.7–15 mmHg, and CPP 70.8–123 mmHg. For ICP the regression coefficient associated with IAP was 0.64±0.05 (95% CI 0.56–0.73, partial correlation 0.70) and for CPP −1.36±0.3 (95% CI −1.94 to −0.78; partial correlation −0.30).

Conclusions

Increases in IAP are associated with increases in ICP and decreases in CPP in ventilated patients with nontraumatic brain injury, even at low levels of IAP.
Appendix
Available only for authorised users
Literature
1.
go back to reference Bloomfield GL, Ridings PC, Blocher CR, Marmarou A, Sugerman HJ (1997) A proposed relationship between increased intra-abdominal, intrathoracic, and intracranial pressure. Crit Care Med 25:496–503CrossRefPubMed Bloomfield GL, Ridings PC, Blocher CR, Marmarou A, Sugerman HJ (1997) A proposed relationship between increased intra-abdominal, intrathoracic, and intracranial pressure. Crit Care Med 25:496–503CrossRefPubMed
2.
go back to reference Josephs LG, Este-McDonald JR, Birkett DH, Hirsch EF (1994) Diagnostic laparoscopy increases intracranial pressure. J Trauma 36:815–818PubMed Josephs LG, Este-McDonald JR, Birkett DH, Hirsch EF (1994) Diagnostic laparoscopy increases intracranial pressure. J Trauma 36:815–818PubMed
3.
go back to reference Holthausen UH, Nagelschmidt M, Troidl H (1999) CO (2) pneumoperitoneum: what we know and what we need to know. World J Surg 23:794–800CrossRefPubMed Holthausen UH, Nagelschmidt M, Troidl H (1999) CO (2) pneumoperitoneum: what we know and what we need to know. World J Surg 23:794–800CrossRefPubMed
4.
go back to reference Bloomfield GL, Ridings PC, Blocher CR, Marmarou A, Sugerman HJ (1996) Effects of increased intra-abdominal pressure upon intracranial and cerebral perfusion pressure before and after volume expansion. J Trauma 40:936–941PubMed Bloomfield GL, Ridings PC, Blocher CR, Marmarou A, Sugerman HJ (1996) Effects of increased intra-abdominal pressure upon intracranial and cerebral perfusion pressure before and after volume expansion. J Trauma 40:936–941PubMed
5.
go back to reference 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 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
6.
go back to reference Bloomfield G, Saggi B, Blocher C, Sugerman H (1999) Physiologic effects of externally applied continuous negative abdominal pressure for intra-abdominal hypertension. J Trauma 46:1009–1014PubMed Bloomfield G, Saggi B, Blocher C, Sugerman H (1999) Physiologic effects of externally applied continuous negative abdominal pressure for intra-abdominal hypertension. J Trauma 46:1009–1014PubMed
7.
go back to reference Schob OM, Allen DC, Benzel E, Curet MJ, Adams MS, Baldwin NG, Largiader F, Zucker KA (1996) A comparison of the pathophysiologic effects of carbon dioxide, nitrous oxide, and helium pneumoperitoneum on intracranial pressure. Am J Surg 172:248–253CrossRefPubMed Schob OM, Allen DC, Benzel E, Curet MJ, Adams MS, Baldwin NG, Largiader F, Zucker KA (1996) A comparison of the pathophysiologic effects of carbon dioxide, nitrous oxide, and helium pneumoperitoneum on intracranial pressure. Am J Surg 172:248–253CrossRefPubMed
8.
go back to reference Ben-Haim M, Mandeli J, Friedman RL, Rosenthal RJ (2000) Mechanisms of systemic hypertension during acute elevation of intraabdominal pressure. J Surg Res 91:101–105CrossRefPubMed Ben-Haim M, Mandeli J, Friedman RL, Rosenthal RJ (2000) Mechanisms of systemic hypertension during acute elevation of intraabdominal pressure. J Surg Res 91:101–105CrossRefPubMed
9.
go back to reference Rosenthal RJ, Friedman RL, Kahn AM, Martz J, Thiagarajah S, Cohen D, Shi Q, Nussbaum M (1998) Reasons for intracranial hypertension and hemodynamic instability during acute elevations of intra-abdominal pressure: observations in a large animal model. J Gastrointest Surg 2:415–425CrossRefPubMed Rosenthal RJ, Friedman RL, Kahn AM, Martz J, Thiagarajah S, Cohen D, Shi Q, Nussbaum M (1998) Reasons for intracranial hypertension and hemodynamic instability during acute elevations of intra-abdominal pressure: observations in a large animal model. J Gastrointest Surg 2:415–425CrossRefPubMed
10.
go back to reference Rosenthal RJ, Hiatt JR, Phillips EH, Hewitt W, Demetriou AA, Grode M (1997) Intracranial pressure. Effects of pneumoperitoneum in a large-animal model. Surg Endosc 11:376–380CrossRefPubMed Rosenthal RJ, Hiatt JR, Phillips EH, Hewitt W, Demetriou AA, Grode M (1997) Intracranial pressure. Effects of pneumoperitoneum in a large-animal model. Surg Endosc 11:376–380CrossRefPubMed
11.
go back to reference Halverson A, Buchanan R, Jacobs L, Shayani V, Hunt T, Riedel C, Sackier J (1998) Evaluation of mechanism of increased intracranial pressure with insufflation. Surg Endosc 12:266–269CrossRefPubMed Halverson A, Buchanan R, Jacobs L, Shayani V, Hunt T, Riedel C, Sackier J (1998) Evaluation of mechanism of increased intracranial pressure with insufflation. Surg Endosc 12:266–269CrossRefPubMed
12.
go back to reference Citerio G, Vascotto E, Villa F, Celotti S, Pesenti A (2001) Induced abdominal compartment syndrome increases intracranial pressure in neurotrauma patients: a prospective study. Crit Care Med 29:1466–1471CrossRefPubMed Citerio G, Vascotto E, Villa F, Celotti S, Pesenti A (2001) Induced abdominal compartment syndrome increases intracranial pressure in neurotrauma patients: a prospective study. Crit Care Med 29:1466–1471CrossRefPubMed
13.
go back to reference Miglietta MA, Salzano LJ, Chiu WC, Scalea TM (2003) Decompressive laparotomy: a novel approach in the management of severe intracranial hypertension. J Trauma 55:551–554PubMed Miglietta MA, Salzano LJ, Chiu WC, Scalea TM (2003) Decompressive laparotomy: a novel approach in the management of severe intracranial hypertension. J Trauma 55:551–554PubMed
14.
go back to reference Bloomfield GL, Dalton JM, Sugerman HJ, Ridings PC, DeMaria EJ, Bullock R (1995) Treatment of increasing intracranial pressure secondary to the acute abdominal compartment syndrome in a patient with combined abdominal and head trauma. J Trauma 39:1168–1170PubMed Bloomfield GL, Dalton JM, Sugerman HJ, Ridings PC, DeMaria EJ, Bullock R (1995) Treatment of increasing intracranial pressure secondary to the acute abdominal compartment syndrome in a patient with combined abdominal and head trauma. J Trauma 39:1168–1170PubMed
15.
go back to reference Irgau I, Koyfman Y, Tikellis JI (1995) Elective intraoperative intracranial pressure monitoring during laparoscopic cholecystectomy. Arch Surg 130:1011–1013PubMed Irgau I, Koyfman Y, Tikellis JI (1995) Elective intraoperative intracranial pressure monitoring during laparoscopic cholecystectomy. Arch Surg 130:1011–1013PubMed
16.
go back to reference Malbrain ML, Chiumello D, Pelosi P, Wilmer A, Brienza N, Malcangi V, Bihari D, Innes R, Cohen J, Singer P, Japiassu A, Kurtop E, De Keulenaer BL, Daelemans R, Del Turco M, Cosimini P, Ranieri M, Jacquet L, Laterre PF, Gattinoni L (2004) Prevalence of intra-abdominal hypertension in critically ill patients: a multicentre epidemiological study. Intensive Care Med 30:822–829CrossRefPubMed Malbrain ML, Chiumello D, Pelosi P, Wilmer A, Brienza N, Malcangi V, Bihari D, Innes R, Cohen J, Singer P, Japiassu A, Kurtop E, De Keulenaer BL, Daelemans R, Del Turco M, Cosimini P, Ranieri M, Jacquet L, Laterre PF, Gattinoni L (2004) Prevalence of intra-abdominal hypertension in critically ill patients: a multicentre epidemiological study. Intensive Care Med 30:822–829CrossRefPubMed
17.
go back to reference Deeren DH, Leijs J, Van den Brande E, Daelemans R, Lins RL, Malbrain ML (2003) Relationship between intracranial and intra-abdominal pressure in ICU patients. Crit Care Med 31:A89 Deeren DH, Leijs J, Van den Brande E, Daelemans R, Lins RL, Malbrain ML (2003) Relationship between intracranial and intra-abdominal pressure in ICU patients. Crit Care Med 31:A89
18.
go back to reference Malbrain ML (2004) Different techniques to measure intra-abdominal pressure (IAP): time for a critical re-appraisal. Intensive Care Med 30:357–371CrossRefPubMed Malbrain ML (2004) Different techniques to measure intra-abdominal pressure (IAP): time for a critical re-appraisal. Intensive Care Med 30:357–371CrossRefPubMed
19.
go back to reference De Potter TJ, Dits H, Malbrain ML (2005) Intra and interobserver variability during in vitro validation of two novel methods for intra-abdominal pressure monitoring. Intensive Care Med 31:747–751CrossRefPubMed De Potter TJ, Dits H, Malbrain ML (2005) Intra and interobserver variability during in vitro validation of two novel methods for intra-abdominal pressure monitoring. Intensive Care Med 31:747–751CrossRefPubMed
20.
go back to reference Schachtrupp A, Tons C, Fackeldey V, Hoer J, Reinges M, Schumpelick V (2003) Evaluation of two novel methods for the direct and continuous measurement of the intra-abdominal pressure in a porcine model. Intensive Care Med 29:1605–1608CrossRefPubMed Schachtrupp A, Tons C, Fackeldey V, Hoer J, Reinges M, Schumpelick V (2003) Evaluation of two novel methods for the direct and continuous measurement of the intra-abdominal pressure in a porcine model. Intensive Care Med 29:1605–1608CrossRefPubMed
21.
go back to reference Bland JM, Altman DG (1995) Calculating correlation coefficients with repeated observations. I. Correlation within subjects. BMJ 310:446PubMed Bland JM, Altman DG (1995) Calculating correlation coefficients with repeated observations. I. Correlation within subjects. BMJ 310:446PubMed
22.
go back to reference Malbrain ML (2004) Is it wise not to think about intraabdominal hypertension in the ICU? Curr Opin Crit Care 10:132–145CrossRefPubMed Malbrain ML (2004) Is it wise not to think about intraabdominal hypertension in the ICU? Curr Opin Crit Care 10:132–145CrossRefPubMed
23.
go back to reference De Waele JJ, Benoit D, Hoste E, Colardyn F (2003) A role for muscle relaxation in patients with abdominal compartment syndrome? Intensive Care Med 29:332PubMed De Waele JJ, Benoit D, Hoste E, Colardyn F (2003) A role for muscle relaxation in patients with abdominal compartment syndrome? Intensive Care Med 29:332PubMed
24.
go back to reference Andrews PJ, Citerio G (2004) Intracranial pressure. I. Historical overview and basic concepts. Intensive Care Med 30:1730–1733CrossRefPubMed Andrews PJ, Citerio G (2004) Intracranial pressure. I. Historical overview and basic concepts. Intensive Care Med 30:1730–1733CrossRefPubMed
25.
go back to reference Citerio G, Andrews PJ (2004) Intracranial pressure. II. Clinical applications and technology. Intensive Care Med 30:1882–1885CrossRefPubMed Citerio G, Andrews PJ (2004) Intracranial pressure. II. Clinical applications and technology. Intensive Care Med 30:1882–1885CrossRefPubMed
Metadata
Title
Correlation between intra-abdominal and intracranial pressure in nontraumatic brain injury
Authors
Dries H. Deeren
Hilde Dits
Manu L. N. G. Malbrain
Publication date
01-11-2005
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 11/2005
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-005-2802-2

Other articles of this Issue 11/2005

Intensive Care Medicine 11/2005 Go to the issue