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Annals of Intensive Care
Published in: Annals of Intensive Care 1/2019

Open Access 01-12-2019 | Care | Review

Ventilation in patients with intra-abdominal hypertension: what every critical care physician needs to know

Authors: Adrian Regli, Paolo Pelosi, Manu L. N. G. Malbrain

Published in: Annals of Intensive Care | Issue 1/2019

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Abstract

The incidence of intra-abdominal hypertension (IAH) is high and still underappreciated by critical care physicians throughout the world. One in four to one in three patients will have IAH on admission, while one out of two will develop IAH within the first week of Intensive Care Unit stay. IAH is associated with high morbidity and mortality. Although considerable progress has been made over the past decades, some important questions remain regarding the optimal ventilation management in patients with IAH. An important first step is to measure intra-abdominal pressure (IAP). If IAH (IAP > 12 mmHg) is present, medical therapies should be initiated to reduce IAP as small reductions in intra-abdominal volume can significantly reduce IAP and airway pressures. Protective lung ventilation with low tidal volumes in patients with respiratory failure and IAH is important. Abdominal-thoracic pressure transmission is around 50%. In patients with IAH, higher positive end-expiratory pressure (PEEP) levels are often required to avoid alveolar collapse but the optimal PEEP in these patients is still unknown. During recruitment manoeuvres, higher opening pressures may be required while closely monitoring oxygenation and the haemodynamic response. During lung-protective ventilation, whilst keeping driving pressures within safe limits, higher plateau pressures than normally considered might be acceptable. Monitoring of the respiratory function and adapting the ventilatory settings during anaesthesia and critical care are of great importance. This review will focus on how to deal with the respiratory derangements in critically ill patients with IAH.
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Metadata
Title
Ventilation in patients with intra-abdominal hypertension: what every critical care physician needs to know
Authors
Adrian Regli
Paolo Pelosi
Manu L. N. G. Malbrain
Publication date
01-12-2019
Publisher
Springer International Publishing
Published in
Annals of Intensive Care / Issue 1/2019
Electronic ISSN: 2110-5820
DOI
https://doi.org/10.1186/s13613-019-0522-y

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Annals of Intensive Care 1/2019 Go to the issue

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PEEP titration in moderate to severe ARDS: plateau versus transpulmonary pressure

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Correction to: Risk factors for mortality in elderly and very elderly critically ill patients with sepsis: a prospective, observational, multicenter cohort study