Positive end-expiratory pressure adjusted for intra-abdominal pressure – A pilot study

• Published in: Journal of critical care 2018-02, Vol.43, p.390-394
• Main Authors: Regli, Adrian, De Keulenaer, Bart Leon, Palermo, Annamaria, van Heerden, Peter Vernon
• Format: Article
• Language: English
• Subjects: Abdomen; Abdominal compartment syndrome; Aged; Airway pressures; Compartment syndrome; Cuff leak; Female; Humans; Hypertension; Hypoxemia; Intensive care; Intra-abdominal hypertension; Intra-Abdominal Hypertension - etiology; Intra-Abdominal Hypertension - physiopathology; Intra-Abdominal Hypertension - therapy; Intra-abdominal pressure; Male; Middle Aged; Patient safety; Pilot Projects; Positive end-expiratory pressure; Positive-Pressure Respiration; Respiration, Artificial; Respiratory compliance; Respiratory distress syndrome; Respiratory Insufficiency - complications; Respiratory Insufficiency - physiopathology; Respiratory Insufficiency - therapy; Respiratory system; Respiratory therapy; Treatment Outcome; Ventilators
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2017.10.012

Intra-abdominal hypertension (IAH) is associated with impaired respiratory function. Animal data suggest that positive end-expiratory pressure (PEEP) levels adjusted to intra-abdominal pressure (IAP) levels may counteract IAH-induced respiratory dysfunction. In this pilot study, our aim was to assess whether PEEP adjusted for IAP can be applied safely in patients with IAH. We included patients on mechanical ventilation and with IAH. Patients were excluded with severe cardiovascular dysfunction or severe hypoxemia or if the patient was in imminent danger of dying. Following a recruitment manoeuvre, the following PEEP levels were randomly applied: PEEP of 5cmH2O (baseline), PEEP=50% of IAP, and PEEP=100% of IAP. After a 30min equilibration period we measured arterial blood gases and cardio-respiratory parameters. Fifteen patients were enrolled. Six (41%) patients did not tolerate PEEP=100% IAP due to hypoxemia, hypotension or endotracheal cuff leak. PaO2/FiO2 ratios were 234 (68), 271 (99), and 329 (107) respectively. The differences were significant (p=0.009) only between baseline and PEEP=100% IAP. PEEP=100% of IAP was not well-tolerated and only marginally improved oxygenation in ventilated patients with IAH. •Best positive end-expiratory pressure (PEEP) to apply in patients with intra-abdominal hypertension (IAH) is unknown.•Applying PEEP adjusted for intra-abdominal pressure to 100% improved oxygenation in some patients but was frequently not tolerated.•Applying PEEP adjusted for intra-abdominal pressure to 50% was well tolerated and improved respiratory compliance, but not oxygenation.