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

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

Research output: Contribution to journalReview article

2 Citations (Scopus)

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.

Original languageEnglish
Article number52
JournalAnnals of Intensive Care
Volume9
Issue number1
DOIs
Publication statusPublished - 1 Dec 2019

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Intra-Abdominal Hypertension
Critical Care
Ventilation
Physicians
Pressure
Positive-Pressure Respiration
Lung
Tidal Volume
Critical Illness
Respiratory Insufficiency
Intensive Care Units
Thorax
Anesthesia
Hemodynamics
Morbidity

Cite this

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title = "Ventilation in patients with intra-abdominal hypertension: what every critical care physician needs to know",
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.",
keywords = "Abdominal compartment syndrome, Compliance, Driving pressure, Intra-abdominal hypertension, Intra-abdominal pressure, Mechanical ventilation, Positive end-expiratory pressure, Protective ventilation, Recruitment, Ventilator-induced lung injury",
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Ventilation in patients with intra-abdominal hypertension : what every critical care physician needs to know. / Regli, Adrian; Pelosi, Paolo; Malbrain, Manu L.N.G.

In: Annals of Intensive Care, Vol. 9, No. 1, 52, 01.12.2019.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Ventilation in patients with intra-abdominal hypertension

T2 - what every critical care physician needs to know

AU - Regli, Adrian

AU - Pelosi, Paolo

AU - Malbrain, Manu L.N.G.

PY - 2019/12/1

Y1 - 2019/12/1

N2 - 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.

AB - 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.

KW - Abdominal compartment syndrome

KW - Compliance

KW - Driving pressure

KW - Intra-abdominal hypertension

KW - Intra-abdominal pressure

KW - Mechanical ventilation

KW - Positive end-expiratory pressure

KW - Protective ventilation

KW - Recruitment

KW - Ventilator-induced lung injury

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U2 - 10.1186/s13613-019-0522-y

DO - 10.1186/s13613-019-0522-y

M3 - Review article

VL - 9

JO - Annals of Intensive Care

JF - Annals of Intensive Care

SN - 2110-5820

IS - 1

M1 - 52

ER -