Increases in intra-abdominal pressure affect pulmonary compliance.
OBJECTIVE
To determine the effect of increased intra-abdominal pressure (IAP) on pulmonary compliance and to determine an effective means to measure IAP.


METHODS
A prospective study.


METHODS
An urban tertiary care hospital.


METHODS
Twenty-six adult patients undergoing laparoscopic cholecystectomy.


METHODS
Intra-operative management of laparoscopic cholecystectomy requiring endotracheal intubation with general anesthesia, nasogastric and urinary bladder catheters, and position changes. Additional interventions included use of a rectal manometer and a respiratory pressure module inserted within the ventilator circuit.


METHODS
Correlation of changes in IAP with changes in dynamic pulmonary compliance, measured as tidal volume/(end inspiratory pressure--end expiratory pressure) and comparison of three different measurement techniques (bladder, rectal, and gastric) with a standard technique (insufflation pressure) in three different positions (supine, Trendelenburg's, and reverse Trendelenburg's).


RESULTS
Compliance was significantly related to insufflation pressure (P < .001) by analysis of variance. In the gas insufflation model, the mean increment in bladder pressure reflected most closely the IAP increment in the supine position (5.7 vs 6 mm Hg) but not in the Trendelenburg (2.1 vs 6 mm Hg) and reverse Trendelenburg positions (3.4 vs 6 mm Hg). Rectal and gastric pressures were also position dependent and technically less reliable.


CONCLUSIONS
Increased IAP has a major influence on pulmonary compliance (50% decrease at 16 mm Hg). Measurements of IAP by intraorgan manometry are position dependent and may not accurately reflect the intraperitoneal pressure.
Obeid
F
F
Department of Surgery, Henry Ford Hospital, Detroit, Mich, USA.
Saba
A
A
Fath
J
J
Guslits
B
B
Chung
R
R
Sorensen
V
V
Buck
J
J
Horst
M
M
D000005:Abdomen; D000328:Adult; D017081:Cholecystectomy, Laparoscopic; D006801:Humans; D007327:Insufflation; D008170:Lung Compliance / Q000502:physiology*; D016343:Monitoring, Intraoperative / Q000379:methods*; D011312:Pressure; D011446:Prospective Studies