Treatment of intracranial hypertension using nonsurgical abdominal decompression.
BACKGROUND
Elevated intra-abdominal pressure (IAP) increases intracranial pressure (ICP) and reduces cerebral perfusion pressure (CPP). We evaluated a nonsurgical means of reducing IAP to reverse this process.


METHODS
Swine with a baseline ICP of 25 mm Hg produced by an intracranial balloon catheter were studied. In group 1 (n = 5), IAP was increased by 25 mm Hg. Continuous negative abdominal pressure (CNAP) was then applied. Group 2 (n = 4) had neither IAP elevation nor CNAP. Group 3 (n = 4) had CNAP without IAP elevation.


RESULTS
Elevation of IAP by 25 mm Hg above baseline led to deleterious changes in ICP (25.8+/-0.8 to 39.0+/-2.8; p < 0.05) and CPP (85.2+/-2.0 to 64.8+/-2.6; p < 0.05). CNAP led to a reduction in IAP (30.2+/-1.2 to 20.4+/-1.3; p < 0.05) and improvements in cerebral perfusion (ICP, 33+/-2.7; CPP, 74.4+/-1.2; both p < 0.05). Group 2 had stable ICP (25.8+/-0.25 to 28.7+/-1.7; p > 0.05) and CPP (80.8+/-1.4 to 80.5+/-1.8; p > 0.05). In group 3, CNAP decreased cardiac index (2.9+/-0.2 to 1.1+/-0.4; p < 0.05), mean arterial pressure (105.2+/-4.0 to 38.2+/-12.0; p < 0.05), and CPP (74.2+/-4.7 to 14.5+/-12.2; p < 0.05).


CONCLUSIONS
Elevations in IAP led to increased ICP and decreased CPP. CNAP ameliorated these intracranial disturbances. With normal IAP, CNAP impaired cerebral perfusion.
Saggi
B H
BH
Department of Surgery, Medical College of Virginia of Virginia Commonwealth University, Richmond, USA.
Bloomfield
G L
GL
Sugerman
H J
HJ
Blocher
C R
CR
Hull
J P
JP
Marmarou
A P
AP
Bullock
M R
MR
D000704:Analysis of Variance; D000818:Animals; D001784:Blood Gas Analysis; D005260:Female; D006439:Hemodynamics; D019586:Intracranial Hypertension / Q000503:physiopathology / Q000628:therapy*; D008150:Lower Body Negative Pressure / Q000295:instrumentation / Q000379:methods*; D008297:Male; D011897:Random Allocation; D013552:Swine