Increasing abdominal pressure with and without PEEP: effects on intra-peritoneal, intra-organ and intra-vascular pressures.
BACKGROUND
Intra-organ and intra-vascular pressures can be used to estimate intra-abdominal pressure. The aim of this prospective, interventional study was to assess the effect of PEEP on the accuracy of pressure estimation at different measurement sites in a model of increased abdominal pressure.


METHODS
Catheters for pressure measurement were inserted into the stomach, urinary bladder, peritoneal cavity, pulmonary artery and inferior vena cava of 12 pigs. The pressures were recorded simultaneously at baseline, during 10 cm H20 PEEP, external abdominal pressure (7 kg weight) plus PEEP, external abdominal pressure without PEEP, and again under baseline conditions. RESULTS (MEAN +/- SD): PEEP alone increased diastolic pulmonary artery and inferior vena cava pressure but had no effect on the other pressures. PEEP and external abdominal pressure increased intraperitoneal pressure from 6 +/- 1 mm Hg to 9 +/- 2 mm Hg, urinary bladder pressure from 6 +/- 2 mm Hg to 11 +/- 2 mm Hg (p = 0.012), intragastric pressure from 6 +/- 2 mm Hg to 11 +/- 2 mm Hg (all p <or= 0.001), and inferior vena cava pressure from 11 +/- 4 mm Hg to 15 +/- 4 mm Hg (p = 0.01). Removing PEEP and maintaining extraabdominal pressure was associated with a decrease in pulmonary artery diastolic but not in any of the other pressures. There was a significant correlation among all pressures. Bias (-1 mm Hg) and limits of agreement (3 to -5 mm Hg) were similar for the comparisons of absolute intraperitoneal pressure with intra-gastric and urinary bladder pressure, but larger for the comparison between intraperitoneal and inferior vena cava pressure (-5, 0 to -11 mm Hg). Bias (0 to -1 mm Hg) and limits of agreement (3 to -4 mm Hg) for pressure changes were similar for all comparisons


CONCLUSIONS
Our data suggest that pressure changes induced by external abdominal pressure were not modified by changing PEEP between 0 and 10 cm H20.
Jakob
Stephan M
SM
Department of Intensive Care Medicine, University Hospital Inselspital and University of Bern, Bern, Switzerland. stephan.jakob@insel.ch
Knuesel
Rafael
R
Tenhunen
Jyrki J
JJ
Pradl
Richard
R
Takala
Jukka
J
D000005:Abdomen / Q000502:physiology*; D000818:Animals; D005260:Female; D023421:Models, Animal; D010529:Peritoneal Cavity / Q000502:physiology*; D011175:Positive-Pressure Respiration; D011312:Pressure; D011651:Pulmonary Artery / Q000502:physiology*; D013270:Stomach / Q000502:physiology*; D013552:Swine; D001743:Urinary Bladder / Q000502:physiology*; D014682:Vena Cava, Inferior / Q000502:physiology