Cardiopulmonary effects of matching positive end-expiratory pressure to abdominal pressure in concomitant abdominal hypertension and acute lung injury.
BACKGROUND
To evaluate the cardiopulmonary effects of positive end-expiratory pressure (PEEP) equalization to intra-abdominal pressure (IAP) in an experimental model of intra-abdominal hypertension (IAH) and acute lung injury (ALI).


METHODS
Eight anesthetized pigs were submitted to IAH of 20 mm Hg with a carbon dioxide insufflator for 30 minutes and then submitted to lung lavage with saline and Tween (2.5%). Pressure x volume curves of the respiratory system were performed by a low flow method during IAH and ALI, and PEEP was subsequently adjusted to 27 cm . H2O for 30 minutes.


RESULTS
IAH decreases pulmonary and respiratory system static compliances and increases airway resistance, alveolar-arterial oxygen gradient, and respiratory dead space. The presence of concomitant ALI exacerbates these findings. PEEP identical to AP moderately improved oxygenation and respiratory mechanics; however, an important decline in stroke index and right ventricle ejection fraction was observed.


CONCLUSIONS
Simultaneous IAH and ALI produce important impairments in the respiratory physiology. PEEP equalization to AP may improve the respiratory performance, nevertheless with a secondary hemodynamic derangement.
da Silva Almeida
Juliana Roberta
JR
Intensive Care and Anesthesiology Research Laboratory, Research and Education Institute, Hospital Sirio-Libanes, Bela Vista, São Paulo, Brazil.
Machado
Fabio Santana
FS
Schettino
Guilherme Paula Pinto
GP
Park
Marcelo
M
Azevedo
Luciano Cesar Pontes
LC
D034841:Abdominal Cavity / Q000503:physiopathology*; D055371:Acute Lung Injury / Q000503:physiopathology* / Q000628:therapy*; D000818:Animals; D003161:Compartment Syndromes / Q000503:physiopathology / Q000628:therapy; D004195:Disease Models, Animal; D005260:Female; D006334:Heart Function Tests; D006439:Hemodynamics / Q000502:physiology; D006973:Hypertension / Q000503:physiopathology; D011175:Positive-Pressure Respiration / Q000379:methods*; D011312:Pressure; D011336:Probability; D011897:Random Allocation; D012126:Respiratory Dead Space; D015656:Respiratory Mechanics / Q000502:physiology; D013318:Stroke Volume; D034421:Sus scrofa; D014655:Vascular Resistance / Q000502:physiology