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The effect of increased intra-abdominal pressure on orbital subarachnoid space width and intraocular pressure

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Neural Regeneration Research 2018年第2期13卷 353-359页

作者： Su-meng Liu Ning-li Wang Zhen-tao Zuo Wei-wei Chen Di-ya Yang Zhen Li Yi-wen Cao Beijing Tongren Eye Center Beijing Tongren Hospital Capital Medical University Beijing Ophthalmology and Visual Sciences Key Laboratory Beijing Institute of Ophthalmology Beijing Tongren Hospital Capital Medical University State Key Laboratory of Brain and Cognitive Science Institute of Biophysics Chinese Academy of Sciences Department of Neurology Xuanwu Hospital Capital Medical University

In accordance with the trans-lamina cribrosa pressure difference theory, decreasing the trans-lamina cribrosa pressure difference can re- lieve glaucomatous optic neuropathy. Increased intracranial pressure can also reduce optic nerve damage in glaucoma patients, and a safe, effective and noninvasive way to achieve this is by increasing the intra-abdominal pressure. The purpose of this study was to observe the changes in orbital subarachnoid space width and intraocular pressure at elevated intra-abdominal pressure. An inflatable abdominal belt was tied to each of 15 healthy volunteers, aged 22-30 years （12 females and 3 males）, at the navel level, without applying pressure to the abdomen, before they laid in the magnetic resonance imaging machine. The baseline orbital subarachnoid space width around the optic nerve was measured by magnetic resonance imaging at 1, 3, 9, and 15 mm behind the globe. The abdominal belt was inflated to increase the pressure to 40 mmHg （1 mmHg = 0.133 kPa）, then the orbital subarachnoid space width was measured every 10 minutes for 2 hours. After removal of the pressure, the measurement was repeated 10 and 20 minutes later. In a separate trial, the intraocular pressure was measured for all the subjects at the same time points, before, during and after elevated intra-abdominal pressure. Results showed that the baseline mean orbital subarachnoid space width was 0.88 ＋ 0.1 mm （range： 0.77-1.05 mm）, 0.77 ＋ 0.11 mm （range： 0.60-0.94 mm）, 0.70 ＋ 0.08 mm （range： 0.62-0.80 ram）, and 0.68 _＋ 0.08 mm （range： 0.57-0.77 mm） at 1, 3, 9, and 15 mm behind the globe, respectively. During the elevated intra-abdominal pressure, the orbital subarachnoid space width increased from the baseline and dilation of the optic nerve sheath was significant at 1, 3 and 9 mm behind the globe. After decompression of the abdominal pressure, the orbital subarachnoid space width normalized and returned to the baseline value. There was no significant difference in the intraocular pressure before, during and after the int

关键词： nerve regeneration intraocular pressure intra-abdominal pressure intracranial pressure trans-lamina cribrosa pressure difference orbital subarachnoid space width magnetic resonance imaging optic nerve sheath glaucoma cerebrospinal fluid pressure subarachnoid space neural regeneration

Effects of Altered intra-abdominal pressure on the Upper Airway Collapsibility in a Porcine Model

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Chinese Medical Journal 2015年第23期128卷 3204-3210页

作者： Shu-Lin Ren Yan-Ru Li Ji-Xiang Wu Jing-Ying Ye Rachel Jen Department of General Surgery Beijing Tongren Hospital Capital Medical University Beijing 100730 China Department of Otolaryngology Head and Neck Surgery Beijing Tongren Hospital Capital Medical University Beijing 100730 China Department of Otolaryngology Head and Neck Surgery Beijing Tsinghua Changgung Hospital Tsinghua University Beijing 102218 China Department of Medicine Respiratory Division University of British Columbia Vancouver BC Canada

Background： Obstructive sleep apnea is strongly associated with obesity, particularly abdominal obesity common in centrally obese males. Previous studies have demonstrated that intra-abdominal pressure （IAP） is increased in morbid obesity, and tracheal traction forces may influence pharyngeal airway collapsibility. This study aimed to investigate that whether IAP plays a role in the mechanism of upper airway （UA） collapsibility via IAP-related caudal tracheal traction. Methods： An abdominal wall lifting （AWL） system and graded CO2 pneumoperitoneum pressure was applied to four supine, anesthetized Guizhou miniature pigs and its effects on tracheal displacement （TD） and airflow dynamics of UA were studied. Individual run data in 3 min obtained before and after AWL and obtained before and after graded pneumoperitoneum pressure were analyzed. Differences between baseline and AWL/graded pneumoperitoneum pressure data of each pig were examined using a Student＇s t-test or analysis of variance. Results： Application of AWL resulted in decreased IAP and significant caudal TD. The average displacement amplitude was 0.44 mm （P 〈 0.001 ）. There were three subjects showed increased tidal volume （TV）（P 〈 0.01 ） and peak inspiratory airflow （P 〈 0.01 ）; however, the change of flow limitation inspiratory UA resistance （Rua） was not significant. Experimental increased lAP by pneumoperitoneum resulted in significant cranial TD. The average displacement amplitude was 1.07 mm （P 〈 0.001） when lAP was 25 cmH2O compared to baseline. There were three subjects showed reduced Rua while the TV increased （P 〈 0.01 ）. There was one subject had decreased TV and elevated Rua （P 〈 0.001）. Conclusions： Decreased IAP significantly increased caudal TD, and elevated lAP significantly increased cranial TD. However, the mechanism of UA collapsibility appears primarily mediated by changes in lung volume rather than tracheal traction effect. TV plays an independent role in the mechanism of UA collapsibility.

关键词： abdominal Obesity intra-abdominal pressure Lung Volume Obstructive Sleep Apnea Trachea Traction

Should we perform decompressive laparotomy during severe acute pancreatitis with intra-abdominal hypertension below 25 mmHg:Only the gut knows

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World Journal of Gastrointestinal Surgery 2024年第5期16卷 1470-1473页

作者： Thibault Vieille Melissa Crotet Celia Turco Paul Monasterolo Hadrien Winiszewski Gael Piton Medical Intensive Care Unit Besancon University HospitalBesancon 25000France Intensive Care Unit Vesoul HospitalVesoul 70000France Department of Digestive Surgical Oncology-Liver Transplantation Unit Besancon University HospitalBesancon 25000France Inserm UMRS-938 Centre de Recherche Saint-Antoine(CRSA)Sorbonne UniversitéParis 10041NY212France Intensive Care Unit Nord Franche Comte HospitalTrevenans 90400France

We suggest that during severe acute pancreatitis(SAP)with intra-abdominal hypertension,practitioners should consider decompressive laparotomy,even with intra-abdominal pressure(IAP)below 25 mmHg.Indeed,in this setting,non-occlusive mesenteric ischemia(NOMI)may occur even with IAP below this cutoff and lead to transmural necrosis if abdominal perfusion pressure is not promptly restored.We report our experience of 18 critically ill patients with SAP having undergone decompressive laparotomy of which one third had NOMI while IAP was mostly below 25 mmHg.

关键词： Acute pancreatitis abdominal compartment syndrome Decompressive laparotomy Mesenteric ischemia intra-abdominal pressure abdominal perfusion pressure

intra-abdominal pressure monitoring in predicting outcome of patients with severe acute pancreatitis

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Hepatobiliary & Pancreatic Diseases International 2007年第4期6卷 420-423页

作者： Zhang, Wei-Fang Ni, Yun-Lan Cai, Ling Li, Tong Fang, Xue-Ling Zhang, Yun-Tao Zhejiang Univ Sch Med Affiliated Hosp 1 Intens Care Unit Hangzhou 310003 Peoples R China Hangzhou Hosp Tradit Chinese Med Dept Resp Syst Hangzhou 310003 Peoples R China

BACKGROUND: Severe acute pancreatitis (SAP) is a serious disease with many complications, high mortality and poor prognosis. It is characterized by rapid deterioration and poses one of the most difficult challenges in clinical practice. Previous investigations suggest that SAP is one of the main causes of intra-abdominal pressure (IAP) increase. The aim of this study was to evaluate the utility of IAP-monitoring in predicting the severity and prognosis of SAP. METHODS: Eighty-nine patients with SAP who had been treated from February 2001 to December 2005 were studied. Since bladder pressure accurately reflects IAP, we measured it instead of IAP. Bladder pressure was measured at the time of admission and every 12 hours in the course of the disease, 9 consecutive times in all. The APACHE II scores of all patients were obtained within 24 hours after admission. According to a maximum bladder pressure pressure and APACHE II scores in survivors were compared with those in deaths. RESULTS: Sixty-eight of the 89 patients were in the severely-elevated group. Mortality and mean APACHE II scores in this group were much higher than those in the mildly-elevated group (mortality, 39.71% vs. 9.52%; mean APACHE II score, 23.15 +/- 7.42 vs. 15.95 +/- 5.35, Ppressures and APACHE II scores in deaths were significantly greater than those in survivors (mean bladder pressure, 14.1 +/- 3.8 vs. 9.2 +/- 2.3 cmH(2)O, P<0.01; mean APACHE II score, 27.83 +/- 4.87 vs. 18.37 +/- 6.74, P<0.01). CONCLUSION: It is suggested that IAP may be used as a marker of the severity and prognosis of SAP.

关键词： severe acute pancreatitis intra-abdominal pressure APACHE II score mortality

Noninvasive monitoring of intra-abdominal pressure by measuring abdominal wall tension

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World Journal of Emergency Medicine 2015年第2期6卷 137-141页

作者： Yuan-zhuo Chen Shu-ying Yan Yan-qing Chen Yu-gang Zhuang Zhao Wei Shu-qin Zhou Hu Peng Department of Emergency Medicine Shanghai Tenth People's HospitalTongji University Coronary Care Unit Shanghai Jiangong Hospital

BACKGROUND: Noninvasive monitoring of intra-abdominal pressure(IAP) by measuring abdominal wall tension(AWT) was effective and feasible in previous postmortem and animal studies. This study aimed to investigate the feasibility of the AWT method for noninvasively monitoring IAP in the intensive care unit(ICU).METHODS: In this prospective study, we observed patients with detained urethral catheters in the ICU of Shanghai Tenth People's Hospital between April 2011 and March 2013. The correlation between AWT and urinary bladder pressure(UBP) was analyzed by linear regression analysis. The effects of respiratory and body position on AWT were evaluated using the paired samples t test, whereas the effects of gender and body mass index(BMI) on baseline AWT(IAP<12 mm Hg) were assessed using one-way analysis of variance.RESULTS: A total of 51 patients were studied. A significant linear correlation was observed between AWT and UBP(R=0.986, P<0.01); the regression equation was Y=–1.369+9.57X(P<0.01). There were signif icant differences among the different respiratory phases and body positions(P<0.01). However, gender and BMI had no signif icant effects on baseline AWT(P=0.457 and 0.313, respectively).CONCLUSIONS: There was a signif icant linear correlation between AWT and UBP and respiratory phase, whereas body position had signif icant effects on AWT but gender and BMI did not. Therefore, AWT could serve as a simple, rapid, accurate, and important method to monitor IAP in critically ill patients.

关键词： abdominal wall tension intra-abdominal pressure Noninvasive monitoring abdominal compartment syndrome

intra-abdominal pressure-monitoring may predict outcome in severe acute pancreatitis

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Intra-abdominal pressure-monitoring may predict outcome in s...

Surgical decompression for the management of abdominal compartment syndrome with severe acute pancreatitis: A narrative review

2007年浙江省危重病学学术年会

作者：章渭方 Intensive care unit the First Affiliated HospitalCollege of MedicineZhejiang UniversityHangzhouChina

Severe acute pancreatitis(SAP)is a serious disease with many complications,high mortality and poor prognosis.It deteriorates rapidly and poses the most difficult challenges in clinical practice.Previous investigations suggested that SAP was one of the main causes of intra-abdominal pressure(IAP)increasing. The aim of the study was to evaluate the utility of IAP-monitoring in predicting the severity and prognosis in SAP. Adult patients admitted in intensive care unit(ICU)for SAP were enrolled in the study.Because the bladder pressure reflects IAP accurately,we measured the bladder pressure instead of IAP.The bladder pressure was measured at the time of admission and every 12 hours in the course of disease,consecutive 9 times in all.APACHE Ⅱ scores of all patients were obtained within 24 hours after admission.According to the maximum bladder pressures＜10 cmHO,all patients were divided into two groups:mild-elevated group and severe-elevated group.Mortality and the mean APACHE Ⅱ scores in two groups were calculated respectively.Besides,The mean bladder pressure and APACHE Ⅱ scores in survivals were compared with those in deaths. From February 2001 to December 2005,a total of 89 patients with SAP were included in this study. Sixty-eight of the 89 patients were in severe-elevated group.Mortality and the mean APACHE Ⅱ scores in severe-elevated group were much higher than those in mild-elevated group.(mortality,39.71% vs 9.52%;the mean APACHE Ⅱ scores,23.15±7.42 vs 15.95±5.35,p＜0.01).The mean bladder pressure and APACHE Ⅱ scores in deaths were significantly greater than those in survivals(the mean bladder pressure, 14.1±3.8 vs 9.2±2.3,p＜0.01;the mean APACHE Ⅱ scores,27.83±4.87 vs 18.37±6.74,p＜0.01). It is suggested that IAP may be used as a marker of the severity and prognosis in SAP.

关键词： severe acute pancreatitis intra-abdominal pressure APACHE Ⅱ scores mortality prognosis

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世界胃肠外科杂志:英文版(电子版) 2023年第9期15卷 1879-1891页

作者： Prashant Nasa Gunjan Chanchalani Deven Juneja Manu LNG Malbrain Department of Critical Care Medicine NMC Specialty HospitalDubai 7832United Arab Emirates Department of Internal Medicine College of Medicine and Health SciencesAl Ain 15551United Arab Emirates Department of Critical Care Medicine K.J.Somaiya Hospital and Research CentreMumbai 400022India Institute of Critical Care Medicine Max Super Specialty HospitalNew Delhi 110017India First Department of Anaesthesiology and Intensive Therapy Medical University of LublinLublin 20-954Poland Executive Administration International Fluid AcademyLovenjoel 3360Belgium Medical Data Management MedamanGeel 2440Belgium

intra-abdominal hypertension(IAH)and abdominal compartment syndrome(ACS)play a pivotal role in the pathophysiology of severe acute pancreatitis(SAP)and contribute to new-onset and persistent organ failure.The optimal management of ACS involves a multi-disciplinary approach,from its early recognition to measures aiming at an urgent reduction of intra-abdominal pressure(IAP).A targeted literature search from January 1,2000,to November 30,2022,revealed 20 studies and data was analyzed on the type and country of the study,patient demographics,IAP,type and timing of surgical procedure performed,post-operative wound management,and outcomes of patients with ACS.There was no randomized controlled trial published on the ***-pressive laparotomy is effective in rapidly reducing IAP(standardized mean difference=2.68,95%confidence interval:1.19-1.47,Pabdominal Compartment Society on IAH and ACS.This narrative review focuses on the current evidence regarding surgical decompression techniques for managing ACS in patients with SAP.However,there is a lack of high-quality evidence on patient selection,timing,and modality of surgical decompression.Large prospective trials are needed to identify triggers and effective and safe surgical decompression methods in SAP patients with ACS.

关键词： intra-abdominal hypertension intra-abdominal pressure Decompression laparotomy Midline laparotomy abdominal compartment syndrome Acute pancreatitis

abdominal compartment syndrome:Often overlooked conditions in medical intensive care units

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World Journal of Gastroenterology 2020年第3期26卷 266-278页

作者： Venkat Rajasurya Salim Surani Department of Pulmonary and Critical Care Novant Health SystemWinston-SalemNC 27103United States Department of Pulmonary Critical Care and Sleep Medicine Texas A&M Health Science CenterBryanTX 77807United States

intra-abdominal hypertension(IAH)and abdominal compartment syndrome are well recognized entities among surgical patients.Nevertheless,a number of prospective and retrospective observational studies have shown that IAH is prevalent in about half of the critically ill patients in the medical intensive care units(ICU)and has been widely recognized as an independent risk factor for mortality.It is alarming to note that many members of the critical care team in medical ICU are not aware of the consequences of untreated IAH and the delay in making the diagnosis leads to increased morbidity and mortality.Frequently it is underdiagnosed and undertreated in this patient population.Elevated intraabdominal pressure decreases the blood flow to the kidneys and other abdominal viscera and also results in reduced cardiac output and difficulties in ventilating the patient because of increased intrathoracic pressure.When intraabdominal hypertension is not promptly recognized and treated,it leads to abdominal compartment syndrome,multiorgan dysfunction syndrome and death.Large volume fluid resuscitation is very common in medical ICU patients presenting with sepsis,shock and other inflammatory conditions like pancreatitis and it is one of the major risk factors for the development of intra-abdominal hypertension.This article presents an overview of the epidemiology,definitions,risk factors,pathophysiology and management of IAH and abdominal compartment syndrome in critically ill medical ICU patients.

关键词： intra-abdominal pressure intra-abdominal hypertension abdominal compartment syndrome Acute kidney injury Large volume resuscitation Open abdomen Bladder pressure Medical intensive care unit

Study of intra-abdominal hypertension prevalence and awareness level among experienced ICU medical staff

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Journal of Medical Colleges of PLA(China) 2016年第4期31卷 181-187页

作者： Hua-Yu Zhang Dong Liu Hao Tang Shi-Jin Sun Shan-Mu Ai Wen-Qun Yang Dong-Po Jiang Lian-Yang Zhang Trauma Center State Key Laboratory of TraumaBurns and Combined InjuryInstitute of Surgery ResearchDaping HospitalThird Military Medical University

Background:intra-abdominal hypertension(IAH) is a disease with high morbidity and mortality among critically ill patients.The study's objectives were to explore the prevalence of IAH and physicians' awareness of the 2013 World Society of abdominal Compartment Syndrome(WSACS) guidelines in Chinese intensive care units(ICUs).Methods:A cross-sectional study of four ICUs in Southwestern China was conducted from June 17 to August 2,2014.Adult patients admitted to the ICU for more than 24 h,with bladder catheter but without obvious intravesical pressure(IVP) measurement contraindications,were recruited.Intensivists with more than 5 years of ICU working experience were also recruited.Epidemiological information,potential IAH risk factors,IVP measurements and questionnaire results were recorded.Results:Forty-one patients were selected.Fifteen(36.59%) had IVP?12mm Hg.SOFA(Sequential Organ Failure Assessment) hepatic and neurological sub-scores were utilized as independent predictors for IAH via logistic backward analysis.Thirty-seven intensivists participated in the survey(response rate:80.43%).The average score of each center was less than 35 points.All physicians believed the IAH prevalence in their departments was no more than 20.00%.A significant negative correlation was observed between the intensivists' awareness of the 2013 WSACS guidelines and the IAH prevalence in each center(r=-0.975,P=0.025).Conclusion:The prevalence and independent predictors of IAH among the surveyed population are similar to the reports in the literature.Intensivists generally have a low awareness of the 2013 WSACS guidelines.A systematic guideline training program is vital for improving the efficiency of the diagnosis and treatment of IAH.

关键词： intra-abdominal pressure intravesical pressure intra-abdominal hypertension abdominal compartment syndrome Questionnaire