Brief Article
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World J Crit Care Med. May 4, 2013; 2(2): 9-16
Published online May 4, 2013. doi: 10.5492/wjccm.v2.i2.9
Effect of intra-abdominal pressure on respiratory function in patients undergoing ventral hernia repair
Konstantin M Gaidukov, Elena N Raibuzhis, Ayyaz Hussain, Alexey Y Teterin, Alexey A Smetkin, Vsevolod V Kuzkov, Manu LNG Malbrain, Mikhail Y Kirov
Konstantin M Gaidukov, Elena N Raibuzhis, Ayyaz Hussain, Alexey A Smetkin, Vsevolod V Kuzkov, Mikhail Y Kirov, Department of Anesthesiology and Intensive Care Medicine, Northern State Medical University, 163001 Arkhangelsk, Russia
Konstantin M Gaidukov, Elena N Raibuzhis, Alexey A Smetkin, Vsevolod V Kuzkov, Mikhail Y Kirov, Department of Anesthesiology and Intensive Care Medicine, City Hospital #1 of Arkhangelsk, 163001 Arkhangelsk, Russia
Alexey Y Teterin, Department of General Surgery, City Hospital #1 of Arkhangelsk, 163001 Arkhangelsk, Russia
Manu LNG Malbrain, Intensive Care Unit and High Care Burn Unit, ZiekenhuisNetwerk Antwerpen, ZNA Campus Stuivenberg, 2060 Antwerpen, Belgium
Author contributions: Gaidukov KM, Raibuzhis EN, Hussain A, Teterin AY, Smetkin AA, Kuzkov VV and Kirov MY planned the study, were responsible for the design and coordination, collected the data and started drafting the manuscript; Gaidukov KM, Kirov MY and Malbrain MLNG participated in the study design and helped to draft the manuscript; Gaidukov KM, Kirov MY and Malbrain MLNG performed the statistical analysis and helped to draft the manuscript; all authors read and approved the final manuscript.
Correspondence to: Mikhail Y Kirov, MD, PhD, Professor, Department of Anesthesiology and Intensive Care Medicine, Northern State Medical University, Troitsky Prospect 51, 163000 Arkhangelsk, Russia. mikhail_kirov@hotmail.com
Telephone: +7-921-7215691 Fax: +7-8182-632986
Received: December 27, 2012
Revised: March 20, 2013
Accepted: April 27, 2013
Published online: May 4, 2013
Processing time: 185 Days and 11.2 Hours
Abstract

AIM: To determine the influence of intra-abdominal pressure (IAP) on respiratory function after surgical repair of ventral hernia and to compare two different methods of IAP measurement during the perioperative period.

METHODS: Thirty adult patients after elective repair of ventral hernia were enrolled into this prospective study. IAP monitoring was performed via both a balloon-tipped nasogastric probe [intragastric pressure (IGP), CiMON, Pulsion Medical Systems, Munich, Germany] and a urinary catheter [intrabladder pressure (IBP), UnoMeterAbdo-Pressure Kit, UnoMedical, Denmark] on five consecutive stages: (1) after tracheal intubation (AI); (2) after ventral hernia repair; (3) at the end of surgery; (4) during spontaneous breathing trial through the endotracheal tube; and (5) at 1 h after tracheal extubation. The patients were in the complete supine position during all study stages.

RESULTS: The IAP (measured via both techniques) increased on average by 12% during surgery compared to AI (P < 0.02) and by 43% during spontaneous breathing through the endotracheal tube (P < 0.01). In parallel, the gradient between РаСО2 and EtCO2 [Р(а-et)CO2] rose significantly, reaching a maximum during the spontaneous breathing trial. The PаO2/FiO2 decreased by 30% one hour after tracheal extubation (P = 0.02). The dynamic compliance of respiratory system reduced intraoperatively by 15%-20% (P < 0.025). At all stages, we observed a significant correlation between IGP and IBP (r = 0.65-0.81, P < 0.01) with a mean bias varying from -0.19 mmHg (2SD 7.25 mmHg) to -1.06 mm Hg (2SD 8.04 mmHg) depending on the study stage. Taking all paired measurements together (n = 133), the median IGP was 8.0 (5.5-11.0) mmHg and the median IBP was 8.8 (5.8-13.1) mmHg. The overall r2 value (n = 30) was 0.76 (P < 0.0001). Bland and Altman analysis showed an overall bias for the mean values per patient of 0.6 mmHg (2SD 4.2 mmHg) with percentage error of 45.6%. Looking at changes in IAP between the different study stages, we found an excellent concordance coefficient of 94.9% comparing ΔIBP and ΔIGP (n = 117).

CONCLUSION: During ventral hernia repair, the IAP rise is accompanied by changes in Р(а-et)CO2 and PаO2/FiO2-ratio. Estimation of IAP via IGP or IBP demonstrated excellent concordance.

Keywords: Intra-abdominal pressure; Gastric pressure; Bladder pressure; Intra-abdominal hypertension; Hernia; Oxygenation; Respiratory function

Core tip: The surgical repair of ventral hernia is accompanied by a rise of intra-abdominal pressure, a deterioration of CO2 elimination and a decrease in arterial oxygenation. The measurements of intra-abdominal pressure using nasogastric tube and urinary catheter demonstrate a close agreement between both methods; thus, both these methods can be used in clinical practice.