Resumo

RUIZ FERRON, F. et al. Intraabdominal and thoracic pressure in critically ill patients with suspected intraabdominal hypertension. Med. Intensiva [online]. 2011, vol.35, n.5, pp.274-279. ISSN 0210-5691.

Objective: To study the correlation between intraabdominal and intrathoracic pressure in patients with suspected intraabdominal hypertension. Design: A prospective, observational cohort study. Setting: Polyvalent intensive care unit of a University hospital. Patients: Twenty-seven medical-surgical patient dependent upon controlled mechanical ventilation due to acute respiratory failure and with several risk factors for intraabdominal hypertension (IAH). Main variables: Intraabdominal (IAP), esophageal (Peso) and airways pressure were measured under static (st) and dynamic (dyn) conditions. Respiratory system (Crs), lung (Cl) and chest wall compliance (Ccw) were calculated. Results: In 10 patients IAP>12mmHg (IAH, IAPst, 14±2 [12-21] mmHg), while in the rest the pressure proved normal (n=17; IAPst, 8±2 [3-11] mmHg). Peso st was 11±5 (2-27) and Peso dyn 7±4 (2-24) cmH₂O. Depending on the presence or absence of IAH, Peso st was 9±4 vs 7±3cmH₂O (p=0.2) and Peso dyn 6±2 vs 4±3cmH₂O (p=0.3), respectively. The correlation between Peso st and dyn with IAPst was 0.5 (p=0.003) and 0.4 (p=0.03), respectively. The compliance components were decreased (Crs, 31±8; Cl, 52±22 and Ccw, 105±50ml/cmH₂O); Ccw was significantly lower in patients with IAH (81±31 vs 118±55ml/cmH₂O; p=0.02). The correlation coefficient between IAPst and Ccw was -0.7 (p<0.001), and -0.5 (p=0.002) with respect to Crs. Conclusions: A stiffer chest wall was observed in patients with IAH. In patients with risk factors for IAH, pressures in these compartments were highly variable.

Palavras-chave : Intraabdominal pressure; Chest wall compliance; Esophageal pressure; Mechanical ventilation; Abdominal compliance.

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