Increases in Intra-Abdominal Pressure Affect Pulmonary Compliance

Arch Surg. 1995 May;130(5):544-7; discussion 547-8. doi: 10.1001/archsurg.1995.01430050094016.

Abstract

Objectives: To determine the effect of increased intra-abdominal pressure (IAP) on pulmonary compliance and to determine an effective means to measure IAP.

Design: A prospective study.

Setting: An urban tertiary care hospital.

Patients: Twenty-six adult patients undergoing laparoscopic cholecystectomy.

Interventions: Intra-operative management of laparoscopic cholecystectomy requiring endotracheal intubation with general anesthesia, nasogastric and urinary bladder catheters, and position changes. Additional interventions included use of a rectal manometer and a respiratory pressure module inserted within the ventilator circuit.

Main outcome measures: Correlation of changes in IAP with changes in dynamic pulmonary compliance, measured as tidal volume/(end inspiratory pressure--end expiratory pressure) and comparison of three different measurement techniques (bladder, rectal, and gastric) with a standard technique (insufflation pressure) in three different positions (supine, Trendelenburg's, and reverse Trendelenburg's).

Results: Compliance was significantly related to insufflation pressure (P < .001) by analysis of variance. In the gas insufflation model, the mean increment in bladder pressure reflected most closely the IAP increment in the supine position (5.7 vs 6 mm Hg) but not in the Trendelenburg (2.1 vs 6 mm Hg) and reverse Trendelenburg positions (3.4 vs 6 mm Hg). Rectal and gastric pressures were also position dependent and technically less reliable.

Conclusions: Increased IAP has a major influence on pulmonary compliance (50% decrease at 16 mm Hg). Measurements of IAP by intraorgan manometry are position dependent and may not accurately reflect the intraperitoneal pressure.

Publication types

  • Clinical Trial
  • Controlled Clinical Trial

MeSH terms

  • Abdomen*
  • Adult
  • Cholecystectomy, Laparoscopic*
  • Humans
  • Insufflation*
  • Lung Compliance / physiology*
  • Monitoring, Intraoperative / methods*
  • Pressure
  • Prospective Studies