Preload assessment in patients with an open abdomen

J Trauma. 1999 Jan;46(1):16-22. doi: 10.1097/00005373-199901000-00004.


Background: Intra-abdominal hypertension and abdominal compartment syndrome cause significant morbidity and mortality in surgical and trauma patients. Maintenance of intravascular preload and use of open abdomen techniques are essential. The accuracy of pulmonary artery occlusion pressure (PAOP) and central venous pressure (CVP) in patients with intra-abdominal hypertension has been questioned.

Methods: Twenty surgical and trauma patients with intra-abdominal hypertension requiring open abdominal decompression were monitored using volumetric thermodilution pulmonary artery catheters. Hemodynamic, oxygenation, inspiratory, and intravesicular pressure measurements were collected prospectively. PAOP, CVP, and right ventricular end-diastolic volume index (RVEDVI) were compared as estimates of preload status.

Results: Multiple regression analysis demonstrated that cardiac index correlated significantly better with RVEDVI (r = 0.69) than with PAOP (r = -0.27) or CVP (r = -0.28) during resuscitation after open abdominal decompression (p < 0.0001).

Conclusion: RVEDVI is superior to PAOP and CVP as an estimate of preload status in patients with an open abdomen.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Catheterization, Central Venous
  • Catheterization, Swan-Ganz
  • Central Venous Pressure*
  • Compartment Syndromes / physiopathology
  • Compartment Syndromes / surgery*
  • Decompression, Surgical*
  • Female
  • Heart Function Tests
  • Humans
  • Hypertension / physiopathology
  • Hypertension / surgery*
  • Injury Severity Score
  • Lactates / blood
  • Lower Body Negative Pressure* / methods
  • Male
  • Middle Aged
  • Prospective Studies
  • Pulmonary Wedge Pressure*
  • Regression Analysis
  • Reproducibility of Results
  • Ventricular Function, Right


  • Lactates