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BJA Advance Access published online on April 4, 2006
British Journal of Anaesthesia, doi:10.1093/bja/ael071
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org
Accepted January 24, 2006

Laboratory Investigation

Effects of increased intra-abdominal pressure on central circulation

E. Vivier 1, O. Metton 2, V. Piriou 3, F. Lhuillier 1, J. M. Cottet-Emard 4, P. Branche 1, S. Duperret 1, and J. P. Viale 5 *

1 Department of Anaesthesiology and Intensive Care, Hôpital de la Croix-Rousse, Lyon, France
2 Department of Surgery, Hôpital Louis Pradel, Lyon, France
3 Department of Anaesthesiology and Intensive Care, Hôpital Lyon Sud, Lyon, France
4 Laboratoire de Physiologie de l'Environnement, Faculté de Médecine, Lyon, France
5 UPRES EA 1896, Laboratoire de Physiologie, Faculté de Médecine, Lyon, France

* To whom correspondence should be addressed.
J. P. Viale, E-mail: jean-paul.viale{at}chu-lyon.fr


  Abstract

Background. In an experimental model we investigated the effects of a gradual increase in intra-abdominal pressure (IAP) on the central circulation.

Methods. Seven pigs were anaesthetized, mechanically ventilated and instrumented. IAP was gradually increased by 5 mm Hg up to 30 mm Hg by abdominal banding in normovolaemic animals, and then they were made hypovolaemic after blood withdrawal. Right atrial pressure (RAP) and left ventricular end-diastolic pressure (LVEDP) at each step and aortic, femoral and inferior vena cava blood flows were measured. Left ventricular end-diastolic area (LVEDA) was determined using epicardial echocardiography.

Results. Cardiac output maintained at mild IAP was reduced to 76 (24)% of the initial value at 30 mm Hg IAP [mean (SD)] in normovolaemic animals, and 72 (22)% (P<0.001) in hypovolaemic animals. In normovolaemic animals the LVEDA and LVEDP were significantly increased at an IAP of 10 and 15 mm Hg by 26 (24)% and 38 (23)%, respectively. At these IAP values, the difference between the RAP and IAP was positive. When this gradient became negative, that is beyond 15 mm Hg in normovolaemia and for all IAP values in hypovolaemic animals, the LVEDA declined, reaching 78 (16)% and 62 (22)% (P<0.05) of the initial values in normovolaemic and hypovolaemic groups at the highest IAP value.

Conclusions. These results showed that a gradual increase in IAP led to a redistribution of abdominal blood volume towards the thoracic compartment, at IAP lower than 15 mm Hg in normovolaemia, and at its expense at higher values of IAP. In hypovolaemia there was no thoracic compartment gain. Whereas the absolute or transmural RAPs were not informative of the direction of this blood shift, an RAP greater than IAP was associated with an intrathoracic compartment gain.

Keywords: circulatory changes; complications, intra-abdominal hypertension; monitoring, echocardiography.
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