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Electronic Letters to:

Review Articles:
A. Helmy, M. Vizcaychipi, and A. K. Gupta
Traumatic brain injury: intensive care management
Br. J. Anaesth. 2007; 99: 32-42 [Abstract] [Full text] [PDF]
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[Read E-letter] Effect of intra-abdominal pressure on intra-cerebral pressure in traumatic brain injury
Paul G Hayden   (14 August 2007)

Effect of intra-abdominal pressure on intra-cerebral pressure in traumatic brain injury 14 August 2007
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Paul G Hayden

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Re: Effect of intra-abdominal pressure on intra-cerebral pressure in traumatic brain injury

Editor,

I would like to congratulate Helmy and colleagues on their excellent review of intensive care management of traumatic brain injury (TBI).1 In the section on miscellaneous management strategies, whilst the authors briefly mentioned using laxatives to ensure regular bowel opening to reduce the effects of intra-abdominal hypertension (IAH), they did not clarify the effects of raised intra-abdominal pressure (IAP) on intra- cerebral pressure (ICP). This is of particular relevance when managing patients admitted to the ICU with traumatic brain injury and additional injuries, many of whom require large volume resuscitation, placing them at increased risk of IAH.2

Increasing IAP has been demonstrated to raise ICP, probably via a transmitted elevation in intra-thoracic pressure from the abdominal compartment, limiting venous drainage from the brain with a resultant increase in ICP.3,4 Furthermore, clinical investigations have reported that elevated ICP can be ameliorated by interventions to reduce IAP.2,4

Thus, routine monitoring of IAP and the utilisation of strategies to limit its increase should be considered in patients admitted with TBI, particularly those with additional traumatic injuries and in whom intra- cranial pressure is refractory to conventional therapies.2,3

P. Hayden London, UK

E-mail: paulhayden@doctors.org.uk

1. Helmy A, Vizcaychipi M, Gupta AK. Traumatic brain injury: intensive care management. Br J Anaesth. 2007;99(1):32-42.

2. Scalea TM, Bochicchio GV, Habashi N, McCunn M, Shih D, McQuillan K, Aarabi B. Increased intra-abdominal, intrathoracic, and intracranial pressure after severe brain injury: multiple compartment syndrome. J Trauma. 2007;62(3):647-56

3. De laet I, Citerio G, Malbrain ML. The influence of intraabdominal hypertension on the central nervous system: current insights and clinical recommendations, is it all in the head? Acta Clin Belg Suppl. 2007;(1):89- 97.

4. Citerio G, Vascotto E, Villa F, Celotti S, Pesenti A. Induced abdominal compartment syndrome increases intracranial pressure in neurotrauma patients: a prospective study. Crit Care Med. 2001;29(7):1466- 71.

5. Joseph DK, Dutton RP, Aarabi B, Scalea TM. Decompressive laparotomy to treat intractable intracranial hypertension after traumatic brain injury. J Trauma. 2004;57(4):687-93

Conflict of Interest:

None declared