Gastric tonometry and direct intraabdominal pressure monitoring in abdominal compartment syndrome

Presented at the 48th Annual International Congress of the British Association of Paediatric Surgeons, London, England, July 18-21, 2001.
https://doi.org/10.1053/jpsu.2002.30257Get rights and content

Abstract

Background/Purpose: Abdominal compartment syndrome (ACS) may complicate abdominal closure in patients with abdominal wall defects, abdominal trauma, intraperitoneal bleeding, and infection. Increased intraabdominal pressure (IAP) leads to respiratory compromise, organ hypoperfusion, and a high mortality rate. This study evaluates the efficacy of continuous direct monitoring of IAP and gastric tissue pH in detecting impending ACS. Methods: Ten mongrel puppies weighing 2.8 to 6.4 kg underwent general endotracheal anesthesia, placement of an intraabdominal inflatable balloon to simulate ACS and a Swan-Ganz catheter to measure direct IAP. A gastric tonometer, nasogastric tube, foley catheter, and arterial catheter also were inserted. Half-hourly inflation's of the intraabdominal balloon were used to simulate the development of ACS. Direct intraabdominal (IAP), gastric (GP), bladder (BP), and peak airway pressures (PAP) were measured. Gastric tonometry fluid and arterial blood gas levels were obtained during inflation, and the gastric tissue pH level was calculated. Data were statistically analyzed using Pearson's correlation coefficients. Results: Baseline pressures were 2 to 5 cm H2O in the stomach and bladder catheters, 1 to 3 mm Hg in the intraabdominal catheter, and correlated with a gastric tissue pH level of 7.4. Significantly high correlation coefficients (cc) were observed between IAP versus BP (cc, 0.77; P <.002). IAP versus GP (cc, 0.79; P <.002) and IAP versus PAP (c, 0.83; P <.0004). A high negative correlation coefficient was noted between gastric pH and IAP (cc, 0.61; P <.026). The pH level dropped to 7.0 with BP and GP of 20 cm H2O and IAP of 10 mm Hg, to 6.8 at 30 cm H2O and 20 mm Hg, and 6.5 at 40 cm H2O and 30 mm Hg, respectively. However, correlation coefficients between gastric tissue pH and BP, GP, or PAP were not significant. Conclusions: These data suggest that continuous direct intraabdominal pressure monitoring is a simple and effective method that correlates well with indirect bladder or gastric pressure measurement. Changes in gastric tissue pH in association with increased intraabdominal pressure may be an early indicator of impending abdominal compartment syndrome. These observations indicate that these techniques may be more sensitive than current methods of indirect measurement, which may be associated with delayed recognition of ACS. J Pediatr Surg 37:214-218. Copyright © 2002 by W.B. Saunders Company.

Section snippets

Materials and methods

The Indiana University School of Medicine Animal Care and Use Committee approved this experimental protocol, and all animal treatment met National Institutes of Health guidelines for animal use.

Ten conditioned male beagles were obtained that weighed 2.8 to 6.4 kg, and they were fasted overnight. Each animal was premedicated intravenously with atropine (0.2 mg/kg) and then anesthetized with thiopentothal (20 mg/kg). Animals were orotracheally intubated, ventilated, and maintained under general

Results

Findings consistent with an abdominal compartment syndrome were established in each beagle, with no deaths occurring before euthanasia. Of note, however, midway through the experiment in the third beagle, the gastric pressures that had been rising gradually as expected fell to baseline levels. At laparotomy to confirm catheter placement, the nasogastric tube was found to be in the esophagus. Because of catheter malposition and the inconsistency of this single animal's data, the pressures from

Discussion

Congenital abdominal wall defects with associated antenatal intestinal herniation (omphalocele and gastroschisis) are a relatively common problem in the neonatal period. Although the herniated viscera can be reduced successfully and the abdominal wall managed by primary closure, a small abdominal cavity or large defect may create insufficient space for safe reduction of the intestines. Reduction in these instances may require temporary coverage by application of a prosthetic silo and subsequent

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