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Hemodynamic effects of increased intra-abdominal pressure in critically ill children
Letícia G T Silveira1, Isabela C Brocca1, Erika S Moraes2
1Universidade Estadual de Campinas (UNICAMP), Hospital das Clínicas, Departamento de Pediatria, Unidade de Terapia Intensiva Pediátrica, Campinas, SP, Brazil.
Insights
The abdominal compression maneuver (ACM) significantly increases intra-abdominal pressure (IAP), impairing cardiac function in children. This maneuver also effectively distends the left internal jugular vein (LIJV) in over half of subjects.
Area of Science:
- Pediatric Critical Care Medicine
- Hemodynamics
- Intra-abdominal Hypertension
Background:
- Intra-abdominal hypertension (IAH) is a critical condition in children, potentially leading to significant cardiovascular compromise.
- Understanding the hemodynamic effects of interventions that increase intra-abdominal pressure (IAP) is crucial for patient management.
Purpose of the Study:
- To assess the impact of elevated intra-abdominal pressure (IAP) on cardiac index (CI) during an abdominal compression maneuver (ACM) in children.
- To evaluate the effectiveness of the ACM in achieving adequate distension of the left internal jugular vein (LIJV).
Main Methods:
- A prospective observational study was conducted in a pediatric intensive care unit (PICU).
- Intra-abdominal pressure (IAP) was incrementally increased using an abdominal compression maneuver (ACM).
- Cardiac index (CI) was measured via transthoracic echocardiography, and left internal jugular vein (LIJV) cross-sectional area (CSA) via ultrasonography at each IAH grade.
Main Results:
- Twenty-four children were studied, with median age and weight of 3.5 months and 6.37kg.
- Cardiac index (CI) showed a progressive decline with increasing intra-abdominal hypertension (IAH) grades.
- A 25% increase in left internal jugular vein (LIJV) cross-sectional area (CSA) was observed in 58% of participants during the ACM.
Conclusions:
- The abdominal compression maneuver (ACM) significantly elevates intra-abdominal pressure (IAP), causing reversible cardiovascular impairment.
- The ACM is effective in distending the left internal jugular vein (LIJV) in a majority of pediatric subjects.
- Even mild intra-abdominal hypertension (IAH) can lead to substantial cardiac dysfunction in children, necessitating awareness of these hemodynamic effects.
Objective:
To evaluate the influence of intra-abdominal pressure on the cardiac index (CI) at different intra-abdominal hypertension grades achieved when performing an abdominal compression maneuver (ACM). Evaluating the effectiveness of the ACM in distending the left internal jugular vein (LIJV).
Methods:
Prospective observational study conducted in the PICU of a quaternary care teaching hospital. Participants underwent the ACM and the IAP was measured with an indwelling urinary catheter. At each IAH grade reached during the ACM, the CI was measured by transthoracic echocardiography and the LIJV cross-sectional area (CSA) was determined by ultrasonography.
Results:
Twenty-four children were included (median age and weight of 3.5 months and 6.37kg, respectively). The median CI observed at baseline and during IAH grades I, II, III, and IV were 3.65L/min/m2 (IQR 3.12-4.03), 3.38L/min/m2 (IQR 3.04-3.73), 3.16L/min/m2 (IQR 2.70-3.53), 2.89L/min/m2 (IQR 2.38-3.22), and 2.42L/min/m2 (IQR 1.91-2.79), respectively. A 25% increase in the LIJV CSA area was achieved in 14 participants (58%) during the ACM.
Conclusion:
The ACM significantly increases IAP, causing severe reversible impairment in the cardiovascular system and is effective in distending the LIJV in just over half of the subjects. Even low levels of HIA can result in significant cardiac dysfunction in children. Therefore, health professionals should be aware of the negative hemodynamic repercussions caused by the increased IAP.
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