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Increases in Intra-abdominal Pressure Affect Pulmonary Compliance

Farouck Obeid, MD; Amer Saba, MD; John Fath, MD, MPH; Benjamin Guslits, MD, FRCP(C); Ray Chung, MD; Victor Sorensen, MD; Joseph Buck, MD; H. Mathilda Horst, MD
Arch Surg. 1995;130(5):544-548. doi:10.1001/archsurg.1995.01430050094016.
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Objectives:  To determine the effect of increased intra-abdominal pressure (IAP) on pulmonary compliance and to determine an effective means to measure IAP.

Design:  A prospective study.

Setting:  An urban tertiary care hospital.

Patients:  Twenty-six adult patients undergoing laparoscopic cholecystectomy.

Interventions:  Intra-operative management of laparoscopic cholecystectomy requiring endotracheal intubation with general anesthesia, nasogastric and urinary bladder catheters, and position changes. Additional interventions included use of a rectal manometer and a respiratory pressure module inserted within the ventilator circuit.

Main Outcome Measures:  Correlation of changes in IAP with changes in dynamic pulmonary compliance, measured as tidal volume/(end inspiratory pressure—end expiratory pressure) and comparison of three different measurement techniques (bladder, rectal, and gastric) with a standard technique (insufflation pressure) in three different positions (supine, Trendelenburg's, and reverse Trendelenburg's

Results:  Compliance was significantly related to insufflation pressure (P<.001) by analysis of variance. In the gas insufflation model, the mean increment in bladder pressure reflected most closely the IAP increment in the supine position (5.7 vs 6 mm Hg) but not in the Trendelenburg (2.1 vs 6 mm Hg) and reverse Trendelenburg positions (3.4 vs 6 mm Hg). Rectal and gastric pressures were also position dependent and technically less reliable.

Conclusions:  Increased IAP has a major influence on pulmonary compliance (50% decrease at 16 mm Hg). Measurements of IAP by intraorgan manometry are position dependent and may not accurately reflect the intraperitoneal pressure.(Arch Surg. 1995;130:544-548)


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