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Mechanical ventilation and intra-abdominal hypertension: 'Beyond Good and Evil'

Intra-abdominal hypertension is frequent in surgical and medical critically ill patients. Intra-abdominal hypertension has a serious impact on the function of respiratory as well as peripheral organs. In the presence of alveolar capillary damage, which occurs in acute respiratory distress syndrome (...

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Detalles Bibliográficos
Autores principales: Pelosi, Paolo, Vargas, Maria
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2012
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3672607/
https://www.ncbi.nlm.nih.gov/pubmed/23256904
http://dx.doi.org/10.1186/cc11874
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author Pelosi, Paolo
Vargas, Maria
author_facet Pelosi, Paolo
Vargas, Maria
author_sort Pelosi, Paolo
collection PubMed
description Intra-abdominal hypertension is frequent in surgical and medical critically ill patients. Intra-abdominal hypertension has a serious impact on the function of respiratory as well as peripheral organs. In the presence of alveolar capillary damage, which occurs in acute respiratory distress syndrome (ARDS), intra-abdominal hypertension promotes lung injury as well as edema, impedes the pulmonary lymphatic drainage, and increases intra-thoracic pressures, leading to atelectasis, airway closure, and deterioration of respiratory mechanics and gas exchange. The optimal setting of mechanical ventilation and its impact on respiratory function and hemodynamics in ARDS associated with intra-abdominal hypertension are far from being assessed. We suggest that the optimal ventilator management of patients with ARDS and intra-abdominal hypertension would include the following: (a) intra-abdominal, esophageal pressure, and hemodynamic monitoring; (b) ventilation setting with protective tidal volume, recruitment maneuver, and level of positive end-expiratory pressure set according to the 'best' compliance of the respiratory system or the lung; (c) deep sedation with or without neuromuscular paralysis in severe ARDS; and (d) open abdomen in selected patients with severe abdominal compartment syndrome.
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spelling pubmed-36726072013-12-18 Mechanical ventilation and intra-abdominal hypertension: 'Beyond Good and Evil' Pelosi, Paolo Vargas, Maria Crit Care Commentary Intra-abdominal hypertension is frequent in surgical and medical critically ill patients. Intra-abdominal hypertension has a serious impact on the function of respiratory as well as peripheral organs. In the presence of alveolar capillary damage, which occurs in acute respiratory distress syndrome (ARDS), intra-abdominal hypertension promotes lung injury as well as edema, impedes the pulmonary lymphatic drainage, and increases intra-thoracic pressures, leading to atelectasis, airway closure, and deterioration of respiratory mechanics and gas exchange. The optimal setting of mechanical ventilation and its impact on respiratory function and hemodynamics in ARDS associated with intra-abdominal hypertension are far from being assessed. We suggest that the optimal ventilator management of patients with ARDS and intra-abdominal hypertension would include the following: (a) intra-abdominal, esophageal pressure, and hemodynamic monitoring; (b) ventilation setting with protective tidal volume, recruitment maneuver, and level of positive end-expiratory pressure set according to the 'best' compliance of the respiratory system or the lung; (c) deep sedation with or without neuromuscular paralysis in severe ARDS; and (d) open abdomen in selected patients with severe abdominal compartment syndrome. BioMed Central 2012 2012-12-18 /pmc/articles/PMC3672607/ /pubmed/23256904 http://dx.doi.org/10.1186/cc11874 Text en Copyright ©2012 BioMed Central Ltd
spellingShingle Commentary
Pelosi, Paolo
Vargas, Maria
Mechanical ventilation and intra-abdominal hypertension: 'Beyond Good and Evil'
title Mechanical ventilation and intra-abdominal hypertension: 'Beyond Good and Evil'
title_full Mechanical ventilation and intra-abdominal hypertension: 'Beyond Good and Evil'
title_fullStr Mechanical ventilation and intra-abdominal hypertension: 'Beyond Good and Evil'
title_full_unstemmed Mechanical ventilation and intra-abdominal hypertension: 'Beyond Good and Evil'
title_short Mechanical ventilation and intra-abdominal hypertension: 'Beyond Good and Evil'
title_sort mechanical ventilation and intra-abdominal hypertension: 'beyond good and evil'
topic Commentary
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3672607/
https://www.ncbi.nlm.nih.gov/pubmed/23256904
http://dx.doi.org/10.1186/cc11874
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