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İntraabdominal Basınç Göstergesi Olarak Vena Kava İnferior Çapının Ultrasonografi ile Değerlendirilmesi

Year 2020, Volume: 22 Issue: 3, 166 - 170, 30.12.2020
https://doi.org/10.18678/dtfd.753242

Abstract

Amaç: İntraabdominal hipertansiyon (IAH) ve abdominal kompartıman sendromu (ACS) anlamlı morbidite ve mortalite nedenleri arasında kabul edilmektedir. Bu çalışmanın amacı IAH, ACS ve abdominal perfüzyon basıncı (APP) değerlendirilmesinin non-invaziv bir teknik olarak ultrasonografi (US) ile yapılabilirliğinin araştırılmasıdır.
Gereç ve Yöntemler: Çalışmaya acil servise başvuran ve yoğun bakım ihtiyacı olan mesane sondası takılan 95 hasta dahil edildi. İlk muayenede mesane içi basınç ölçümü yöntemi ile intraabdominal basınçları (IAP) ölçüldü. Vena kava inferior (VCI) çapı, pulsed wave (PW) ve santral venöz basınç (CVP) değerleri US ile kaydedildi. Hastalar IAP değerlerine göre 3 gruba (İAB <12 mm Hg, İAB =12-20 mm Hg, İAB >20 mm Hg) ayrıldı. Her grup kendi içinde VCI inspiryum (i) çapı ve VCI ekspiryum (e) çapı ile ayrı ayrı değerlendirildi.
Bulgular: Hastaların yaş ortalaması 68,6±14,5 (aralık, 24-91) yıl idi. Hastaların ortanca IAP değerleri 9,55 mm Hg olarak saptanırken APP ortalaması 70,41±17,67 mm Hg idi. IAP'si normal (<12 mm Hg) olan Grup 1 ile diğer gruplar arasında VCIi ve VCIe çapları açısından istatistiksel anlamlı fark saptandı (p<0,001). Tüm hastalarda, VCI çapı ile CVP arasındaki korelasyon anlamlı bulundu (p<0,001).
Sonuç: Bu çalışmada, IAP varlığı ile hem VCIi ve VCIe çapları arasında, hem de CVP değerleri arasında anlamlı bir korelasyon saptanmıştır. Yüksek VCI çap ve CVP değerlerinin değerlendirilerek IAP’ın non-invaziv yöntemlerle tanınmasının erken tanı ve tedavi imkanı sağlayarak morbidite ve mortaliteyi azaltmada etkili olabileceğini düşünmekteyiz.

References

  • Rogers WK, Garcia L. Intraabdominal hypertension, abdominal compartment syndrome, and the open abdomen. Chest. 2018;153(1):238-50.
  • Cheatham ML. Nonoperative management of intraabdominal hypertension and abdominal compartment syndrome. World J Surg. 2009;33(6):1116-22.
  • Cheatham ML, Safcsak K. Is the evolving management of intra-abdominal hypertension and abdominal compartment syndrome improving survival? Crit Care Med. 2010;38(2):402-7.
  • Sarı R, Yabanoğlu H, Kuş M, Arer İM. Management and clinical outcomes of iatrogenic injury secondary to endoscopic retrograde cholangiopancreatography. Istanbul Med J. 2020;21(1):28-32.
  • Kirkpatrick AW, Roberts DJ, De Waele J, Jaeschke R, Malbrain MLNG, De Keulenaer B, et al. Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome. Intensive Care Med. 2013;39(7):1190-206.
  • Quintel M, Pelosi P, Caironi P, Meinhardt JP, Luecke T, Herrmann P, et al. An increase of abdominal pressure increases pulmonary oedema in oleic acid induced lung injury. Am J Respir Crit Care Med. 2004;169(4):534-41.
  • Malbrain MLNG, Chiumello D, Pelosi P, Bihari D, Innes R, Ranieri VM, et al. Incidence and prognosis of intraabdominal hypertension in a mixed population of critically ill patients: a multiple-center epidemiological study. Crit Care Med. 2005;33(2):315-22.
  • Simonson JS, Schiller NB. Sonospirometry: a new method for noninvasive estimation of mean right atrial pressure based on two-dimensional echographic measurements of the inferior vena cava during measured inspiration. J Am Coll Cardiol. 1988;11(3):557-64.
  • Arabadzhiev GM, Tzaneva VG, Peeva KG. Intra-abdominal hypertension in the ICU - a prospective epidemiological study. Clujul Med. 2015;88(2):188-95.
  • Ravishankar N, Hunter J. Measurement of intra-abdominal pressure in intensive care units in the United Kingdom: a national postal questionnaire study. Br J Anaesth. 2005;94(6):763-6.
  • Lashutka MK, Chandra A, Murray HN, Phillips GS, Hiestand BC. The relationship of intraocular pressure to intracranial pressure. Ann Emerg Med. 2004;43(5):585-91.
  • Kron IL, Harman PK, Nolan SP. The measurement of intra-abdominal pressure as a criterion for abdominal re-exploration. Ann Surg. 1984;199(1):28-30.
  • Malbrain MLNG, Cheatham ML, Kirkpatrick A, Sugrue M, Parr M, De Waele J, et al. Results from the International Conference of Experts on Intra-abdominal Hypertension and Abdominal Compartment Syndrome. I. Definitions. Intensive Care Med. 2006;32(11):1722-32.
  • Regli A, Pelosi P, Malbrain MLNG. Ventilation in patients with intra-abdominal hypertension: what every critical care physician needs to know. Ann Intensive Care. 2019;9(1):52.
  • Lyon M, Blaivas M, Brannam L. Sonographic measurement of the inferior vena cava as a marker of blood loss. Am J Emerg Med. 2005;23(1):45-50.
  • Tetsuka T, Ando Y, Ono S, Asano Y. Change in inferior vena caval diameter detected by ultrasonography during and after hemodialysis. ASAIO J. 1995;41(1):105-10.
  • Marcelino P, Borba A, Fernandes AP, Marum S, Germano N, Lopes MRG. Non invasive evaluation of central venous pressure using echocardiography in the intensive care--specific features of patients with right ventricular enlargement and chronic exacerbated pulmonary disease. Rev Port Pneumol. 2006;12(6):637-58.
  • Wachsberg RH. Narrowing of the upper abdominal inferior vena cava in patients with elevated intraabdominal pressure: sonographic observations. J Ultrasound Med. 2000;19(3):217-22.

The Ultrasonographic Evaluation of Vena Cava Inferior Diameter as an Intraabdominal Pressure Indicator

Year 2020, Volume: 22 Issue: 3, 166 - 170, 30.12.2020
https://doi.org/10.18678/dtfd.753242

Abstract

Aim: Intraabdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are accepted as a significant cause of morbidity and mortality. The aim of this study is to investigate the utility of ultrasonography (US) as a non-invasive technique for evaluation of IAH, ACS and abdominal perfusion pressure (APP).
Material and Methods: Ninety-five patients with intensive care unit requirement, who applied to emergency department and also received a urine catheter were included in the study. During first evaluation intraabdominal pressure (IAP) calculated via measuring intravesical pressure. Inferior vena cava (VCI) diameter, pulsed wave (PW) and central venous pressure (CVP) were recorded by using US. Patients were divided into three groups according to their IAP (IAP <12 mm Hg, IAP =12-20 mm Hg, IAP >20 mm Hg). Each group were evaluated separately in terms of VCI inspirium (i) and expirium (e) diameters.
Results: Mean age of the patients was 68.6±14.5 (range, 24-91) years. Median IAP was 9.55 mm Hg and mean APP was 70.41±17.67 mm Hg. VCIi and VCIe diameters were significantly different in Group 1 with normal (<12 mm Hg) IAP (p<0.001). Correlation between VCI diameter and CVP among all patients were significant (p<0.001).
Conclusion: A significant correlation between both VCIi and VCIe diameters, and CVP values in case of IAH presence was found in this study. We think that, recognition of IAP with non-invasive methods via evaluating high values of VCI diameter and CVP is effective for reducing morbidity and mortality providing early diagnosis and treatment.

References

  • Rogers WK, Garcia L. Intraabdominal hypertension, abdominal compartment syndrome, and the open abdomen. Chest. 2018;153(1):238-50.
  • Cheatham ML. Nonoperative management of intraabdominal hypertension and abdominal compartment syndrome. World J Surg. 2009;33(6):1116-22.
  • Cheatham ML, Safcsak K. Is the evolving management of intra-abdominal hypertension and abdominal compartment syndrome improving survival? Crit Care Med. 2010;38(2):402-7.
  • Sarı R, Yabanoğlu H, Kuş M, Arer İM. Management and clinical outcomes of iatrogenic injury secondary to endoscopic retrograde cholangiopancreatography. Istanbul Med J. 2020;21(1):28-32.
  • Kirkpatrick AW, Roberts DJ, De Waele J, Jaeschke R, Malbrain MLNG, De Keulenaer B, et al. Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome. Intensive Care Med. 2013;39(7):1190-206.
  • Quintel M, Pelosi P, Caironi P, Meinhardt JP, Luecke T, Herrmann P, et al. An increase of abdominal pressure increases pulmonary oedema in oleic acid induced lung injury. Am J Respir Crit Care Med. 2004;169(4):534-41.
  • Malbrain MLNG, Chiumello D, Pelosi P, Bihari D, Innes R, Ranieri VM, et al. Incidence and prognosis of intraabdominal hypertension in a mixed population of critically ill patients: a multiple-center epidemiological study. Crit Care Med. 2005;33(2):315-22.
  • Simonson JS, Schiller NB. Sonospirometry: a new method for noninvasive estimation of mean right atrial pressure based on two-dimensional echographic measurements of the inferior vena cava during measured inspiration. J Am Coll Cardiol. 1988;11(3):557-64.
  • Arabadzhiev GM, Tzaneva VG, Peeva KG. Intra-abdominal hypertension in the ICU - a prospective epidemiological study. Clujul Med. 2015;88(2):188-95.
  • Ravishankar N, Hunter J. Measurement of intra-abdominal pressure in intensive care units in the United Kingdom: a national postal questionnaire study. Br J Anaesth. 2005;94(6):763-6.
  • Lashutka MK, Chandra A, Murray HN, Phillips GS, Hiestand BC. The relationship of intraocular pressure to intracranial pressure. Ann Emerg Med. 2004;43(5):585-91.
  • Kron IL, Harman PK, Nolan SP. The measurement of intra-abdominal pressure as a criterion for abdominal re-exploration. Ann Surg. 1984;199(1):28-30.
  • Malbrain MLNG, Cheatham ML, Kirkpatrick A, Sugrue M, Parr M, De Waele J, et al. Results from the International Conference of Experts on Intra-abdominal Hypertension and Abdominal Compartment Syndrome. I. Definitions. Intensive Care Med. 2006;32(11):1722-32.
  • Regli A, Pelosi P, Malbrain MLNG. Ventilation in patients with intra-abdominal hypertension: what every critical care physician needs to know. Ann Intensive Care. 2019;9(1):52.
  • Lyon M, Blaivas M, Brannam L. Sonographic measurement of the inferior vena cava as a marker of blood loss. Am J Emerg Med. 2005;23(1):45-50.
  • Tetsuka T, Ando Y, Ono S, Asano Y. Change in inferior vena caval diameter detected by ultrasonography during and after hemodialysis. ASAIO J. 1995;41(1):105-10.
  • Marcelino P, Borba A, Fernandes AP, Marum S, Germano N, Lopes MRG. Non invasive evaluation of central venous pressure using echocardiography in the intensive care--specific features of patients with right ventricular enlargement and chronic exacerbated pulmonary disease. Rev Port Pneumol. 2006;12(6):637-58.
  • Wachsberg RH. Narrowing of the upper abdominal inferior vena cava in patients with elevated intraabdominal pressure: sonographic observations. J Ultrasound Med. 2000;19(3):217-22.
There are 18 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Research Article
Authors

İzzettin Ertaş 0000-0001-7364-6564

Mehmet Zeki Buldanlı 0000-0002-6491-7630

Sadık Girişgin 0000-0003-2669-0532

İbrahim Ali Özemir 0000-0001-8693-9358

Nuray Çolapkulu 0000-0002-3033-8702

Publication Date December 30, 2020
Submission Date June 15, 2020
Published in Issue Year 2020 Volume: 22 Issue: 3

Cite

APA Ertaş, İ., Buldanlı, M. Z., Girişgin, S., Özemir, İ. A., et al. (2020). The Ultrasonographic Evaluation of Vena Cava Inferior Diameter as an Intraabdominal Pressure Indicator. Duzce Medical Journal, 22(3), 166-170. https://doi.org/10.18678/dtfd.753242
AMA Ertaş İ, Buldanlı MZ, Girişgin S, Özemir İA, Çolapkulu N. The Ultrasonographic Evaluation of Vena Cava Inferior Diameter as an Intraabdominal Pressure Indicator. Duzce Med J. December 2020;22(3):166-170. doi:10.18678/dtfd.753242
Chicago Ertaş, İzzettin, Mehmet Zeki Buldanlı, Sadık Girişgin, İbrahim Ali Özemir, and Nuray Çolapkulu. “The Ultrasonographic Evaluation of Vena Cava Inferior Diameter As an Intraabdominal Pressure Indicator”. Duzce Medical Journal 22, no. 3 (December 2020): 166-70. https://doi.org/10.18678/dtfd.753242.
EndNote Ertaş İ, Buldanlı MZ, Girişgin S, Özemir İA, Çolapkulu N (December 1, 2020) The Ultrasonographic Evaluation of Vena Cava Inferior Diameter as an Intraabdominal Pressure Indicator. Duzce Medical Journal 22 3 166–170.
IEEE İ. Ertaş, M. Z. Buldanlı, S. Girişgin, İ. A. Özemir, and N. Çolapkulu, “The Ultrasonographic Evaluation of Vena Cava Inferior Diameter as an Intraabdominal Pressure Indicator”, Duzce Med J, vol. 22, no. 3, pp. 166–170, 2020, doi: 10.18678/dtfd.753242.
ISNAD Ertaş, İzzettin et al. “The Ultrasonographic Evaluation of Vena Cava Inferior Diameter As an Intraabdominal Pressure Indicator”. Duzce Medical Journal 22/3 (December 2020), 166-170. https://doi.org/10.18678/dtfd.753242.
JAMA Ertaş İ, Buldanlı MZ, Girişgin S, Özemir İA, Çolapkulu N. The Ultrasonographic Evaluation of Vena Cava Inferior Diameter as an Intraabdominal Pressure Indicator. Duzce Med J. 2020;22:166–170.
MLA Ertaş, İzzettin et al. “The Ultrasonographic Evaluation of Vena Cava Inferior Diameter As an Intraabdominal Pressure Indicator”. Duzce Medical Journal, vol. 22, no. 3, 2020, pp. 166-70, doi:10.18678/dtfd.753242.
Vancouver Ertaş İ, Buldanlı MZ, Girişgin S, Özemir İA, Çolapkulu N. The Ultrasonographic Evaluation of Vena Cava Inferior Diameter as an Intraabdominal Pressure Indicator. Duzce Med J. 2020;22(3):166-70.