İzzettin ERTAŞ, Mehmet Zeki BULDANLI, Sadık GİRİŞGİN, İbrahim Ali ÖZEMİR, Nuray ÇOLAPKULU

İntraabdominal Basınç Göstergesi Olarak Vena Kava İnferior Çapının Ultrasonografi ile Değerlendirilmesi

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 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 (

Anahtar Kelimeler:

vena kava inferior, intraabdominal basınç, abdominal kompartıman sendromu, intraabdominal hipertansiyon

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

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 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 (

Keywords:

vena cava inferior, intraabdominal pressure, abdominal compartment syndrome, intraabdominal hypertension,

PDF

___

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.