Chapter 188 - Intraabdominal Pressure Monitoring Flashcards
What is the gold standard of the IAP measurement? In this gold standard method, how should the patient be placed and where should the manometer be zeroed to?
Urinary bladder method (insert a foley catheter into the bladder)
Patient should be in lateral recumbency and the manometer should be zeroed to the symphysis pubis
What can affect the IAP readings?
Body positioning, body condition, pregnancy, increased abdominal wall muscle tone (e.g. pain, anxiety), External abdominal pressure application (e.g. bandage), volume of infusate
What is the normal IAP in dogs and cats?
Dogs: 0 – 5 cmH2O
Cats: 4-8 cmH2O (sedated), 6-11 cmH2O (awake)
How does the increased intra-abdominal pressure affect the abdominal perfusion pressure (APP)?
It leads to decreased in abdominal perfusion pressure
Abdominal perfusion pressure = mean arterial pressure (MAP) − intraabdominal pressure (IAP)
How does the increased intra-abdominal pressure affect the cardiac output?
When the intra-abdominal pressure increases, the vascular volume is shifted from the abdomen to the thorax. The preload increases so the cardiac output will increase transiently. Later on, the cardiac output decreases because of increased systemic vascular resistance (compression of the abdominal vasculature) and venous return from the caudal part of the body is reduced.
If a patient with intra-abdominal hypertension needs mechanical ventilation, what mode is better for the patient? Volume-control or pressure-control? And why?
Volume-control. Because increased IAP causes decreased pulmonary compliance, if you choose pressure-control mode, with the same pressure the lung that can be expanded is less than normal, so the ventilation will not be very efficient.
What can cause iatrogenic intra-abdominal hypertension?
Diagnostic peritoneal lavage, intracavitary infusion of drugs such as analgesics and antineoplastic agents, peritoneal dialysis
