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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care
Minerva Anestesiologica 2014 July;80(7):785-95
Association between intra-abdominal pressure and jugular bulb saturation in critically ill patients
Kotlinska-Hasiec E. 1, Dabrowski W. 1, Rzecki Z. 1, Rybojad B. 2, Pilat J. 3, De Keulenaer B. 4, Lng Malbrain M. 5 ✉
1 Department of Anesthesiology and Intensive Therapy, Medical University of Lublin, Lublin, Poland;
2 Department of Pediatric Anesthesiology and Intensive Therapy, Medical University of Lublin, Lublin, Poland;
3 Department of General Surgery, Transplantology and Clinical Nutrition, Medical University of Lublin, Lublin, Poland;
4 Intensive Care Unit, Fremantle Hospital, Fremantle WA, Australia;
5 Intensive Care Unit and High Care Burn Unit, Ziekenhuis Netwerk Antwerpen, ZNA Campus Stuivenberg/St-Erasmus, Antwerp, Belgium
BACKGROUND: Disorders in cerebral circulation following elevated intra-abdominal pressure (IAP) may lead to silent brain ischemia, which can be serious problem in sedated critically ill patients. The aim of the present study was to analyse the possible association between jugular venous bulb pressure (JVBP) and jugular venous bulb saturation (SjO2) to IAP in critically ill patients.
METHODS: Adult septic shock patients with acute kidney injury were studied just after the admission to Intensive Care Unit and after 24 and 48 hours of treatment. Patients were divided into: CVVH group (patients treated with continuous veno-venous haemofiltration) and furosemide group (patients treated with furosemide infusion). The IAP was measured via the bladder. The right jugular vein was retrogradely cannulated for JVBP and SjO2 measurement. Intra-abdominal hypertension was defined as a sustained increase of IAP equal to or above 12 mmHg.
RESULTS: Forty patients (25 male and 15 female patients) were studied. In all participants, IAP strongly correlated with JVBP (P<0.001, r=0.73). This correlation was stronger in the furosemide group than the CVVH group. Moreover, an increase in IAP was related to an increase in JVBP and a decrease in SjO2. There was an inverse correlation between IAP and SjO2 (P<0.001, r=-0.55). This correlation was stronger in furosemide group than CVVH group.
CONCLUSION: IAP is correlated to JVBP and inversely correlated to SjO2. Increase in IAP leads to elevation in JVBP and decrease in SjO2. Renal replacement therapy disturbs the correlation between IAP, JVBP and SjO2.