Use of gastric balloon manometry for estimation of intra-abdominal pressure in horses

Evaluation of the effects of medial saphenous venous pressures as an indirect method of measurement of intra-abdominal pressures in the horse

OBJECTIVE

To evaluate the effect of changes in intra-abdominal pressure (IAP) on medial saphenous venous pressure (MSVP) and hemodynamics in normal horses.

DESIGN

Experimental, in-vivo study.

SETTING

University Teaching Hospital.

ANIMALS

Convenience sample of 7 mixed breed horses; 5 geldings, and 2 mares.

INTERVENTIONS

Pneumoperitoneum was induced in horses under standing sedation with carbon dioxide gas using a laparoscopic insufflator for a total of 60 minutes to simulate clinical elevation in IAP. Pressure was increased stepwise to 20 mm Hg over 30 minutes, and maintained at that pressure for 30 minutes to evaluate the effect of sustained intra-abdominal hypertension. The MSVP and vital parameters were recorded, along with direct arterial blood pressure from the transverse facial artery.

MEASUREMENTS AND MAIN RESULTS

As IAP increased, MSVP increased in a stepwise manner, in concert with changes in IAP. The consistency in measurement between MSVP and IAP was high (intraclass correlation coefficient = 0.92; P < 0.001) and repeated measures correlation was excellent (r = 0.98; P < 0.001). Heart rate was unchanged over the course of the experiment (P = 0.09), however, respiratory rate increased with increasing IAP (P < 0.001). Arterial blood pressure also increased with insufflation (P < 0.001), with a significant difference at an IAP of 15 mm Hg (P = 0.04).

CONCLUSIONS

This report provides preliminary data demonstrating a strong correlation between equine MSVP and changes in IAP, similar to that observed in other species. Further investigations are needed to evaluate this relationship, and to confirm these results in clinical patients.

Experimentally Induced Open Pneumothorax in Horses

The objective of this study was to evaluate clinical and cardiovascular parameters and pleural and intra-abdominal pressures of horses after experimentally induced unilateral open pneumothorax. Prospective, experimental study-animals: seven healthy adult horses, 4 females and 3 males. Left hemithorax thoracotomy was carried out to create an open pneumothorax for 60 minutes. Pleural pressure (P_pl) was directly obtained at the midpoint of the left eighth intercostal space before thoracotomy. Esophageal pressure (P_es), arterial blood gas analysis, left ventricular function, and ultrasonographic assessment of pneumothorax extent/resolution were performed at the baseline, and 5, 10, 15, 30, 45, and 60 minutes after thoracotomy, and on the first, second, third, fifth, and seventh days postoperatively. Intra-abdominal pressure was only recorded while the pneumothorax was present. There was moderate correlation (Spearman's rs = 0.404; R² = 0.8; P < .00001; Bland-Altman bias = -2.59; s.d. = 2.11) between P_es and P_pl. Esophageal pressure increased (P < .05) after open pneumothorax until the fifth day postoperatively. Partial pressure of oxygen in arterial blood reduced (P < .05) until the third day postoperatively when it returned to the baseline. No significant variations in P_aCO₂, pH in arterial blood, and in left ventricular function were appreciated. The extent of the pneumothorax was assessed by thoracic ultrasonography. Esophageal pressure, in association with blood gas analysis and thoracic ultrasonography, could be used to aid diagnosis of pneumothorax in horses. Horses tolerate open pneumothorax, with minimum cardiovascular impairment, even without aspiration of free air from within pleural space to restore thoracic wall integrity.

Direct intra-abdominal pressures and abdominal perfusion pressures in unsedated normal horses

OBJECTIVES

To determine whether direct intra-abdominal pressures (IAP) and calculated direct abdominal perfusion pressures (APP) are location dependent within the abdomen of standing horses. We hypothesize that IAP will be increased and calculated APP will be decreased at a ventral abdominal location (V) when compared to values obtained from the left (LFl) or right flank (RFl).

DESIGN

Prospective experimental design.

SETTING

University-based equine research facility.

ANIMALS

Seven healthy adult horses, 4 geldings and 3 mares.

INTERVENTIONS

Measurements of direct IAP obtained from the RFl, LFl, and V locations via abdominal cannulation and direct arterial blood pressures obtained via catheterization of the transverse facial artery were obtained in fasted, standing, unsedated horses. APP was calculated for each location by the subtraction of IAP from the mean arterial pressure. Differences between sites of measurement for IAP, APP, and their gradients were calculated and compared by ANOVA and t-tests.

MEASUREMENTS AND MAIN RESULTS

Mean flank IAP measurements were subatmospheric and negative compared to ventral IAP values (LFl = -3 mm Hg, RFl = -5 mm Hg, V = 25 mm Hg; P < 0.001 between each flank and the ventral location). Ventrum APP was lower than flank APP (V = 82 mm Hg; LFl = 106 mm Hg; RFl = 108 mm Hg; P = 0.029 between each flank and the ventral location). Gradient calculations between sites showed the IAP increased and APP decreased from dorsal to ventral (P < 0.05) and from right to left (P = 0.004) within the abdomen.

CONCLUSIONS

IAP and calculated APP are location dependent. These data provide new information regarding abdominal pressure profiles in standing healthy adult horses.