Pathophysiology of intraabdominal hypertension and abdominal compartment syndrome and relevance to veterinary critical care

Cardiovascular and Respiratory Effects of Increased Intra-Abdominal Pressure with and without Dexmedetomidine in Anesthetized Dogs

Intra-abdominal pressure (IAP) elevation during capnoperitoneum can cause adverse cardiovascular and respiratory effects. This study aimed to determine if a sequentially increased IAP affects cardiovascular and respiratory variables in anesthetized dogs and evaluate the effects of the constant-rate infusion of dexmedetomidine (Dex) on cardiovascular and respiratory variables with increased IAP. Five dogs were anesthetized and instrumented, and a Veress needle was equipped to adjust the IAP using a carbon dioxide insufflator. Stabilization was conducted for 1 h, and physiological variables were measured at IAPs of 0, 5, 10, 15, and 20 mmHg and after desufflation. After the washout period, the dogs underwent similar procedures along with a constant-rate infusion of dexmedetomidine. The cardiovascular effects of increased IAP up to 20 mmHg were not significant in healthy beagle dogs and those administered with dexmedetomidine. When comparing the control and dexmedetomidine groups, the overall significant effects of dexmedetomidine were noted on heart rate, cardiac output, and systemic vascular resistance during the experiment. Respiratory effects were not observed during abdominal insufflation when compared between different IAPs and between the two groups. Overall, an increased IAP of up to 20 mmHg did not significantly affect cardiovascular and respiratory variables in both the control and dexmedetomidine groups. This study suggests that the administration of a dexmedetomidine infusion is applicable in laparoscopic procedures in healthy dogs.

Intra-abdominal hypertension and abdominal compartment syndrome

PURPOSE OF REVIEW

Intra-abdominal hypertension (IAH) has been acknowledged as an important contributor to organ dysfunction in critically ill patients, both in surgical and medical conditions. As our understanding of the pathophysiology evolves, risk factors are better recognized, preventive measures can now be implemented and therapeutic interventions tailored to the physiology of the patient. In the current review, we want to highlight developing insights in the epidemiology and treatment of patients with IAH and ACS.

RECENT FINDINGS

The impact of IAH and ACS on kidney function and other outcomes continues to draw attention in recent studies. New methods for IAP measurement are under development, and the search for biomarkers to detect IAH or ACS continues. In conditions wherein IAH and ACS are common, recent studies allow better prevention and treatment of these conditions, based on the contemporary ICU management consisting of IAP measurement, judicious fluid resuscitation and decompressive laparotomy where necessary. Surgical treatment options including open abdomen therapy continue to be improved with demonstrable impact on outcomes.

SUMMARY

In this manuscript, we provide an overview of recent insights and developments in the epidemiology, monitoring and treatment of patients with IAH and/or ACS.