Hipertensão intra-abdominal associada à lesão pulmonar aguda: efeitos sobre a pressão intracraniana

Antonio Luis Eiras Falcão, Douglas Guimarães de Oliveira
2011 Revista Brasileira de Terapia Intensiva  
Hipertensão intra-abdominal associada à lesão pulmonar aguda: efeitos sobre a pressão intracraniana EDITORIAL Intra-abdominal hypertension (IAH) is defined as intra-abdominal pressure (IAP) above 12 mmHg and may be categorized as Grade I (12-15 mmHg), Grade II (16-20 mmHg), Grade III (21-25 mmHg) or Grade IV (> 25 mmHg). Recurrent or persistent IAP above 20 mmHg, in association with failure of at least one organ, is called Abdominal Compartment Syndrome (ACS). The mortality and morbidity of IAH
more » ... and ACS are high and may reach 100% for unattended ACS. Considering the head, IAH increases the intracranial pressure (ICP) and reduces the cerebral perfusion pressure (CPP). (3) (5) The mechanic effects of inferior vena cava compression during IAH reduces lumbar venous plexus flow and may also be responsible for the increased ICP. (5) ot only IAH, but also the increase in ITP due to mechanical ventilation, may determine ICP changes. The use of high inspiratory pressure and positive end-expiratory pressure (PEEP), which results in increased airway pressures, can lead to increased ITP and consequently, to increased central venous pressure, resulting in increased ICP. However, the effects of positive pressure ventilation on ICP are apparently influenced by several factors, including pulmonary and cerebral compliance. (6) n the study entitled "Modulation of intracranial pressure in an experimental model of abdominal hypertension and acute lung injury," the authors evaluated the association between IAH and pulmonary injury on the ICP. According to their results, this interaction impacted the ICP more significantly than IAH alone. The applicability of these findings is immediate. (7) he authors found that plateau (P plateau ), Peak (P peak ) and Pleural (P pl ) pressures were significantly increased with IAH and acute lung injury (ALI), without significant hemodynamic changes. With respect to the association of IAH, ALI and 27 cmH 2 O PEEP, significant hemodynamic
doi:10.1590/s0103-507x2011000200002 fatcat:3ilmn5e2wjcetbe5owvjloxkyi