The effect of the abdominal perfusion pressure on visceral circulation in critically ill patients with multiorgan dysfunction

Abstract

Ongoing studies investigating the intra abdominal pressure (IAP) shifted the belief of mesenteric circulation not to be only a culprit of decreased arterial hypoperfusion, but also other hydrostatic forces may impose its perfusion and may also act directly on the tissues. While the gut theory stated the engine of multiorgan dysfunction syndrome (MODS), abdominal perfusion pressure (APP) was examined in MODS patients to assess mesenteric circulation instead of merely abdominal arterial hypoperfusion. Aim: We aimed to study the correlation between increased fluid gain and low APP and increased risk for visceral organ hypoperfusion. Patients and methods: 106 MODS patients were studied retrospectively, and included if a SOFA subscore of ⩾2 was recorded in at least 2 organ systems, routine laboratory investigations, lactate, fluid gain was defined as the cumulative positive fluid gained during resuscitation. Vital signs were recorded and IAP (measured through UB, closed loop small volume technique) and APP which is derived from the equation (mean arterial blood pressure MAP – intraabdominal pressure IAP) and Liver SOFA subscore were calculated as indirect markers of mesenteric hypoperfusion. Results: The APP on admission was negatively correlated with lactate and fluid gain (r = −0.388 and −.225 P = 0.0001 and .021 respectively). The lower the APP, the worse the Liver SOFA subscore (85.3 ± 14.2, 75.7 ± 15.3, 73.1 ± 24.6, 76.6 ± 16.8 and 66 ± 17.1 p 0.012), SOFA and lactate were the significant predictors for APP. Conclusion: Low APP and positive fluid gain are associated with deteriorating visceral circulation manifested by high lactate levels and deteriorating liver function.

Keywords

• Abdominal perfusion pressure visceral circulation