Treatment of intracranial hypertension using nonsurgical abdominal decompression

Bob H. Saggi, Geoffrey L. Bloomfield, Harvey J. Sugerman, Charles R. Blocker, Jason P. Hull, Anthony P. Marmarou, Malcolm R. Bullock

Research output: Contribution to journalArticle

52 Scopus citations

Abstract

Background: Elevated intra-abdominal pressure (IAP) increases intracranial pressure (ICP) and reduces cerebral perfusion pressure (CPP). We evaluated a nonsurgical means of reducing IAP to reverse this process. Methods: Swine with a baseline ICP of 25 mm Hg produced by an intracranial balloon catheter were studied. In group 1 (n = 5), IAP was increased by 25 mm Hg. Continuous negative abdominal pressure (CNAP) was then applied. Group 2 (n = 4) had neither IAP elevation nor CNAP. Group 3 (n = 4) had CNAP without IAP elevation. Results: Elevation of IAP by 25 mm Hg above baseline led to deleterious changes in ICP (25.8 0.8 to 39.0 ± 2,8; p < 0.05) and CPP (85.2 ± 2.0 to 64.8 ± 2.6; p < 0.05). CNAP led to a reduction in IAP (30.2 ± 1.2 to 20.4 ± 1.3; p < 0.05) and improvements in cerebral perfusion (ICP, 33 ± 2.7; CPP, 74.4 ± 1.2; both p < 0.05). Group 2 had stable ICP (25.8 ± 0.25 to 28.7 ± 1.7; p > 0.05) and CPP (80.8 ± 1.4 to 80.5 ± 1.8; p > 0.05). In group 3, CNAP decreased cardiac index (2.9 ± 0.2 to 1.1 ± 0.4; p < 0.05), mean arterial pressure (105.2 ± 4.0 to 38.2 ± 12.0; p < 0.05), and CPP (74.2 ± 4.7 to 14.5 ± 12.2; p < 0.05). Conclusion: Elevations in IAP led to increased ICP and decreased CPP. CNAP ameliorated these intracranial disturbances. With normal IAP, CNAP impaired cerebral perfusion.

Original languageEnglish (US)
Pages (from-to)646-651
Number of pages6
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume46
Issue number4
DOIs
StatePublished - Apr 1999

Keywords

  • Abdominal compartment syndrome
  • Cerebral perfusion pressure
  • Head injury
  • Intracranial pressure
  • Trauma

ASJC Scopus subject areas

  • Surgery

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