Renal arterial resistive index response to intraabdominal hypertension in a porcine model
OBJECTIVE:The abdominal compartment syndrome is a potentially life-threatening condition with frequent renal involvement. There are few if any means of inferring subclinical effects before organ dysfunction. Because intrarenal pressure correlates with renal sonographic indices in other renal disease...
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| Veröffentlicht in: | Critical care medicine 2007-01, Vol.35 (1), p.207-213 |
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| creator | Kirkpatrick, Andrew W Colistro, Robert Laupland, Kevin B Fox, Daniel L Konkin, David E Kock, Volker Mayo, John R Nicolaou, Savvas |
| description | OBJECTIVE:The abdominal compartment syndrome is a potentially life-threatening condition with frequent renal involvement. There are few if any means of inferring subclinical effects before organ dysfunction. Because intrarenal pressure correlates with renal sonographic indices in other renal diseases, the purpose of this study was to determine the relationship between increasing intraabdominal hypertension and renal vascular flow velocities in a porcine model using renal Doppler ultrasound.
DESIGN:Animal study.
SETTING:University research laboratory.
SUBJECTS:Eight anesthetized, mechanically ventilated, well-hydrated, 30-kg female Yorkshire pigs.
INTERVENTIONS:Intraabdominal hypertension was induced by instillation of warmed intraperitoneal saline through a midline laparoscopic port. Intraabdominal pressure (IAP) was continuously monitored directly from the peritoneum and indirectly from the bladder. IAP was varied from 0 to 50 mm Hg in increments of 5 mm Hg. At each IAP level, gray-scale, color, and spectral Doppler renal arcuate artery ultrasound was obtained and resistive index (RI) and peak airway pressure calculated.
MEASUREMENTS AND MAIN RESULTS:Excellent agreement between direct and indirect IAP was found (bias, 0.032 mm Hg; 95% limits, −5.5 to 5.6 mm Hg). A linear relationship between RI and indirect IAP was observed and was defined by the regression equationRI = 0.553 + 0.0104 × bladder pressure. There was a trend toward different RIs between left and right kidneys (p = .052) at the same IAP. RI varied in a linear fashion at low peak airway pressure and demonstrated an inflection point with steeper subsequent slope after peak airway pressure of 30 cm H2O. RI values rapidly returned to near baseline after abdominal decompression.
CONCLUSIONS:In this model, the renal artery RI correlated strongly and linearly with the severity of intraabdominal hypertension, making renal Doppler ultrasound a potential noninvasive screening tool for the renal effects of intraabdominal hypertension. Further studies are warranted. |
| doi_str_mv | 10.1097/01.CCM.0000249824.48222.B7 |
| format | Article |
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DESIGN:Animal study.
SETTING:University research laboratory.
SUBJECTS:Eight anesthetized, mechanically ventilated, well-hydrated, 30-kg female Yorkshire pigs.
INTERVENTIONS:Intraabdominal hypertension was induced by instillation of warmed intraperitoneal saline through a midline laparoscopic port. Intraabdominal pressure (IAP) was continuously monitored directly from the peritoneum and indirectly from the bladder. IAP was varied from 0 to 50 mm Hg in increments of 5 mm Hg. At each IAP level, gray-scale, color, and spectral Doppler renal arcuate artery ultrasound was obtained and resistive index (RI) and peak airway pressure calculated.
MEASUREMENTS AND MAIN RESULTS:Excellent agreement between direct and indirect IAP was found (bias, 0.032 mm Hg; 95% limits, −5.5 to 5.6 mm Hg). A linear relationship between RI and indirect IAP was observed and was defined by the regression equationRI = 0.553 + 0.0104 × bladder pressure. There was a trend toward different RIs between left and right kidneys (p = .052) at the same IAP. RI varied in a linear fashion at low peak airway pressure and demonstrated an inflection point with steeper subsequent slope after peak airway pressure of 30 cm H2O. RI values rapidly returned to near baseline after abdominal decompression.
CONCLUSIONS:In this model, the renal artery RI correlated strongly and linearly with the severity of intraabdominal hypertension, making renal Doppler ultrasound a potential noninvasive screening tool for the renal effects of intraabdominal hypertension. Further studies are warranted.</description><identifier>ISSN: 0090-3493</identifier><identifier>EISSN: 1530-0293</identifier><identifier>DOI: 10.1097/01.CCM.0000249824.48222.B7</identifier><identifier>PMID: 17080005</identifier><identifier>CODEN: CCMDC7</identifier><language>eng</language><publisher>Hagerstown, MD: Copyright by by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc</publisher><subject>Abdominal Cavity ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Animals ; Arterial hypertension. Arterial hypotension ; Bias ; Biological and medical sciences ; Blood and lymphatic vessels ; Blood. Blood coagulation. Reticuloendothelial system ; Cardiology. Vascular system ; Clinical manifestations. Epidemiology. Investigative techniques. Etiology ; Compartment Syndromes - complications ; Compartment Syndromes - diagnosis ; Compartment Syndromes - physiopathology ; Disease Models, Animal ; Female ; Hypertension - complications ; Hypertension - diagnosis ; Hypertension - physiopathology ; Hypertension, Renal - diagnostic imaging ; Hypertension, Renal - etiology ; Hypertension, Renal - physiopathology ; Intensive care medicine ; Least-Squares Analysis ; Linear Models ; Mass Screening ; Medical sciences ; Monitoring, Physiologic ; Pharmacology. Drug treatments ; Pilot Projects ; Predictive Value of Tests ; Renal Artery - diagnostic imaging ; Renal Artery - physiopathology ; Renal Circulation ; Severity of Illness Index ; Swine ; Ultrasonography, Doppler ; Urinary Catheterization ; Vascular Resistance</subject><ispartof>Critical care medicine, 2007-01, Vol.35 (1), p.207-213</ispartof><rights>Copyright © by 2007 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.</rights><rights>2007 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3920-e0815bc674ca365a72df76d6fc0275b292a22702e2ab04a18fbd291f2f813da63</citedby><cites>FETCH-LOGICAL-c3920-e0815bc674ca365a72df76d6fc0275b292a22702e2ab04a18fbd291f2f813da63</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,4009,27902,27903,27904</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=18394458$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17080005$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kirkpatrick, Andrew W</creatorcontrib><creatorcontrib>Colistro, Robert</creatorcontrib><creatorcontrib>Laupland, Kevin B</creatorcontrib><creatorcontrib>Fox, Daniel L</creatorcontrib><creatorcontrib>Konkin, David E</creatorcontrib><creatorcontrib>Kock, Volker</creatorcontrib><creatorcontrib>Mayo, John R</creatorcontrib><creatorcontrib>Nicolaou, Savvas</creatorcontrib><title>Renal arterial resistive index response to intraabdominal hypertension in a porcine model</title><title>Critical care medicine</title><addtitle>Crit Care Med</addtitle><description>OBJECTIVE:The abdominal compartment syndrome is a potentially life-threatening condition with frequent renal involvement. There are few if any means of inferring subclinical effects before organ dysfunction. Because intrarenal pressure correlates with renal sonographic indices in other renal diseases, the purpose of this study was to determine the relationship between increasing intraabdominal hypertension and renal vascular flow velocities in a porcine model using renal Doppler ultrasound.
DESIGN:Animal study.
SETTING:University research laboratory.
SUBJECTS:Eight anesthetized, mechanically ventilated, well-hydrated, 30-kg female Yorkshire pigs.
INTERVENTIONS:Intraabdominal hypertension was induced by instillation of warmed intraperitoneal saline through a midline laparoscopic port. Intraabdominal pressure (IAP) was continuously monitored directly from the peritoneum and indirectly from the bladder. IAP was varied from 0 to 50 mm Hg in increments of 5 mm Hg. At each IAP level, gray-scale, color, and spectral Doppler renal arcuate artery ultrasound was obtained and resistive index (RI) and peak airway pressure calculated.
MEASUREMENTS AND MAIN RESULTS:Excellent agreement between direct and indirect IAP was found (bias, 0.032 mm Hg; 95% limits, −5.5 to 5.6 mm Hg). A linear relationship between RI and indirect IAP was observed and was defined by the regression equationRI = 0.553 + 0.0104 × bladder pressure. There was a trend toward different RIs between left and right kidneys (p = .052) at the same IAP. RI varied in a linear fashion at low peak airway pressure and demonstrated an inflection point with steeper subsequent slope after peak airway pressure of 30 cm H2O. RI values rapidly returned to near baseline after abdominal decompression.
CONCLUSIONS:In this model, the renal artery RI correlated strongly and linearly with the severity of intraabdominal hypertension, making renal Doppler ultrasound a potential noninvasive screening tool for the renal effects of intraabdominal hypertension. Further studies are warranted.</description><subject>Abdominal Cavity</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Animals</subject><subject>Arterial hypertension. Arterial hypotension</subject><subject>Bias</subject><subject>Biological and medical sciences</subject><subject>Blood and lymphatic vessels</subject><subject>Blood. Blood coagulation. Reticuloendothelial system</subject><subject>Cardiology. Vascular system</subject><subject>Clinical manifestations. Epidemiology. Investigative techniques. Etiology</subject><subject>Compartment Syndromes - complications</subject><subject>Compartment Syndromes - diagnosis</subject><subject>Compartment Syndromes - physiopathology</subject><subject>Disease Models, Animal</subject><subject>Female</subject><subject>Hypertension - complications</subject><subject>Hypertension - diagnosis</subject><subject>Hypertension - physiopathology</subject><subject>Hypertension, Renal - diagnostic imaging</subject><subject>Hypertension, Renal - etiology</subject><subject>Hypertension, Renal - physiopathology</subject><subject>Intensive care medicine</subject><subject>Least-Squares Analysis</subject><subject>Linear Models</subject><subject>Mass Screening</subject><subject>Medical sciences</subject><subject>Monitoring, Physiologic</subject><subject>Pharmacology. Drug treatments</subject><subject>Pilot Projects</subject><subject>Predictive Value of Tests</subject><subject>Renal Artery - diagnostic imaging</subject><subject>Renal Artery - physiopathology</subject><subject>Renal Circulation</subject><subject>Severity of Illness Index</subject><subject>Swine</subject><subject>Ultrasonography, Doppler</subject><subject>Urinary Catheterization</subject><subject>Vascular Resistance</subject><issn>0090-3493</issn><issn>1530-0293</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2007</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpFkMFu1DAQhi0EotvCK6AICW4J47ETx9zoCgpSERKCAyfLSSZagxMHO9vSt8fbXWntgz3j7_dIH2OvOVQctHoHvNpuv1aQF0rdoqxki4jVtXrCNrwWUAJq8ZRtADSUQmpxwS5T-g3AZa3Ec3bBFbQ5XW_Yr-80W1_YuFJ0-RIpubS6OyrcPNC_Q72EOVGxhtxZo7XdECZ3yOweFsqxObkw57fCFkuIvZupmMJA_gV7Nlqf6OXpvGI_P338sf1c3n67-bL9cFv2QiOUBC2vu75Rsreiqa3CYVTN0Iw9oKo71GgRFSCh7UBa3o7dgJqPOLZcDLYRV-zt8d8lhr97SquZXOrJeztT2CfTtCJvyTP4_gj2MaQUaTRLdJOND4aDOYg1wE0Wa85izaNYc61y-NVpyr6baDhHTyYz8OYE2NRbP0Y79y6duVZoKes2c_LI3Qefnac_fn9P0ezI-nX3OFqgbEoEUMBzVR46IP4DoYGRoA</recordid><startdate>200701</startdate><enddate>200701</enddate><creator>Kirkpatrick, Andrew W</creator><creator>Colistro, Robert</creator><creator>Laupland, Kevin B</creator><creator>Fox, Daniel L</creator><creator>Konkin, David E</creator><creator>Kock, Volker</creator><creator>Mayo, John R</creator><creator>Nicolaou, Savvas</creator><general>Copyright by by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc</general><general>Lippincott</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>200701</creationdate><title>Renal arterial resistive index response to intraabdominal hypertension in a porcine model</title><author>Kirkpatrick, Andrew W ; Colistro, Robert ; Laupland, Kevin B ; Fox, Daniel L ; Konkin, David E ; Kock, Volker ; Mayo, John R ; Nicolaou, Savvas</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3920-e0815bc674ca365a72df76d6fc0275b292a22702e2ab04a18fbd291f2f813da63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2007</creationdate><topic>Abdominal Cavity</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Animals</topic><topic>Arterial hypertension. Arterial hypotension</topic><topic>Bias</topic><topic>Biological and medical sciences</topic><topic>Blood and lymphatic vessels</topic><topic>Blood. Blood coagulation. Reticuloendothelial system</topic><topic>Cardiology. Vascular system</topic><topic>Clinical manifestations. Epidemiology. Investigative techniques. Etiology</topic><topic>Compartment Syndromes - complications</topic><topic>Compartment Syndromes - diagnosis</topic><topic>Compartment Syndromes - physiopathology</topic><topic>Disease Models, Animal</topic><topic>Female</topic><topic>Hypertension - complications</topic><topic>Hypertension - diagnosis</topic><topic>Hypertension - physiopathology</topic><topic>Hypertension, Renal - diagnostic imaging</topic><topic>Hypertension, Renal - etiology</topic><topic>Hypertension, Renal - physiopathology</topic><topic>Intensive care medicine</topic><topic>Least-Squares Analysis</topic><topic>Linear Models</topic><topic>Mass Screening</topic><topic>Medical sciences</topic><topic>Monitoring, Physiologic</topic><topic>Pharmacology. Drug treatments</topic><topic>Pilot Projects</topic><topic>Predictive Value of Tests</topic><topic>Renal Artery - diagnostic imaging</topic><topic>Renal Artery - physiopathology</topic><topic>Renal Circulation</topic><topic>Severity of Illness Index</topic><topic>Swine</topic><topic>Ultrasonography, Doppler</topic><topic>Urinary Catheterization</topic><topic>Vascular Resistance</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kirkpatrick, Andrew W</creatorcontrib><creatorcontrib>Colistro, Robert</creatorcontrib><creatorcontrib>Laupland, Kevin B</creatorcontrib><creatorcontrib>Fox, Daniel L</creatorcontrib><creatorcontrib>Konkin, David E</creatorcontrib><creatorcontrib>Kock, Volker</creatorcontrib><creatorcontrib>Mayo, John R</creatorcontrib><creatorcontrib>Nicolaou, Savvas</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Critical care medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kirkpatrick, Andrew W</au><au>Colistro, Robert</au><au>Laupland, Kevin B</au><au>Fox, Daniel L</au><au>Konkin, David E</au><au>Kock, Volker</au><au>Mayo, John R</au><au>Nicolaou, Savvas</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Renal arterial resistive index response to intraabdominal hypertension in a porcine model</atitle><jtitle>Critical care medicine</jtitle><addtitle>Crit Care Med</addtitle><date>2007-01</date><risdate>2007</risdate><volume>35</volume><issue>1</issue><spage>207</spage><epage>213</epage><pages>207-213</pages><issn>0090-3493</issn><eissn>1530-0293</eissn><coden>CCMDC7</coden><abstract>OBJECTIVE:The abdominal compartment syndrome is a potentially life-threatening condition with frequent renal involvement. There are few if any means of inferring subclinical effects before organ dysfunction. Because intrarenal pressure correlates with renal sonographic indices in other renal diseases, the purpose of this study was to determine the relationship between increasing intraabdominal hypertension and renal vascular flow velocities in a porcine model using renal Doppler ultrasound.
DESIGN:Animal study.
SETTING:University research laboratory.
SUBJECTS:Eight anesthetized, mechanically ventilated, well-hydrated, 30-kg female Yorkshire pigs.
INTERVENTIONS:Intraabdominal hypertension was induced by instillation of warmed intraperitoneal saline through a midline laparoscopic port. Intraabdominal pressure (IAP) was continuously monitored directly from the peritoneum and indirectly from the bladder. IAP was varied from 0 to 50 mm Hg in increments of 5 mm Hg. At each IAP level, gray-scale, color, and spectral Doppler renal arcuate artery ultrasound was obtained and resistive index (RI) and peak airway pressure calculated.
MEASUREMENTS AND MAIN RESULTS:Excellent agreement between direct and indirect IAP was found (bias, 0.032 mm Hg; 95% limits, −5.5 to 5.6 mm Hg). A linear relationship between RI and indirect IAP was observed and was defined by the regression equationRI = 0.553 + 0.0104 × bladder pressure. There was a trend toward different RIs between left and right kidneys (p = .052) at the same IAP. RI varied in a linear fashion at low peak airway pressure and demonstrated an inflection point with steeper subsequent slope after peak airway pressure of 30 cm H2O. RI values rapidly returned to near baseline after abdominal decompression.
CONCLUSIONS:In this model, the renal artery RI correlated strongly and linearly with the severity of intraabdominal hypertension, making renal Doppler ultrasound a potential noninvasive screening tool for the renal effects of intraabdominal hypertension. Further studies are warranted.</abstract><cop>Hagerstown, MD</cop><pub>Copyright by by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc</pub><pmid>17080005</pmid><doi>10.1097/01.CCM.0000249824.48222.B7</doi><tpages>7</tpages></addata></record> |
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| ispartof | Critical care medicine, 2007-01, Vol.35 (1), p.207-213 |
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| subjects | Abdominal Cavity Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Animals Arterial hypertension. Arterial hypotension Bias Biological and medical sciences Blood and lymphatic vessels Blood. Blood coagulation. Reticuloendothelial system Cardiology. Vascular system Clinical manifestations. Epidemiology. Investigative techniques. Etiology Compartment Syndromes - complications Compartment Syndromes - diagnosis Compartment Syndromes - physiopathology Disease Models, Animal Female Hypertension - complications Hypertension - diagnosis Hypertension - physiopathology Hypertension, Renal - diagnostic imaging Hypertension, Renal - etiology Hypertension, Renal - physiopathology Intensive care medicine Least-Squares Analysis Linear Models Mass Screening Medical sciences Monitoring, Physiologic Pharmacology. Drug treatments Pilot Projects Predictive Value of Tests Renal Artery - diagnostic imaging Renal Artery - physiopathology Renal Circulation Severity of Illness Index Swine Ultrasonography, Doppler Urinary Catheterization Vascular Resistance |
| title | Renal arterial resistive index response to intraabdominal hypertension in a porcine model |
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