• M L Cheatham, K Safcsak, E F Block, and L D Nelson.
• Department of Surgical Education, Surgical Critical Care, Orlando Regional Medical Center, Florida 32806, USA. mikec@orhs.org
• J Trauma. 1999 Jan 1;46(1):16-22.

BackgroundIntra-abdominal hypertension and abdominal compartment syndrome cause significant morbidity and mortality in surgical and trauma patients. Maintenance of intravascular preload and use of open abdomen techniques are essential. The accuracy of pulmonary artery occlusion pressure (PAOP) and central venous pressure (CVP) in patients with intra-abdominal hypertension has been questioned.MethodsTwenty surgical and trauma patients with intra-abdominal hypertension requiring open abdominal decompression were monitored using volumetric thermodilution pulmonary artery catheters. Hemodynamic, oxygenation, inspiratory, and intravesicular pressure measurements were collected prospectively. PAOP, CVP, and right ventricular end-diastolic volume index (RVEDVI) were compared as estimates of preload status.ResultsMultiple regression analysis demonstrated that cardiac index correlated significantly better with RVEDVI (r = 0.69) than with PAOP (r = -0.27) or CVP (r = -0.28) during resuscitation after open abdominal decompression (p < 0.0001).ConclusionRVEDVI is superior to PAOP and CVP as an estimate of preload status in patients with an open abdomen.

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