Impairment of Cardiac Performance by Laparoscopy in Patients Receiving Positive End-Expiratory Pressure

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Abstract
INTRA-ABDOMINAL hypertension can cause both hemodynamic and pulmonary compromise when there is intra-abdominal bleeding, intra-abdominal packing, intestinal obstruction, or pneumoperitoneum. The pulmonary effects of intra-abdominal hypertension tend to culminate in elevated peak airway pressures when intra-abdominal pressure (IAP) reaches 30 to 40 mm Hg; there is also a fall in pulmonary compliance and vital capacity and an increase in alveolar dead space.1 The hemodynamic effects of increasing IAP are marked by decreasing cardiac output (CO) thought to be caused by increasing systemic vascular resistance and decreasing venous return.2,3 In the normovolemic human, an increase in IAP may decrease cardiac output when IAP reaches 40 mm Hg.4-7 At this point, patient survival may depend on lowering the IAP by decompressing the abdomen.8,9