Intensive Therapy of the Respiratory Failure Arising after
the Plasty of Large Ventral Hernias

Hasanov FJ; Musayeva NZ; Asgarova GA and Abbasova MT

doi:10.23880/accmj-16000138

Anaesthesia and Critical Care Medicine Journal Research Article 3 min read

Intensive Therapy of the Respiratory Failure Arising after the Plasty of Large Ventral Hernias

Hasanov FJ^*, Musayeva NZ, Asgarova GA and Abbasova MT

^* Corresponding author

ISSN: 2577-4301 10.23880/accmj-16000138 Received: August 14, 2018 Published: September 12, 2018

— views

9 references

PDF

Keywords

Respiratory failure Intra-abdominal pressure Noninvasive ventilation

Abstract

The pressure within the abdominal cavity is normally little more than atmospheric pressure. However, even small increases in intra-abdominal pressure can have adverse effects on renal function, cardiac output, hepatic blood flow, respiratory mechanics and intracranial pressure.

Introduction

The pressure within the abdominal cavity is normally little more than atmospheric pressure [1, 2, 3]. However, even small increases in intra-abdominal pressure can have adverse effects on renal function, cardiac output, hepatic blood flow, respiratory mechanics and intracranial pressure [4, 5, 6]. Significant increases in intra- abdominal pressure are seen in a wide variety of conditions commonly encountered in the intensive care unit [7]. Abdominal compartment syndrome describes the combination of increased intra-abdominal pressure and end-organ dysfunction, has a high mortality [1, 4, 8]. One of the post-operational complications of the plastics of large ventral hernia is the development of respiratory failure (RF) [9]. This is caused by increased intra-abdominal pressure (IAP), encountered in 62% of patients with large ventral hernia. Prognosis herein is substantially determined by timely compensation of the respiratory malfunction of lungs [7, 9].

There search objective – is to define the efficiency of noninvasive artificial ventilation of lungs (NAVL) during RF, arising after the plasty of larger ventral hernias. Keywords: Respiratory failure; Intra-abdominal pressure; Noninvasive ventilation Abbreviations: IAP: Intra-abdominal pressure; RF: Respiratory failure; AH: Abdominal hypertension; RV: Respiratory volume.

Materials and Methods

During the period 2007-2014 168 patients with ventral hernia underwent surgical treatment in SSC named after M.A. Topchubashev. Next post- operational period was complicated by acute RF in 62 patients out of them (36.9%), who made the main group of research. 20 patients who underwent operation because of peptic ulcer of stomach and duodenum were in control group, without any malfunction of respiratory system. Measurement of IAP was conducted by transvesical method before and after NAVL session. Defining IAP higher than 8 cm H2O was considered as the presence of abdominal hypertension (AH).

Results

The RF diagnosis was established by existence of the following criteria, besides the clinical picture: the oxygenation index (РаО2/FiО2<300), РаСО2>45 mm Hg, рН<7.35, respiratory volume (RV) <5 ml/kg, RR>25 a minute. The patients in the main group were divided into 3 groups depending on IAP level. 32 patients with IAP being within 10-15 cm H2O were included in the I group – mild degree of AH, and 21 patients with IAP being within 16-20 сm H2O, that corresponded to AH moderate severity were included in the II group. 9 patients with IAP higher than 20 cm H2O - severe degree of AH were included in the III group.

NAVL began with a standard setting РЕЕР=5 сm H2O

and FiO$_2$=50%. The duration of the session was 4 hours with intervals of 90 minutes. 5 stages were distinguished during the NAVL: I – RF diagnosing; II – the beginning of NAVL; III – setting of optimal NAVL mode; IV – completion of NAVL and V– transition from NAVL mode to spontaneous respiration. It was decided to use NAVL in case; there exist deterioration in two of the following indicators (in the background of respiration by air):

PaO$_2$ being less than 55 mm Hg
PaO$_2$/FiO$_2$ less than 280
PaCO$_2$ more than 45 mm Hg
pH of arterial blood less than 7.35
RV less than 4 ml/kg
RR (respiratory rate) more than 25 a minute.

Positive dynamics were noticed in general condition of patients from the beginning of stage II. During stage III the patients’ condition began to improve considerably according to clinical and also gas exchange and hemodynamic indicators. The skin and visible mucous got normal coloring, the humidity of skin was gone, RR and tachycardia decreased, PaCO$_2$ decreased to 44.2±1.3 mm Hg, PaO$_2$ increased up to 96.2±0.5%, PaO$_2$/FiO$_2$ =276.5±5.1 indicated the elimination of arterial anoxemia which was present before (p<0.01). It became possible to separate patients from respiratory mask during 54.5±2.5 minutes in stage IV. Respiration was gradually stabilized in 96.4% of patients in stage V, PaO$_2$/FiO$_2$ indicator was inclined to normalization.

Conclusion

Thus, it was established that applying NAVL after the plasty of large ventral hernia was effective and enabled to refuse a trachea intubation.

Acknowledgements

Assistance with the study: none
Financial support and sponsorship: none
Conflicts of interest: none
Presentation: this study was presented orally at the 1st Ambroise Pare International Military Surgery Forum 15-18 May 2018, in Baku, Azerbaijan.

References

Acta Clinica Belgica (2007) proceedings of the Third World Congress of the Abdominal Compartment Syndrome. Antwerp, Belgium, pp: 113-118.
Agnew SP, Small W Jr, Wang E, Smith LJ, Hadad I, et al. (2010) Prospective measurements of intra-abdominal volume and pulmonary function after repair of massive ventral hernias with the components separation technique. Ann. Surgery 251(5): 981-988.
Cheatham ML (2009) Nonoperative management of intraabdominal hypertension and abdominal compartment syndrome. World Journal of Surgery 33(6): 1116-1123.
Anthony Iacco, Adewunmi Adeyemo, Thomas Riggs, Randy Janczyk (2014) PSingle institutional experience using biological mesh for abdominal wall reconstruction. The American Journal of Surgery 208(3): 480-484.
Balogh Z, McKinley BA, Holcomb JB, Miller CC, Cocanour CS, et al. (2003) Both primary and secondary abdominal compartment syndrome can be predicted early and are harbingers of multiple organ failure. J Traumav 54(5): 848-859.
Bisgaard T, Kehlet H, Bay-Nielsen M, Iversen MG, Rosenberg J, et al. (2011) A nationwide study on readmission, morbidity, and mortality after umbilical and epigastric hernia repair. Hernia 15(5): 541-546.
Kristian K Jensen, Nadia A Henriksen, Henrik Harling (2014) Standardized measurement of quality of life after incisional hernia repair: asystematic review. The American Journal of Surgery 208(3): 485-493.
Ambrosino N, Vagheggini G (2008) Noninvasive positive pressure ventilation in the acute care setting: where are we? Eur Respir J 31(4): 874-886.
Breuing K, Butler CE, Ferzoco S, Franz M, Hultman CS, et al. (2010) Incisional ventral hernias: review of the literature and recommendations regarding the grading and technique of repair. Surgery 148: 544-558.

← Previous Article Acute Left Ventricular Outflow Tract Obstruction in Non-Mitral Cardiovascular Surgery: A Case Series Analysis Next Article → How to Deal with the Temperature Instability that is Unavoidable During Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC)?