Increases in Intra-abdominal Pressure Affect Pulmonary Compliance

Objectives: To determine the effect of increased intra-abdominal pressure (IAP) on pulmonary compliance and to determine an effective means to measure IAP. Design: A prospective study. Setting: An urban tertiary care hospital. Patients: Twenty-six adult patients undergoing laparoscopic cholecystectomy. Interventions: Intra-operative management of laparoscopic cholecystectomy requiring endotracheal intubation with general anesthesia, nasogastric and urinary bladder catheters, and position changes. Additional interventions included use of a rectal manometer and a respiratory pressure module inserted within the ventilator circuit. Main Outcome Measures: Correlation of changes in IAP with changes in dynamic pulmonary compliance, measured as tidal volume/(end inspiratory pressure—end expiratory pressure) and comparison of three different measurement techniques (bladder, rectal, and gastric) with a standard technique (insufflation pressure) in three different positions (supine, Trendelenburg's, and reverse Trendelenburg's Results: Compliance was significantly related to insufflation pressure ( P Conclusions: Increased IAP has a major influence on pulmonary compliance (50% decrease at 16 mm Hg). Measurements of IAP by intraorgan manometry are position dependent and may not accurately reflect the intraperitoneal pressure. (Arch Surg. 1995;130:544-548)