Intra-abdominal Pressure, Intracranial Pressure, and Hemodynamics: A Central Nervous System-Regulated Response

Abstract

Elevation in intra-abdominal pressure (IAP) can be classified as acute or chronic. The development of ascites from liver cirrhosis and portal hypertension, and the presence of retroperitoneal or intraperitoneal tumor masses are some of the more frequent examples of chronic elevation in IAP. The clinical significance of chronic elevations in IAP is related to the underlying pathology. Acute life-threatening changes are rarely observed. In contrast, acute elevations of intra-abdominal pressure have been shown to induce numerous serious hemodynamic, respiratory, and neurohormonal changes. The establishment of pneumoperitoneum in laparoscopic procedures or edema and hemoperitoneum in the abdominal compartment syndrome are the more frequent clinical settings of acute increase in IAP. The number of advanced laparoscopic procedures performed, combined with prolonged patient exposure to carbon dioxide (CO2) has renewed interest in understanding the pathophysiologic effects of increased IAP.