Respiratory pressure monitoring as an indirect method of intra-abdominal pressure measurement in gastroschisis closure.

AIM OF STUDY: Abdominal compartment syndrome (ACS) is a rare but potentially fatal complication of gastroschisis closure. The liberal use of a staged reduction technique has become a well-established method of avoiding this problem. Unfortunately the use of silos is associated with a high rate of sepsis, prolonged ileus, and ventilation. A method of predicting an impending ACS would help surgeons to decide more objectively which patients would benefit from a staged reduction. A new simple method is presented here which predicts intra-abdominal pressure based on airway pressure readings.

METHOD: Over a four-year period, 34 neonates with gastroschisis underwent measurement of Pplateau respiratory pressures and simultaneous intra-vesical pressures.

RESULT: The Pplateau pressures were approximately 10 cmH2O higher than any concurrent intra-vesical pressure readings. ACS occurred, in one patient, when pressure measurements were above 15 cmH2O (intra-vesical) or 25 cmH2O (Pplateau).

CONCLUSION

By measuring Pplateau pressures, it is possible to predict the intra-abdominal pressure and hence avoid the development of an abdominal compartment syndrome on closing the abdominal wall in gastroschisis.