Comparação de diferentes métodos para avaliação da pressão intra-abdominal em canideos
Miniatura indisponível
Ficheiros
Data
2015
Autores
Título da revista
ISSN da revista
Título do Volume
Editora
Resumo
O aumento da pressão intra-abdominal (PIA) é uma complicação associada a
alterações fisiopatológicas em diversos sistemas, podendo levar a insuficiência
multiorgânica e por fim morte. Esta alteração é bastante estudada em medicina humana,
estando frequentemente associada a cirurgia ou trauma. A medição indirecta da PIA ainda
está sujeita a alguma controvérsia, contudo dado o elevado custo da medição directa, existe
a necessidade de encontrar um método fiável para a sua medição. O objectivo deste estudo
foi determinar o método indirecto mais preciso para a medição da PIA em cães, assim como
avaliar a influência da posição corporal na sua medição.
O estudo foi realizado numa população de 29 cães que deram entrada no serviço
de Anatomia Patológica para realização de necropsia. A medição da PIA foi realizada de
forma directa pelo micro sensor Codman e indirectamente pelo método transvesical (MT) e
por manometria intra-gástrica (MIG), em cinco posições: decúbito lateral, decúbito ventral,
decúbito dorsal, trendelenburg e trendelenburg reversa.
As pressões obtidas pelo método directo apresentaram leituras contantes em todas
as posições, não demonstrando diferenças estatisticamente significativas quando
comparando as medições nas cinco posições (P = 0.765). As pressões obtidas por este
método foram 3.07 ± 3.04 mmHg em decúbito lateral; 2.31 ± 3.38 mmHg em decúbito
ventral; 1.93 ± 3.44 mmHg em decúbito dorsal; 2.35 ± 3.22 mmHg na posição trendelenburg;
e 2.24 ± 3.29 mmHg na posição trendelenburg reversa. As pressões obtidas pelo método
transvesical apresentaram leituras constantes nas posições de decúbito lateral, decúbito
dorsal e decúbito ventral, não demonstrando diferenças estatisticamente significativas
quando comparando as medições nas cinco posições (P = 0.091). As pressões obtidas por
este método foram 4.52 ± 3.12 mmHg em decúbito lateral; 3.59 ± 2.94 mmHg em decúbito
ventral; 3.40 ± 3.43 mmHg em decúbito dorsal; 2.57 ± 3.14 mmHg na posição trendelenburg;
e 4.55 ± 2.98 mmHg na posição trendelenburg reversa. Em relação à medição por
manometria intra-gástrica, as medições obtidas demonstraram leituras variáveis, com
valores consideravelmente diferentes nas posições trendelenburg e trendelenburg reversa,
apresentando assim diferenças estatisticamente significativas quando comparando as
medições nas cinco posições (P = 0.0001). As pressões obtidas por este método foram 4.73
± 2.16 mmHg em decúbito lateral; 3.04 ± 1.55 mmHg em decúbito ventral; 2.59 ± 1.99
mmHg em decúbito dorsal; 7.14 ± 2.72 mmHg na posição trendelenburg; e 0.11 ± 0.28
mmHg na posição trendelenburg reversa.A medição da PIA pelo método directo, não demonstrou diferenças estatisticamente
5
significativas nas várias posições, contrariamente aos métodos indirectos, onde se verificou
que as posições trendelenburg e trendelenburg reversa afectam a mensuração correcta da
PIA, podendo estas ser subestimadas ou superestimadas.
Increased intra-abdominal pressure (IAP) is a complication associated with pathophysiological changes in various systems, leading to mutli-organic failure and finally death. This change is widely studied in human medicine, often being associated with surgery or trauma. The indirect measurement of IAP is still subject to some controversy, however given the high cost of direct measurement, there is a need to find a reliable method for measuring them. The objective of this study was to determine the more accurate indirect method for measuring the IAP in dogs as well as to evaluate the influence of the position in the measurement. The study was conducted in a population of 29 dogs received at the Pathology Service to perform autopsies. Measurement of PIA was conducted directly by the micro sensor Codman and indirectly by transvesical method (MT) and intragastric manometry (MIG), in five positions: lateral decubitus, prone, supine, trendelenburg and reverse trendelenburg. The pressures obtained by the direct method showed constants readings in all positions, with no statistically significant differences when comparing measurements at five positions (P = 0765). The pressures obtained by this method were 3.7 ± 4.3 mmHg in the lateral position; 2:31 ± 3:38 mmHg in the prone position; ± 1.93 mmHg 3:44 supine; 2:35 ± 3:22 mmHg trendelenburg position; and 24.2 ± 29.3 mmHg in reverse trendelenburg position. The pressures obtained by transvesical method showed constant readings in the lateral decubitus position, supine and prone position, with no statistically significant differences when comparing measurements at five positions (P = 0.091). The pressures obtained by this method were 4:52 ± 3:12 mmHg in the lateral position; 3:59 ± 2.94 mmHg in the prone position; 3:40 ± 3:43 mmHg in the supine position; 2:57 ± 3:14 mmHg trendelenburg position; and 4:55 ± 2.98 mmHg in reverse trendelenburg position. React to measurement by intragastric manometry, measurements obtained showed variable readings, with considerably different values in trendelenburg and reverse trendelenburg positions, thus presenting statistically significant differences when comparing measurements at five positions (P = 0.0001). The pressures obtained by this method were 4.73 ± 2.16 mmHg in the lateral position; 3:04 ± 1:55 mmHg in the prone position; 2:59 ± 1.99 mmHg in the supine position; 7.14 ± 2.72 mmHg in trendelenburg position; and 0:11 ± 0:28 mmHg in reverse trendelenburg position. Measurement of PIA by the direct method, showed no statistically significant differences in various positions, in contrast to indirect methods, where it appeared that the trendelenburg positions and reverse trendelenburg affect the correct measurement of IAP, these may be underestimated or overestimated. Key-words: Intra-abdominal pressure, Intra-abdominal hypertension, Intra-bladder pressure, Intra-gastric pressure.
Increased intra-abdominal pressure (IAP) is a complication associated with pathophysiological changes in various systems, leading to mutli-organic failure and finally death. This change is widely studied in human medicine, often being associated with surgery or trauma. The indirect measurement of IAP is still subject to some controversy, however given the high cost of direct measurement, there is a need to find a reliable method for measuring them. The objective of this study was to determine the more accurate indirect method for measuring the IAP in dogs as well as to evaluate the influence of the position in the measurement. The study was conducted in a population of 29 dogs received at the Pathology Service to perform autopsies. Measurement of PIA was conducted directly by the micro sensor Codman and indirectly by transvesical method (MT) and intragastric manometry (MIG), in five positions: lateral decubitus, prone, supine, trendelenburg and reverse trendelenburg. The pressures obtained by the direct method showed constants readings in all positions, with no statistically significant differences when comparing measurements at five positions (P = 0765). The pressures obtained by this method were 3.7 ± 4.3 mmHg in the lateral position; 2:31 ± 3:38 mmHg in the prone position; ± 1.93 mmHg 3:44 supine; 2:35 ± 3:22 mmHg trendelenburg position; and 24.2 ± 29.3 mmHg in reverse trendelenburg position. The pressures obtained by transvesical method showed constant readings in the lateral decubitus position, supine and prone position, with no statistically significant differences when comparing measurements at five positions (P = 0.091). The pressures obtained by this method were 4:52 ± 3:12 mmHg in the lateral position; 3:59 ± 2.94 mmHg in the prone position; 3:40 ± 3:43 mmHg in the supine position; 2:57 ± 3:14 mmHg trendelenburg position; and 4:55 ± 2.98 mmHg in reverse trendelenburg position. React to measurement by intragastric manometry, measurements obtained showed variable readings, with considerably different values in trendelenburg and reverse trendelenburg positions, thus presenting statistically significant differences when comparing measurements at five positions (P = 0.0001). The pressures obtained by this method were 4.73 ± 2.16 mmHg in the lateral position; 3:04 ± 1:55 mmHg in the prone position; 2:59 ± 1.99 mmHg in the supine position; 7.14 ± 2.72 mmHg in trendelenburg position; and 0:11 ± 0:28 mmHg in reverse trendelenburg position. Measurement of PIA by the direct method, showed no statistically significant differences in various positions, in contrast to indirect methods, where it appeared that the trendelenburg positions and reverse trendelenburg affect the correct measurement of IAP, these may be underestimated or overestimated. Key-words: Intra-abdominal pressure, Intra-abdominal hypertension, Intra-bladder pressure, Intra-gastric pressure.
Descrição
Orientação : Nuno Cardoso
Palavras-chave
MESTRADO INTEGRADO EM MEDICINA VETERINÁRIA, VETERINÁRIA, CÃES, FISIOPATOLOGIA, MÉTODOS DE AVALIAÇÃO, PRESSÃO INTRA-ABDOMINAL, DOGS, PHYSIOPATHOLOGY, ABDOMEN, ASSESSMENT METHODS, INTRA-ABDOMINAL PRESSURE, CANÍDEOS, CANIDS, MEDICINA VETERINÁRIA, VETERINARY MEDICINE, ABDÓMEN