Abstract

EFFECT OF POSITION ON INTRA-ABDOMINAL PRESSURE (IAP)

Made Oka Ari Kamayani, F.Sri Susilaningsih, Titin Mulyati
Background: The increase in IAP will affect the various systems in the body
included: cerebral, cardiovascular, respiratory, gastrointestinal, and renal. Patients
who needed mechanical ventilation and given Positive end Expiratory Pressure
(PEEP) is often increased IAP because PEEP may limit the expansion of the
abdominal cavity, so the monitoring of the IAP is needed to be done . Trans-vessica
technique using a urinary catheter is the most reliable and less invasive to measure
IAP. IAP measurement is done by giving the patient supine position. This position in
patients who experienced a loss of consciousness and needed mechanical ventilation
in ICU raises the risk of aspiration that can develop into pneumonia aspiration.
Objective: To determine the effect of the position on the IAP.
Methods: An EBSCO and Cochrane Database search was conducted and enhanced
by the addition of other sources and conference articles.
Results: Patient who needed mechanical ventilation tend to have high abdominal
pressure that become the predisposing factor for the occurrence of gastric aspiration
due to increased gastro-esophageal reflux. Gastro-esophageal reflux can be
aggravated by the supine position. One of interventions to prevent aspiration is to
provide the HOB elevation position at least 30. Giving HOB elevation position more
than 20 can increase IAP measurement. Giving HOB elevation causes the change of
hydrostatic force, so the fluid tends to be accumulated at the bottom and press the
bladder thereby increasing IAP measurement results. IAP measurement results are
also affected by the volume of normal saline instillation into the bladder during the
measurement. The greater volume of normal saline instillation into the bladder, the
greater measurement results of IAP.
Conclusion : the position of HOB elevation more than 20 increase IAP measurement
results