PURPOSE To evaluate the effect of deepening of sedation on intra-abdominal pressure (IAP).
METHODS 37 adult mechanically ventilated ICU patients with intra-abdominal hypertension received a bolus dose and subsequent infusion of propofol (bolus: 1 mg/kg, infusion: 3 mg/kg/h). IAP, mean arterial pressure (MAP), abdominal perfusion pressure (APP), depth of sedation according to Richmond Agitation-Sedation Scale (RASS), respiratory parameters, and vasopressor dose were assessed after bolus and at 15, 30 and 60 min of infusion of propofol.
RESULTS Median IAP at baseline was 15 (13-16) mm Hg. During the intervention, median IAP decreased by 1 mm Hg at all time points. In 24% of patients IAP decreased by ≥3 mm Hg. Compared to baseline, MAP and APP were reduced at all time points. Deepening of sedation per RASS was achieved in 70% of patients at all time points. No changes in respiratory tidal volumes nor plateau pressures were observed. Vasopressor therapy with noradrenaline was started or increased in 43% of patients, whereas the increase in patients already receiving noradrenaline prior to the intervention was not significant.
CONCLUSIONS Deepening of sedation with propofol results in a small decrease in IAP and greater simultaneous decrease in MAP and APP, requiring increased vasopressor support in some cases.