resuscitation endpoints

Q: Which of the following is found to be a better target for  resuscitation endpoints for improved  blood supply to abdominal viscera?

A) arterial pH
B) base deficit
C) arterial lactate
D) hourly urinary output 
E) abdominal perfusion pressure


Answer: E

Abdominal perfusion pressure (APP) is defined/calculated as the

 APP = MAP - IAP 

Where

• MAP = Mean Arterial Pressure, and 
• IAP = Intra-Abdominal Pressure

Studies have shown that APP is better than all other resuscitation endpoints as described in the first four choices of the question above. APP of at least 60 mm Hg is correlated with improved survival from Abdominal Compartment Syndrome (ACS) reflecting the improved blood supply to abdominal viscera.

#hemodynamics


References:

1. Schein M, Ivatury R. Intra-abdominal hypertension and the abdominal compartment syndrome. Br J Surg 1998; 85:1027. 

2. Caldwell CB, Ricotta JJ. Changes in visceral blood flow with elevated intraabdominal pressure. J Surg Res 1987; 43:14.