From the Guidelines
Splinting in a ventilated patient with a distended abdomen refers to the mechanical restriction of diaphragmatic movement caused by increased intra-abdominal pressure, which impairs effective ventilation. In the context of a patient with an open abdomen, splinting is also related to the use of negative pressure wound therapy (NPWT) to provide a seal over the wound, allowing for the removal of fluids and promotion of wound healing 1. The goal of splinting in this scenario is to minimize the movement of the abdominal wall and underlying organs, reducing the risk of further injury or complications. Key considerations in managing a ventilated patient with a distended abdomen include:
- Addressing the underlying cause of abdominal distention
- Optimizing ventilator settings to overcome increased intra-abdominal pressure
- Positioning the patient to reduce pressure on the diaphragm
- Monitoring for signs of abdominal compartment syndrome, a life-threatening condition that may require surgical intervention. In terms of NPWT settings, continuous pressure levels of up to 80 mmHg are recommended 1, with lower pressures (as low as 50 mmHg) suggested for vulnerable patients to minimize the risk of damage to underlying organs. It is essential to balance the potential benefits of NPWT, including effective fluid removal, with the potential risks, such as decreased bowel blood flow associated with higher negative pressure levels 1. Overall, the management of a ventilated patient with a distended abdomen requires careful consideration of the underlying causes of abdominal distention, optimization of ventilator settings, and careful use of NPWT to promote wound healing while minimizing the risk of complications.
From the Research
Definition of Splinting
- Splinting in a patient who is ventilated with a distended abdomen refers to the use of measures to reduce abdominal pressure and improve ventilation [(2,3,4,5)].
- This can include the use of neuromuscular blocking agents, analgesia, and sedation to increase abdominal wall compliance and reduce intra-abdominal pressure [(2,4,6)].
Causes of Abdominal Compartment Syndrome
- Abdominal compartment syndrome is caused by excessive pressure within the abdominal compartment due to diminished abdominal wall compliance, increased intraluminal contents, increased abdominal contents, or capillary leak/fluid resuscitation 2.
- It can also occur in patients with a distended abdomen, who are at risk of developing abdominal compartment syndrome due to increased intra-abdominal pressure [(3,4,5)].
Management of Abdominal Compartment Syndrome
- Management of abdominal compartment syndrome involves increasing abdominal wall compliance, evacuating gastrointestinal contents, avoiding excessive fluid resuscitation, and decompressive laparotomy in select cases [(2,3,4,5)].
- Neuromuscular blockade can be used to reduce abdominal compartment pressures and improve ventilation in patients with abdominal compartment syndrome 6.