Title of thesis: Influence of intra-abdominal pressure on the stability of the lumbar spine Definition of the problem: This thesis addresses the problem of the stabilization mechanism of the lumbar spine and the influence of intra-abdominal pressure on the stability of the lumbar spine. Objectives: The aim of my thesis is to locate, evaluate and process all available resources and to bring up the issue of IAP and its influence on the lumbar spine. The work should provide the widest possible insight into the problems of IAP effects on the stability of the lumbar spine, summarize differing opinions, and allow easier orientation in the isme. Method: The work is treated as a search, focusing on the processing and retrieval of literature concerning the issue. Studies included range from 1953 to present. To which I will use a variety of sources of literature, internet and consultation with the head of my thesis. Results: The increase in IAP, which is provided by a synchronous contraction of the diaphragm, pelvic floor muscles and m. transversus abdominis, can effectively stabilize the spine. But you can not determine with certainty whether this mechanism to support the stability of the lumbar spine is indeed used or the stability is provided by contraction of muscles, leading to an increase in IAP, and...

The theoretical part of the diploma thesis describes the role of abdominal muscles in intra-abdominal pressure and the effect on postural stabilization. The issue of postural stabilization was analyzed in a physiological situation and frequent pathologies related with inadequate postural stabilization have been described. The current possibilities of evaluating the activity of abdominal muscles and intra-abdominal pressure were presented. Methodology: 25 healthy probands (mean age 22.4 years, SD ± 1.76) were evaluated in five posturally different situations - breathing stereotype test, intra-abdominal pressure regulation test, diaphragm test, hip flexion test and arm elevation test. Testing was performed with a prototype of the DNS Brace digital pressure sensor. The resulting pressure values of the abdominal wall expansion were correlated with the corresponding postural tests according to the DNS concept, which were performed by two DNS instructors with more than five years of experience. Results: A statistically significant correlation (p = 0.001 to 0.24) between abdominal wall pressure values and palpation-evaluated postural tests was demonstrated in four of the five tested positions. Correlation was strong in diaphragm test (r = 0.75 and 0.661) and mean in other tests (r = 0.567 to 0.415). Only...

In patients affected by acute respiratory failure or acute respiratory distress syndrome (ARDS) the leading cause of death is failure of different vital organs other than the lungs, so called multiple organ dysfunction syndrome (MODS). The abdominal organs have a crucial role in the pathogenesis of this syndrome. There is a lack of knowledge regarding the mechanisms by which mechanical ventilation can affect the abdominal compartment. One hypothesis is that mechanical ventilation can interfere with abdominal fluid balance causing edema and inflammation. We addressed the question whether different levels of ventilatory support (mechanical ventilation with different levels of positive end-expiratory pressure, PEEP, and spontaneous breathing with or without PEEP) can influence abdominal edema and inflammation in both healthy and endotoxin-exposed animals. The effect on lymphatic drainage from the abdomen exerted by different degrees of ventilatory support was evaluated (paper I). We demonstrated that endotoxin increases abdominal lymph production, that PEEP and mechanical ventilation increase lymph production but also impede lymphatic drainage; spontaneous breathing improves lymphatic drainage from the abdomen. By adapting a non-invasive nuclear medicine imaging technique and validating it (paper II), we have been able to evaluate extravascular fluid accumulation (edema formation) in the abdomen over time (paper III) demonstrating that edema increases during endotoxemia, mimicking a sepsis-like condition, and that spontaneous breathing, compared to mechanical ventilation, reduces extravascular fluid. Pro-inflammatory cytokines TNF-α and IL-6 in intestinal biopsies are reduced during spontaneous breathing compared to mechanical ventilation. Abdominal edema results in increased intra-abdominal pressure (IAP): in paper IV we analyzed the effect of increased intra-abdominal pressure on the respiratory system. Pulmonary shunt fraction increased with high IAP both in healthy and LPS animals, resulting in decreased level of oxygenation. These changes are only partially reversible by reducing IAP. In conclusion, mechanical ventilation is a life-saving tool but the possible side effect at the extra-pulmonary level should be considered, and the introduction of some degree of spontaneous breathing when clinically possible is a suggested choice.

Colonic ischaemia (CI), Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are devastating complications after abdominal aortic aneurysm (AAA) surgery. The aims of this thesis were to study the incidence and clinical consequences of IAH/ACS and the association between CI and intra-abdominal pressure (IAP) among patients undergoing OR for ruptured AAA (rAAA), to compare extraluminal pHi monitoring, with standard intra-luminal monitoring among patients operated on for AAA, and to study the frequency and clinical consequences of IAH/ACS after endovascular repair (EVAR) for rAAA. The incidence of ACS was 26% in a retrospective study of 27 patients undergoing OR for rAAA. Consensus definitions on IAH/ACS were appropriate for patients after OR for rAAA: 78% (7/9) of patients with IAH grade III or IV developed organ failure and all patients who developed CI had some degree of IAH. Active fluid resuscitation treating hypovolaemia to avoid CI may partly cause IAH. The association between CI and IAP was investigated in a prospective study on 29 patients operated on for rAAA, 86% (25/29) were treated for hypovolaemia and ten (34%) had both IAH and CI. Since monitoring colonic perfusion is very important and there is no ideal method, a new technique, extraluminal colonic tonometry to detect colonic perfusion was compared with standard intraluminal tonometry. Although, this new method was not able to determine the severity of ischaemia it may serve as a screening test. EVAR of rAAA is feasible and patients may benefit from this less invasive procedure. Of 29 patients treated with this technique, 10% developed ACS, and all patients except one with preoperative shock developed some degree of IAH. In conclusion, IAP/ACS is common after both OR and EVAR for rAAA, and is associated with adverse outcome. Monitoring IAP and colonic perfusion with timely intervention may improve outcome.

Submitted by ANA CAROLINA DOS SANTOS DEMARCHI null (carol_demarchi@hotmail.com) on 2016-04-02T14:54:57Z No. of bitstreams: 1 Tese_Repositório_Unesp_AnaCarolinaDemarchipdf.pdf: 1702968 bytes, checksum: eb996abea5f69285187e67149717aac1 (MD5) / Approved for entry into archive by Felipe Augusto Arakaki (arakaki@reitoria.unesp.br) on 2016-04-05T14:52:16Z (GMT) No. of bitstreams: 1 demarchi_acs_dr_bot.pdf: 1702968 bytes, checksum: eb996abea5f69285187e67149717aac1 (MD5) / Made available in DSpace on 2016-04-05T14:52:16Z (GMT). No. of bitstreams: 1 demarchi_acs_dr_bot.pdf: 1702968 bytes, checksum: eb996abea5f69285187e67149717aac1 (MD5) Previous issue date: 2016-02-22 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Fundamentação. A presença de Hipertensão Abdominal é condição frequente em pacientes de UTI com importante impacto sobre a mortalidade. Tais pacientes contam com diversos fatores de risco para aumento da pressão abdominal, entre eles ventilação mecânica e balanço hídrico positivo. Um discreto aumento da pressão abdominal pode levar a disfunções orgânicas, entre elas a Lesão Renal Aguda, complicação bastante prevalente, que acomete pacientes internados em terapia intensiva, com importante impacto sobre a mortalidade. Pacientes de terapia intensiva e em ventilação mecânica são diariamente submetidos a técnicas de fisioterapia respiratória, entretanto não foram localizados estudos que demonstrassem os efeitos das técnicas mais utilizadas em terapia intensiva sobre a pressão intra-abdominal e função renal destes pacientes. Objetivos. Avaliar a influência de diferentes técnicas de fisioterapia respiratória sobre a pressão intra-abdominal de pacientes de terapia intensiva, bem como o comportamento da função renal e hemodinâmica abdominal com a aplicação destas técnicas. Casuística e Método. Foi realizado ensaio clínico, randomizado, controlado, cruzado, no período de março de 2013 a dezembro de 2014, no Serviço de Terapia Intensiva da Faculdade de Medicina de Botucatu-SP. Os pacientes foram randomizados para receberem três possíveis sequências de técnicas que incluíam: Compressão Torácica Expiratória, Hiperinsuflação Manual e Bag-Squeezing. Todos os pacientes foram submetidos às três técnicas, em dias diferentes e consecutivos. Para análise das técnicas os dados foram reagrupados de acordo com as intervenções realizadas e comparados entre si. Foram avaliados parâmetros hemodinâmicos e pressão intra-abdominal antes, após e nas duas horas seguintes às intervenções. A função renal foi avaliada por meio do clearance de creatinina, clearance de uréia e fração de excreção de sódio e a pressão intra-abdominal avaliada pelo método original de Kron nos mesmos momentos. Resultados. Foram avaliados 31 pacientes, 17 do gênero masculino com idade média de 58,1 ±17,6 anos. A Pressão intra-abdominal diminuiu de forma estatisticamente significante com a utilização das três técnicas e nos dois momentos em que foram avaliadas. Imediatamente após a técnica Hiperinsuflação Manual, houve aumento estatisticamente significante do gradiente de filtração glomerular e com a técnica Bag-Squeezing, observou-se aumento do gradiente de filtração glomerular imediatamente após e nas duas horas seguintes à intervenção. Foi observado aumento da pressão de perfusão abdominal imediatamente após e nas duas horas seguintes à aplicação da referida técnica. O clearance de uréia apresentou aumento após a aplicação da técnica Bag-Squeezing e também foi observado aumento da fração de excreção de sódio com as técnicas Hiperinsuflação Manual e Bag-Squeezing. Conclusões. Técnicas de fisioterapia respiratória reduziram a pressão e melhoraram a hemodinâmica intra-abdominais de pacientes de terapia intensiva. As técnicas Hiperinsuflação Manual e Bag-Squeezing aumentaram a fração de excreção de sódio e apenas a última o clearance de uréia. De maneira geral, as técnicas empregadas se associaram a melhora dos parâmetros de avaliados. / Rationale: The presence of Abdominal Hypertension is a frequent condition in ICU patients with a significant impact on mortality. Critical patients have several risk factors for increased abdominal pressure, including mechanical ventilation and positive water balance. A slight increase in abdominal pressure can lead to organ dysfunction, including the Acute Renal Injury, which is a prevalent complication affecting patient in intensive care with a significant impact on mortality. Patients submitted mechanical ventilation are daily undergoing respiratory therapy techniques, however there aren’t studies demonstrating the effects of the techniques used in intensive care on intra-abdominal pressure and renal function in these patients. Objective: To evaluate the influence of different techniques of respiratory physiotherapy on intra-abdominal pressure on critical patients as well as the behavior of renal function and abdominal hemodynamic by implementing these techniques. Patients and Methods: Clinical trial conducted randomized, controlled, crossover, from March 2013 to December 2014 in the Intensive Care Unit at Hospital of São Paulo State University (UNESP-HC) (Botucatu, Brazil). Patients were randomized to receive three sequences of techniques that included: Chest Compression Expiratory, Hyperinflation and Manual Bag-Squeezing. All patients were submitted to three techniques in different consecutive days. Analysis of the technical data were grouped according to the measures carried out and compared among each other. Hemodynamic parameters were evaluated and intra-abdominal pressure before, after and within two hours after the intervention. Renal function was assessed by creatinine clearance, urea clearance and sodium excretion fraction and the intra-abdominal pressure assessed by the original method of Kron at the same moments. Results: We evaluated 31 patients, 17 males with a mean age of 58.1 ± 17.6 years. Intra-abdominal pressure decreased in a statistically significant way with the use of three techniques and two different times that were evaluated. Immediately after the Manual Hyperinflation technique there was a statistically significant increase in glomerular filtration gradient and the Bag-Squeezing technique, there was also an increase in glomerular filtration gradient immediately after and in two hours of intervention. There was an increase of abdominal perfusion pressure immediately at the end and two hours after application of this technique. The urea clearance showed an increase after the implementation of the Bag-Squeezing technique and increased sodium excretion fraction to the technical Manual Hyperinflation and Bag-Squeezing also were observed. Conclusions: Respiratory therapy techniques reduced pressure and improved intra-abdominal hemodynamic in critical care patients. Technical Manual Hyperinflation and Bag-Squeezing increased sodium excretion fraction, and only the last technique increase the clearance of urea. In general, the techniques employed were associated with improvement of the evaluated parameters.

Orientador: Luís Cuadrado Martín / Resumo: Fundamentação. A presença de Hipertensão Abdominal é condição frequente em pacientes de UTI com importante impacto sobre a mortalidade. Tais pacientes contam com diversos fatores de risco para aumento da pressão abdominal, entre eles ventilação mecânica e balanço hídrico positivo. Um discreto aumento da pressão abdominal pode levar a disfunções orgânicas, entre elas a Lesão Renal Aguda, complicação bastante prevalente, que acomete pacientes internados em terapia intensiva, com importante impacto sobre a mortalidade. Pacientes de terapia intensiva e em ventilação mecânica são diariamente submetidos a técnicas de fisioterapia respiratória, entretanto não foram localizados estudos que demonstrassem os efeitos das técnicas mais utilizadas em terapia intensiva sobre a pressão intra-abdominal e função renal destes pacientes.Objetivos. Avaliar a influência de diferentes técnicas de fisioterapia respiratória sobre a pressão intra-abdominal de pacientes de terapia intensiva, bem como o comportamento da função renal e hemodinâmica abdominal com a aplicação destas técnicas.Casuística e Método. Foi realizado ensaio clínico, randomizado, controlado, cruzado, no período de março de 2013 a dezembro de 2014, no Serviço de Terapia Intensiva da Faculdade de Medicina de Botucatu-SP. Os pacientes foram randomizados para receberem três possíveis sequências de técnicas que incluíam: Compressão Torácica Expiratória, Hiperinsuflação Manual e Bag-Squeezing. Todos os pacientes foram submetidos às ... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Rationale: The presence of Abdominal Hypertension is a frequent condition in ICU patients with a significant impact on mortality. Critical patients have several risk factors for increased abdominal pressure, including mechanical ventilation and positive water balance. A slight increase in abdominal pressure can lead to organ dysfunction, including the Acute Renal Injury, which is a prevalent complication affecting patient in intensive care with a significant impact on mortality. Patients submitted mechanical ventilation are daily undergoing respiratory therapy techniques, however there aren’t studies demonstrating the effects of the techniques used in intensive care on intra-abdominal pressure and renal function in these patients.Objective: To evaluate the influence of different techniques of respiratory physiotherapy on intra-abdominal pressure on critical patients as well as the behavior of renal function and abdominal hemodynamic by implementing these techniques.Patients and Methods: Clinical trial conducted randomized, controlled, crossover, from March 2013 to December 2014 in the Intensive Care Unit at Hospital of São Paulo State University (UNESP-HC) (Botucatu, Brazil). Patients were randomized to receive three sequences of techniques that included: Chest Compression Expiratory, Hyperinflation and Manual Bag-Squeezing. All patients were submitted to three techniques in different consecutive days. Analysis of the technical data were grouped according to the measures ... (Complete abstract click electronic access below) / Doutor

This thesis is focusing on objectifying the postural function of diaphragm with a biofeedback sensor in patients with low back pain (LBP). The theoretical part provides an overview of known facts about the postural function of the abdominal muscles and diaphragm and the connection between their activation and the change in intra-abdominal pressure and the origin of LBP. The thesis gives specifics of LBP, its etiology and possible methods of classification of non-specific LBP, as well as the methods of evaluating subjective disability. Other methods of objectifying postural functions other than the one used in this thesis are mentioned briefly. Methodology: In the experimental part, we used a capacitive force sensor to test 31 patients with non-specific chronic LBP (aver. age 25.25, SD ± 4.66, aver. height 176.77 cm, SD ± 9.97, aver. weight 77.93 kg, SD ±18.40) in 3 posturally different seated scenarios - resting breathing, with added external load when the subjects held a dumbbell of 20 % of their body weight) and with maximum voluntary increase in intra-abdominal pressure (the diaphragm test). The sensor position was on lumbar triangle and in the groin area. Oswestry Questionaire v2.1a was used to evaluate subjective disability. Results: An independent t-test analysis showes increase in the...

The thesis examines the relationship between the level of intra-abdominal pressure and abdominal wall expansion. The theoretical part brings an overview of knowledge about the function of intra-abdominal pressure and about the possibilities of objectification of postural functions. There are described studies which dealt with the influence of intra-abdominal pressure on the stability of spine. Theoretical part also includes detailed description of individual invasive and non-invasive methods of measurement of intra-abdominal pressure and activation of abdominal muscles. Work methodology: In the practical part the intra-abdominal pressure was measured using anorectal manometry and abdominal wall expansion by utilizing DNS brace device. 31 healthy examinees with average age of 26.77 (SD 3.01) were measured in five different standing postural situations: during resting breathing, Valsalva Maneuver, Müller's maneuver, diaphragm test and in the situation with added external load in the form of static holding of dumbbell. Results of the thesis: Among the values of the pressure gathered from the DNS brace device and from anorectal manometry was proven statistically important correlation (p < 0.001) in all five tested situations. In all situations the Pearson Correlation Coefficient was higher than 0.6...

Introduction: The aim of this work was to determine the difference in abdominal wall expansion and thus indirectly the amount of intra-abdominal pressure in various postural positions, first without any correction, then after verbal and manual instruction according to Dynamic Neuromuscular Stabilization (DNS) principles. The amount of activation of abdominal wall muscles in various postural positions helps determine the positions in which optimal postural stabilization is best activated. These positions may be suitable for postural therapy and training. The theoretical part introduces optimal trunk stabilization according to developmental kinesiology principles and DNS concept. Then, the relationship between the intra-abdominal pressure and postural activity of abdominal muscles is introduced as well as the most common methods of objectification. Participants and Methods: 30 healthy subjects (15 women and 15 men) aged 20 to 25 years (mean age 22.73 years, SD 1.88) were tested using the Ohm Belt device. This device uses pressure sensors that are attached to the abdominal wall in the area above the groin and in the trigonum lumbale and thus allows non-invasive monitoring of abdominal wall expansion and indirect measurement of the intra-abdominal pressure. The subjects were tested in five postural...