Venous Pressure as a Guide to Pneumoperitoneum Therapy in Pulmonary Emphysema

¹ The College of Physicians and Surgeons, Columbia University and the Presbyterian Hospital, New York.

1) Venous pressures were determined during the administration of pneumoperitoneum in 10 patients with pulmonary emphysema.

2) Six patients showed a consistent drop or no change in venous pressure. All derived excellent benefits from pneumoperitoneum.

3) In three patients in whom a rise in venous pressure was recorded, pneumoperitoneum had to be discontinued because of respiratory embarrassment following it.

4) One patient who on one occasion had no change in venous pressure tolerated pneumoperitoneum well for three months. Subsequently, dyspnea became so incapacitating following the procedure that it had to be abandoned. A rise in venous pressure was noted during the last pneumoperitoneum.

5) An increase in diaphragmatic excursion is felt to be responsible for the lowering of venous pressure in the successful cases of pneumoperitoneum therapy.

6) Direct transmission of the intra-abdominal pressure increase to the intrapleural space through a fixed atrophic diaphragm, in the presence of markedly reduced pulmonary elasticity, blocks the flow of blood into the right heart with resultant increased venous pressure, decreased right cardiac output and stagnant anoxia. This accounts for the respiratory embarrassment in these patients following pneumoperitoneum.

7) Changes in venous pressures during pneumoperitoneum seem to be a good prognostic index for emphysematous patients in whom this form of treatment is contemplated.