There is a direct correlation between intra-abdominal pressure (IAP) and intraperitoneal volume or exchange volume (Vip)1. This relationship is also dependent on patient size (BSA) and perhaps gender and parity. Most adult patients feel comfortable with IAP in the range of 0 to 10 cm H2O and begin to experience mild discomfort at IAP > 12 cm H2O. This translates into Vips in the range of 2.5 to 3.0 L, with an occasional large patient tolerating as much as 4 L. In addition, position has marked influence on this relationship.
Click image to enlarge
The same Vip results in the lowest IAP with the patient in the supine position, intermediate in the standing position and highest in the sitting position2. Knowledge of these relationships should be used to provide the highest possible Vip during the night for patients in need of higher doses of therapy.
References:
-
Gotloib LA, Mines M, Garmizo L, Varka I. Hemodynamic effects of increasing intra-abdominal pressure in peritoneal dialysis. Perit Dial Bull 1:41-43, 1981
-
Diaz-Buxo JA. CCPD is even better than CAPD. Kidney Int 28:S26-S28, 1985