RESUMO
Traditional surgical treatment of widespread purulent peritonitis has some disadvantages that emphasizes the need for new approaches to postoperative care. The authors present successful treatment of diffuse purulent peritonitis using a combination of 'open abdomen' technology and VAC therapy. This approach reduces abdominal inflammation and intra-abdominal pressure. Combination of 'open abdomen' technology and VAC therapy provides effective control of inflammation and stabilization of patients with purulent peritonitis.
Assuntos
Hipertensão Intra-Abdominal , Tratamento de Ferimentos com Pressão Negativa , Peritonite , Humanos , Peritonite/etiologia , Peritonite/cirurgia , Peritonite/diagnóstico , Hipertensão Intra-Abdominal/etiologia , Hipertensão Intra-Abdominal/diagnóstico , Hipertensão Intra-Abdominal/cirurgia , Resultado do Tratamento , Tratamento de Ferimentos com Pressão Negativa/métodos , Masculino , Feminino , Pessoa de Meia-Idade , Índice de Gravidade de DoençaRESUMO
OBJECTIVE: Open abdomen therapy (OAT) is commonly used to prevent or treat abdominal compartment syndrome (ACS) in patients with ruptured abdominal aortic aneurysms (rAAAs). This study aimed to evaluate the incidence, treatment, and outcomes of OAT after rAAA from 2006 to 2021. Investigating data on resuscitation fluid, weight gain, and cumulative fluid balance could provide a more systematic approach to determining the timing of safe abdominal closure. METHODS: This was a single centre observational cohort study. The study included all patients treated for rAAA followed by OAT from October 2006 to December 2021. RESULTS: Seventy-two of the 244 patients who underwent surgery for rAAA received OAT. The mean age was 72 ± 7.85 years, and most were male (n = 61, 85%). The most frequent comorbidities were cardiac disease (n = 31, 43%) and hypertension (n = 31, 43%). Fifty-two patients (72%) received prophylactic OAT, and 20 received OAT for ACS (28%). There was a 25% mortality rate in the prophylactic OAT group compared with the 50% mortality in those who received OAT for ACS (p = .042). The 58 (81%) patients who survived until closure had a median of 12 (interquartile range [IQR] 9, 16.5) days of OAT and 5 (IQR 4, 7) dressing changes. There was one case of colocutaneous fistula and two cases of graft infection. All 58 patients underwent successful abdominal closure, with 55 (95%) undergoing delayed primary closure. In hospital survival was 85%. Treatment trends over time showed the increased use of prophylactic OAT (p ≤ .001) and fewer ACS cases (p = .03) assessed by Fisher's exact test. In multivariable regression analysis fluid overload and weight reduction predicted 26% of variability in time to closure. CONCLUSION: Prophylactic OAT after rAAA can be performed safely, with a high rate of delayed primary closure even after long term treatment.
Assuntos
Aneurisma da Aorta Abdominal , Ruptura Aórtica , Hipertensão Intra-Abdominal , Tratamento de Ferimentos com Pressão Negativa , Telas Cirúrgicas , Humanos , Aneurisma da Aorta Abdominal/cirurgia , Aneurisma da Aorta Abdominal/mortalidade , Masculino , Idoso , Feminino , Tratamento de Ferimentos com Pressão Negativa/efeitos adversos , Ruptura Aórtica/cirurgia , Ruptura Aórtica/mortalidade , Hipertensão Intra-Abdominal/etiologia , Hipertensão Intra-Abdominal/prevenção & controle , Hipertensão Intra-Abdominal/cirurgia , Idoso de 80 Anos ou mais , Resultado do Tratamento , Estudos Retrospectivos , Tração/efeitos adversos , Tração/métodos , Fatores de Tempo , Pessoa de Meia-Idade , Técnicas de Abdome Aberto/efeitos adversos , Fatores de Risco , Técnicas de Fechamento de Ferimentos Abdominais/efeitos adversos , Técnicas de Fechamento de Ferimentos Abdominais/instrumentação , Fasciotomia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/epidemiologiaRESUMO
BACKGROUND: Abdominal compartment syndrome (ACS) is typically attributed to critically unwell patients with trauma, burns, post surgery, and massive ascites. A rare but fatal cause of ACS is bulimia nervosa (BN), which is an eating disorder characterized by bingeing, followed by methods to avoid weight gain, including purging. CASE REPORT: We present a case of a 20-year-old woman who presented with abdominal pain and distension after consuming a large quantity of food the previous night and was unable to purge. She was initially managed conservatively and discharged home, but returned subsequently on the same day with clinical features of ACS secondary to acute gastric distension. Decompression resulted in life-threatening reperfusion injury with critical electrolyte abnormalities and fatal cardiac arrest in the operating theatre. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: A systematic review of the literature found only 11 case reports of ACS secondary to BN, of which only 6 patients survived due to early diagnosis and decompression. Inability to purge and lower limb ischemia appeared to be associated with increased mortality. As BN is a common emergency presentation, the case and systematic review highlights the need to consider ACS as a potentially life-threatening complication of binge eating, particularly when there is unsuccessful purging.
Assuntos
Bulimia Nervosa , Hipertensão Intra-Abdominal , Humanos , Feminino , Bulimia Nervosa/complicações , Hipertensão Intra-Abdominal/etiologia , Adulto Jovem , Dor Abdominal/etiologiaRESUMO
An increased intra-abdominal pressure can result in a manifest abdominal compartment syndrome (ACS) with significant organ damage, which is a life-threatening situation associated with a high mortality. Although the etiology is manifold and critically ill patients on the intensive care unit are particularly endangered, the disease is often not diagnosed even though the measurement of bladder pressure is available as a simple and standardized method; however, particularly the early detection of an increased intra-abdominal pressure is decisive in order to prevent the occurrence of a manifest ACS with (multi)organ failure by means of conservative measures. In cases of a conservative refractory situation, decompressive laparotomy is indicated.
Assuntos
Cuidados Críticos , Descompressão Cirúrgica , Hipertensão Intra-Abdominal , Humanos , Hipertensão Intra-Abdominal/diagnóstico , Hipertensão Intra-Abdominal/terapia , Hipertensão Intra-Abdominal/prevenção & controle , Hipertensão Intra-Abdominal/etiologia , Hipertensão Intra-Abdominal/fisiopatologia , Cuidados Críticos/métodos , Descompressão Cirúrgica/métodos , Descompressão Cirúrgica/efeitos adversos , Laparotomia/efeitos adversos , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/diagnóstico , Insuficiência de Múltiplos Órgãos/prevenção & controle , Insuficiência de Múltiplos Órgãos/diagnóstico , Insuficiência de Múltiplos Órgãos/etiologia , Insuficiência de Múltiplos Órgãos/terapiaRESUMO
PURPOSE: Abdominal compartment syndrome (ACS) is a well-known concept after trauma surgery or after major abdominal surgery in critically ill patients. However, ACS as a complication after complex hernia repair is considered rare and supporting literature is scarce. As complexity in abdominal wall repair increases, with the introduction of new tools and advanced techniques, ACS incidence might rise and should be carefully considered when dealing with complex abdominal wall hernias. In this narrative review, a summary of the current literature will highlight several key features in the diagnosis and management of ACS in complex abdominal wall repair and discuss several treatment options during the different steps of complex AWR. METHODS: We performed a literature search across PubMed using the search terms: "Abdominal Compartment syndrome," "Intra-abdominal pressure," "Complex abdominal hernia," and "Ventral hernia." Articles corresponding to these search terms were individually reviewed by primary author and selected on relevance. CONCLUSION: Intra-abdominal hypertension (IAH) and ACS require imperative attention and should be carefully considered when dealing with complex abdominal wall hernias, even without significant loss of domain. Development of a true abdominal compartment syndrome is relatively rare, but is a devastating complication and should be prevented at all cost. Current evidence on surgical treatment of ACS after hernia repair is scarce, but conservative management might be an option in the early phase and low grades of IAH. However, life-saving treatment by relaparotomy and open abdomen management should be initiated when ACS starts setting in.
Assuntos
Herniorrafia , Hipertensão Intra-Abdominal , Complicações Pós-Operatórias , Humanos , Hipertensão Intra-Abdominal/etiologia , Herniorrafia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Hérnia Ventral/cirurgia , Hérnia Ventral/complicaçõesRESUMO
BACKGROUND: Acute pancreatitis (AP) often presents with varying severity, with a small fraction evolving into severe AP, and is associated with high mortality. Complications such as intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are intricately associated with AP. OBJECTIVE: To assess the clinical implications and predictors of ACS in AP patients. METHODS: We conducted a retrospective study using the National Inpatient Sample (NIS) database on adult AP patients, further stratified by the presence of concurrent ACS. The data extraction included demographics, underlying comorbidities, and clinical outcomes. Multivariate linear and logistic regression analyses were performed using STATA (v.14.2). RESULTS: Of the 1,099,175 adult AP patients, only 1,090 (0.001%) exhibited ACS. AP patients with ACS had elevated inpatient mortality and all major complications, including septic shock, acute respiratory distress syndrome (ARDS), requirement for total parenteral nutrition (TPN), and intensive care unit (ICU) admission (P < 0.01). These patients also exhibited increased odds of requiring pancreatic drainage and necrosectomy (P < 0.01). Predictor analysis identified blood transfusion, obesity (BMI ≥30), and admission to large teaching hospitals as factors associated with the development of ACS in AP patients. Conversely, age, female gender, biliary etiology of AP, and smoking were found less frequently in patients with ACS. CONCLUSION: Our study highlights the significant morbidity, mortality, and healthcare resource utilization associated with the concurrence of ACS in AP patients. We identified potential factors associated with ACS in AP patients. Significantly worse outcomes in ACS necessitate the need for early diagnosis, meticulous monitoring, and targeted therapeutic interventions for AP patients at risk of developing ACS.
Assuntos
Hipertensão Intra-Abdominal , Pancreatite , Adulto , Humanos , Feminino , Pancreatite/complicações , Hipertensão Intra-Abdominal/etiologia , Estudos Retrospectivos , Incidência , Doença AgudaRESUMO
INTRODUCTION: Massive burn patients are at risk of developing intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) as a complication of resuscitation. OBJECTIVE: This study aimed to evaluate the effect of Hydroxyethyl starch (HES) versus 5% albumin solution on intra-abdominal pressure (IAP) in massive burn patients. METHODS: This was a prospective randomized clinical trial carried on at Ain Shams University (ASU) burn unit for 2 years. Where adult patients with burns more than 20% of TBSA were equally randomized into HES group or albumin group. RESULTS: Fifty-two patients were equally randomized into 2 groups. We found no difference in age, sex, weight, type of burn, and TBSA between the two groups. The mean total resuscitation fluid volume in the first 48 h was 213 ml/kg and 206.2 ml/kg for the HES group and the albumin group respectively (p = 0.674). IAP statistically was non-significantly higher in the HES group. We found no statistical difference between the two groups as regards the renal function tests. CONCLUSION: Both HES and 5% albumin solution are effective and safe colloids for burn resuscitation. As regards the IAP, it seems that both 5% albumin and HES have comparable effect regarding IAH in severely burn patients. Both HES and 5% albumin were partially equal in terms of renal involvement and vital data stability.
Assuntos
Queimaduras , Hipertensão Intra-Abdominal , Adulto , Humanos , Estudos Prospectivos , Queimaduras/complicações , Queimaduras/terapia , Ressuscitação , Hipertensão Intra-Abdominal/etiologia , Hipertensão Intra-Abdominal/terapia , Albuminas/uso terapêutico , Amido , Hidratação/efeitos adversosRESUMO
BACKGROUND: Patients with large burns must be carefully resuscitated to balance adequate tissue perfusion with the risk of end-organ damage. One devastating complication of overresuscitation is abdominal compartment syndrome. Reducing the volume of fluids given during resuscitation may reduce the incidence of abdominal compartment syndrome and improve outcomes. OBJECTIVE: To determine whether decreasing fluid resuscitation volume in a burn center reduced the incidence of abdominal compartment syndrome. METHODS: This retrospective cohort study involved all patients with severe burns (total body surface area ≥20%) who were admitted to a burn intensive care unit over 4 years (n = 166). Primary outcomes were required fluid volume, whether differences in the patient characteristics measured affected outcomes, rate of abdominal compartment syndrome, and incidence of abdominal hypertension. After the first 2 years, the Parkland fluid resuscitation algorithm was modified to decrease the volume goal, and patients were assessed for the incidence of abdominal compartment syndrome and related complications such as kidney failure, abdominal hypertension, and ventilator days. RESULTS: A total of 16% of patients resuscitated using the Parkland equation experienced abdominal compartment syndrome compared with 10% of patients resuscitated using the modified algorithm, a difference of 6 percentage points (P = .39). Average volume administered was 11.8 L using the Parkland formula and 9.4 L using the modified algorithm (P = .03). CONCLUSION: Despite a significant decrease in the amount of fluid administered, no significant difference was found in incidence of abdominal compartment syndrome or urine output. Matched prospective studies are needed to improve resuscitation care for patients with large burns.
Assuntos
Hipertensão , Hipertensão Intra-Abdominal , Humanos , Hipertensão Intra-Abdominal/etiologia , Hipertensão Intra-Abdominal/prevenção & controle , Estudos Retrospectivos , Incidência , Ressuscitação , Unidades de Terapia Intensiva , Hidratação , AlgoritmosRESUMO
The intra-abdominal hypertension (IAH) and the abdominal compartment syndrome (ACS) are life-threatening conditions with a significant rate of mortality; therefore, early detection is paramount in their optimal management. IAH is diagnosed when the intra-abdominal pressure (IAP) is more than 12 mmHg. It can occur when the intra-abdominal volume increases (ileus, ascites, trauma, pancreatitis, etc.) and/or the abdominal wall compliance decreases. IAH can cause decreased venous flow, low cardiac output, renal impairment, and decreased respiratory compliance. Consequently, these complications can lead to multiple organ failure and induce the abdominal compartment syndrome (ACS) when IAP rises above 20 mmHg. The diagnosis is usually made with intravesical pressure measurement. However, this measurement was not always possible to obtain; therefore, alternative diagnostic techniques should be considered. In this setting, computed tomography (CT) may play a crucial role, allowing the detection and characterization of pathological conditions that may lead to IAH. This review is focused on the pathogenesis, clinical features, and radiological findings of ACS, because their presence allows radiologists to raise the suspicion of IAH/ACS in critically ill patients, guiding the most appropriate treatment.
Assuntos
Hipertensão Intra-Abdominal , Pancreatite , Humanos , Hipertensão Intra-Abdominal/diagnóstico por imagem , Hipertensão Intra-Abdominal/etiologia , Estado Terminal , Insuficiência de Múltiplos Órgãos , RadiologistasRESUMO
BACKGROUND: Critically ill patients with cirrhosis and ascites are at high risk for intra-abdominal hypertension (IAH) which increases mortality. Clinical guidelines recommend maintaining intra-abdominal pressure (IAP) below 16 mmHg; nonetheless, more than three quarters of critically ill patients with cirrhosis develop IAH during their first week of ICU stay. Standard-of-care intermittent large-volume paracentesis (LVP) relieves abdominal wall tension, reduces IAP, optimizes abdominal perfusion pressure, and is associated with short-term improvement in renal and pulmonary dysfunction. However, there is no evidence of the superiority of different paracentesis strategies in the prevention and treatment of IAH in critically ill patients with cirrhosis. This trial aims to compare the outcomes of continuous passive paracentesis versus LVP in the prevention and treatment of IAH in patients with cirrhosis and ascites. METHODS: An investigator-initiated, open label, randomized controlled trial, set in a general ICU specialized in liver disease, was initiated in August 2022, with an expected duration of 36 months. Seventy patients with cirrhosis and ascites will be randomly assigned, in a 1:1 ratio, to receive one of two methods of therapeutic paracentesis. A stratified randomization method, with maximum creatinine and IAP values as strata, will homogenize patient baseline characteristics before trial group allocation, within 24 h of admission. In the control group, LVP will be performed intermittently according to clinical practice, with a maximum duration of 8 h, while, in the intervention group, continuous passive paracentesis will drain ascitic fluid for up to 7 days. The primary endpoint is serum creatinine concentration, and secondary endpoints include IAP, measured creatinine clearance, daily urine output, stage 3 acute kidney injury and multiorgan dysfunction assessed at day 7 after enrollment, as well as 28-day mortality rate and renal replacement therapy-free days, and length-of-stay. Prespecified values will be used in case of renal replacement therapy or, beforehand ICU discharge, liver transplant and death. Safety analysis will include paracentesis-related complication rate and harm. Data will be analyzed with an intention-to-treat approach. DISCUSSION: This is the first trial to compare the impact of different therapeutic paracentesis strategies on organ dysfunction and outcomes in the prevention and treatment of IAH in critically ill patients with cirrhosis and ascites. TRIAL REGISTRATION: ClinicalTrials.gov NCT04322201 . Registered on 20 December 2019.
Assuntos
Hipertensão Intra-Abdominal , Paracentese , Humanos , Paracentese/efeitos adversos , Paracentese/métodos , Ascite/diagnóstico , Ascite/etiologia , Ascite/terapia , Estado Terminal , Hipertensão Intra-Abdominal/diagnóstico , Hipertensão Intra-Abdominal/etiologia , Hipertensão Intra-Abdominal/terapia , Creatinina , Cirrose Hepática/complicações , Cirrose Hepática/diagnóstico , Cirrose Hepática/terapia , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
RATIONALE: The clinical manifestation of coronavirus disease 2019 (COVID-19) ranges from asymptomatic to critical. The gastrointestinal (GI) tract is involved in the early stages of the disease and is recognized as an important entry site for the virus. Consequently, GI manifestations are common in patients with COVID-19; however, the GI presentation of COVID-19 in relation to bowel dilatation has rarely been reported. Here, we report a case of acute severe gastric distension resulting in aortic compression and abdominal compartment syndrome (ACS) in a patient with COVID-19. PATIENT CONCERNS: A 72-year-old male presented to the emergency department (ED) with severe abdominal distension. The patient had been confirmed to have COVID-19 5 days prior to the visit. DIAGNOSES: Computed tomography revealed critical abdominal distension with severe gastric dilatation, accompanied by compression of the abdominal aorta and distal thrombosis formation. INTERVENTIONS: Intravenous fluid resuscitation and support with inotropic agents were initiated immediately, and a large amount of gastric content was evacuated via a nasogastric (NG) tube. OUTCOME: Finally, the patient was discharged after 12 days of admission without obvious complications. LESSONS: ACS is critical, which can be caused by a severe degree of acute gastric distension (AGD). Evacuation of the intraluminal contents is the most efficient management strategy. Prognosis is poor, and most previous studies of the transition from AGD to ACS have reported unfavorable outcomes.
Assuntos
COVID-19 , Dilatação Gástrica , Hipertensão Intra-Abdominal , Masculino , Humanos , Idoso , Hipertensão Intra-Abdominal/etiologia , COVID-19/complicações , Dilatação Gástrica/complicações , Abdome , Aorta Abdominal , Doença AgudaRESUMO
Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are underrecognized entities in patients of acute pancreatitis (AP). IAH develops in 30% to 60% and ACS in 15% to 30% of all AP patients and they are markers of severe disease with high morbidity and mortality. The detrimental effect of increased IAP has been recognized in several organ systems, including the central nervous system, cardiovascular, respiratory, renal and gastrointestinal systems. The pathophysiology of IAH/ACS development in patients with AP is multifactorial. Pathogenetic mechanisms include over-zealous fluid management, visceral edema, ileus, peripancreatic fluid collections, ascites and retroperitoneal edema. Laboratory and imaging markers are neither sensitive nor specific enough to detect IAH/ACS and intra-abdominal pressure (IAP) monitoring is vital for early diagnosis and the management of patients of AP with IAH/ACS. The treatment of IAH/ACS requires a multi-modality approach with both medical and surgical attention. Medical management consists of nasogastric/rectal decompression, prokinetics, fluid management and diuretics or hemodialysis. If conservative management is not effective, percutaneous drainage of fluid collection or ascites is necessary. Despite medical management, if IAP worsens, surgical decompression is warranted. The review discusses the relevance of IAH/ACS in patients of AP and its management.
Assuntos
Hipertensão Intra-Abdominal , Pancreatite , Humanos , Hipertensão Intra-Abdominal/diagnóstico , Hipertensão Intra-Abdominal/etiologia , Hipertensão Intra-Abdominal/terapia , Pancreatite/complicações , Pancreatite/diagnóstico , Ascite , Doença Aguda , Trato GastrointestinalRESUMO
Ruptured abdominal aortic aneurysms (rAAA), with or without iliac involvement, are a life-threatening scenario with high mortality even after surgical therapy. Several factors have contributed to improving perioperative outcomes in recent years, including the progressive use of endovascular aortic repair (EVAR) and intraoperative balloon occlusion of the aorta, a dedicated treatment algorithm with centralization of care to high-volume centres, and optimized perioperative management protocols. Nowadays, EVAR is applicable in the majority of scenarios even in the emergency setting. Among the factors that influence the postoperative course of rAAA patients, abdominal compartment syndrome (ACS) is a rare but life-threatening complication. As its early clinical diagnosis is often missed but crucial to initiate an emergent surgical decompression therapy, dedicated surveillance protocols and transvesical measurement of the intraabdominal pressure are key for prompt diagnosis and immediate treatment of ACS. Further improvement of rAAA patients' outcome may be achieved by the implementation of simulation-based training (of both technical and non-technical skills for surgeons as well as all involved healthcare personnel in multidisciplinary teams) and by transfer of all rAAA patients to specialized vascular centres with advanced experience and high caseload.
Assuntos
Aneurisma da Aorta Abdominal , Ruptura Aórtica , Implante de Prótese Vascular , Procedimentos Endovasculares , Aneurisma Ilíaco , Hipertensão Intra-Abdominal , Humanos , Hipertensão Intra-Abdominal/diagnóstico , Hipertensão Intra-Abdominal/etiologia , Hipertensão Intra-Abdominal/terapia , Aneurisma Ilíaco/cirurgia , Resultado do Tratamento , Implante de Prótese Vascular/efeitos adversos , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/cirurgia , Ruptura Aórtica/diagnóstico por imagem , Ruptura Aórtica/cirurgia , Aorta/cirurgia , Estudos Retrospectivos , Fatores de RiscoRESUMO
Abdominal compartment syndrome (ACS) has been the subject of increasing research over the past decade owing to its effects on morbidity and mortality in critically ill patients. This study aimed to determine the incidence and risk factors of ACS in patients in an onco-hematological pediatric intensive care unit in a middle-income country and to analyze patient outcomes. This prospective cohort study was conducted between May 2015 and October 2017. Altogether, 253 patients were admitted to the PICU, and 54 fulfilled the inclusion criteria for intra-abdominal pressure (IAP) measurements. IAP was measured using the intra-bladder indirect technique with a closed system (AbViser AutoValve®, Wolfle Tory Medical Inc., USA) in patients with clinical indications for indwelling bladder catheterization. Definitions from the World Society for ACS were used. The data were entered into a database and analyzed. The median age was 5.79 years, and the median pediatric risk of mortality score was 7.1. The incidence of ACS was 27.7%. Fluid resuscitation was a significant risk factor for ACS in the univariate analysis. The mortality rates in the ACS and non-ACS groups were 46.6% and 17.9%, respectively (P < 0.05). This is the first study of ACS in critically ill children with cancer. Conclusion: The incidence and mortality rates were high, justifying IAP measurement in children with ACS risk factors.
Assuntos
Hipertensão Intra-Abdominal , Criança , Humanos , Pré-Escolar , Hipertensão Intra-Abdominal/epidemiologia , Hipertensão Intra-Abdominal/etiologia , Incidência , Estudos Prospectivos , Estado Terminal , Fatores de RiscoRESUMO
BACKGROUND: Constantly elevated intra-abdominal pressure (IAH) can lead to abdominal compartment syndrome (ACS), which is associated with organ dysfunction and even multiorgan failure. Our 2010 survey revealed an inconsistent acceptance of definitions and guidelines among pediatric intensivists regarding the diagnosis and treatment of IAH and ACS in Germany. This is the first survey to assess the impact of the updated guidelines on neonatal/pediatric intensive care units (NICU/PICU) in German-speaking countries after WSACS published those in 2013. METHODS: We conducted a follow-up survey and sent 473 questionnaires to all 328 German-speaking pediatric hospitals. We compared our findings regarding awareness, diagnostics and therapy of IAH and ACS with the results of our 2010 survey. RESULTS: The response rate was 48% (n = 156). The majority of respondents was from Germany (86%) and working in PICUs with mostly neonatal patients (53%). The number of participants who stated that IAH and ACS play a role in their clinical practice rose from 44% in 2010 to 56% in 2016. Similar to the 2010 investigations, only a few neonatal/pediatric intensivists knew the correct WSACS definition of an IAH (4% vs 6%). Different from the previous study, the number of participants who correctly defined an ACS increased from 18 to 58% (p < 0,001). The number of respondents measuring intra-abdominal pressure (IAP) increased from 20 to 43% (p < 0,001). Decompressive laparotomies (DLs) were performed more frequently than in 2010 (36% vs. 19%, p < 0,001), and the reported survival rate was higher when a DL was used (85% ± 17% vs. 40 ± 34%). CONCLUSIONS: Our follow-up survey of neonatal/pediatric intensivists showed an improvement in the awareness and knowledge of valid definitions of ACS. Moreover, there has been an increase in the number of physicians measuring IAP in patients. However, a significant number has still never diagnosed IAH/ACS, and more than half of the respondents have never measured IAP. This reinforces the suspicion that IAH and ACS are only slowly coming into the focus of neonatal/pediatric intensivists in German-speaking pediatric hospitals. The goal should be to raise awareness of IAH and ACS through education and training and to establish diagnostic algorithms, especially for pediatric patients. The increased survival rate after conducting a prompt DL consolidates the impression that the probability of survival can be increased by timely surgical decompression in the case of full-blown ACS.
Assuntos
Síndromes Compartimentais , Hipertensão Intra-Abdominal , Recém-Nascido , Humanos , Criança , Hipertensão Intra-Abdominal/diagnóstico , Hipertensão Intra-Abdominal/etiologia , Hipertensão Intra-Abdominal/terapia , Unidades de Terapia Intensiva Neonatal , Seguimentos , Inquéritos e Questionários , Unidades de Terapia Intensiva Pediátrica , Síndromes Compartimentais/diagnóstico , Síndromes Compartimentais/terapia , Unidades de Terapia IntensivaRESUMO
Intra-abdominal hypertension (IAH) is frequently present in the critically ill and is associated with increased morbidity and mortality. Conventionally, intermittent 'spot-check' manual measurements of bladder pressure in those perceived as high risk are used as surrogates for intra-abdominal pressure (IAP). True patterns of IAH remain unknown. We explored the incidence of IAH in cardiac surgery patients and describe the intra-and postoperative course of IAP using a novel, high frequency, automated bladder pressure measurement system. Sub-analysis of a prospective, multicenter, observational study (NCT04669548) conducted in three large academic medical centers. Continuous urinary output (CUO) and IAP measurements were observed using the Accuryn Monitoring System (Potrero Medical, Hayward, CA). Data collected included demographics, hemodynamic support, and high-frequency IAP and CUO. One Hundred Thirty-Seven cardiac surgery patients were analyzed intraoperatively and followed 48 h postoperatively in the intensive care unit. Median age was 66.4 [58.3, 72.0] years, and 61% were men. Median Foley catheter dwell time was 56.0 [46.8, 77.5] hours, and median baseline IAP was 6.3 [4.0, 8.1] mmHg. 93% (128/137) of patients were in IAH grade I, 82% (113/137) in grade II, 39% (53/137) in grade III, and 5% (7/137) in grade IV for at least 12 cumulative hours. For maximum consecutive duration of IAH, 84% (115/137) of patients spent at least 12 h in grade I, 62% (85/137) in grade II, 18% (25/137) in grade III, and 2% (3/137) in grade IV IAH. During the first 48 h after cardiac surgery, IAH is common and persistent. Improved and automated monitoring of IAP will increase the detection of IAH-which normally would remain undetected using traditional intermittent monitoring methods.
Assuntos
Procedimentos Cirúrgicos Cardíacos , Hipertensão Intra-Abdominal , Masculino , Humanos , Idoso , Feminino , Hipertensão Intra-Abdominal/diagnóstico , Hipertensão Intra-Abdominal/etiologia , Estudos Prospectivos , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , IncidênciaRESUMO
OBJECTIVE: The aim: To improve the results of treatment of patients diagnosed with acute pancreatitis. PATIENTS AND METHODS: Materials and methods: The materials of the work are based on the clinical examination and treatment of 301 patients with acute pancreatitis, in the treatment of which, along with classical treatment, a therapeutic and diagnostic complex was used, which allows predicting and preventing the development of abdominal compartment syndrome (ACS). RESULTS: Results: Managed to reduce the number of cases of infected pancreatic necrosis, effectively predict and prevent the development of abdominal compartment syndrome (ACS), reduce the average length of stay of patients in the hospital. CONCLUSION: Conclusions: The use of the proposed management algorithm for patients with acute pancreatitis allows to shorten the treatment period by effectively predicting and preventing the development of pancreatic necrosis, its septic complications and abdominal compartment syndrome.
Assuntos
Hipertensão Intra-Abdominal , Pancreatite Necrosante Aguda , Humanos , Hipertensão Intra-Abdominal/etiologia , Hipertensão Intra-Abdominal/cirurgia , Pancreatite Necrosante Aguda/terapia , Pancreatite Necrosante Aguda/cirurgia , Doença Aguda , Laparotomia/efeitos adversosRESUMO
PURPOSE OF REVIEW: Intra-abdominal hypertension (IAH) has been acknowledged as an important contributor to organ dysfunction in critically ill patients, both in surgical and medical conditions. As our understanding of the pathophysiology evolves, risk factors are better recognized, preventive measures can now be implemented and therapeutic interventions tailored to the physiology of the patient. In the current review, we want to highlight developing insights in the epidemiology and treatment of patients with IAH and ACS. RECENT FINDINGS: The impact of IAH and ACS on kidney function and other outcomes continues to draw attention in recent studies. New methods for IAP measurement are under development, and the search for biomarkers to detect IAH or ACS continues. In conditions wherein IAH and ACS are common, recent studies allow better prevention and treatment of these conditions, based on the contemporary ICU management consisting of IAP measurement, judicious fluid resuscitation and decompressive laparotomy where necessary. Surgical treatment options including open abdomen therapy continue to be improved with demonstrable impact on outcomes. SUMMARY: In this manuscript, we provide an overview of recent insights and developments in the epidemiology, monitoring and treatment of patients with IAH and/or ACS.