Effect of continuous renal replacement therapy on the control of different grades of intra-abdominal hypertension in patients with severe acute pancreatitis / 中华急诊医学杂志

Objective:To analyze the effect and clinical significance of continuous renal replacement therapy (CRRT) on severe acute pancreatitis complicated with different grades of intra-abdominal hypertension, and to determine whether the level of intra-abdominal pressure can be used as one of the indicators of CRRT in these patients.Methods:From September 2020 to September 2022, the clinical data of 66 patients with severe acute pancreatitis complicated by intra-abdominal pressure (IAP) ≥12 mmHg who were treated with CRRT and admitted to the EICU of Affiliated Hospital of Xuzhou Medical University were retrospectively analyzed. According to the level of IAP, they were divided into group A: 12 mmHg≤IAP < 15 mmHg, 22 cases; group B: 15 mmHg≤IAP≤20 mmHg, 23 cases and group C: IA P>20 mmHg, 21 cases. The general clinical data and IAP values before and after CRRT treatment, as well as the ΔIAP (difference of IAP before and after treatment) were recorded. The difference of IAP before and after treatment and the ΔIAP between group B and group C were compared by independent sample t test. The relationship between IAP before treatment and ?IAP was analyzed by spearman test. Results:There were no significant differences in gender, age, modified Marshall score, APACHE Ⅱ score, number of mechanical ventilation, and etiology among the three groups before treatment( P>0.05). After CRRT treatment, IAP of group A was no significantly changed before and after treatment ( P>0.05). IAP in groups B and C was significantly lower after treatment than before treatment ( P<0.05), and the ΔIAP of group C was significantly higher than that of group B ( P<0.05). There was a positive correlation between IAP before treatment and ?IAP in group B and Group C ( P<0.05). Conclusions:1．For patients with severe pancreatitis complicated with intra-abdominal hypertension, CRRT treatment can effectively reduce IAP when IAP≥15 mmHg, and the higher the IAP, the more obvious effect of CRRT treatment in controlling intra-abdominal pressure. 2. IAP≥15 mmHg can be used as one of the indicators for CRRT in SAP patients.

Monitoring of intra-abdominal pressure:a survey of ICU nurses'practice and cognition in 31 hospitals in Shandong Province / 中华护理杂志

Objective To understand the current situation of practice and cognition of ICU nurses on intra-abdominal pressure monitoring in tertiary general hospitals in Shandong Province,and to analyze the factors affecting their cognition,so as to provide references for formulating intra-abdominal pressure monitoring standards and procedures,and carrying out targeted training in the future.Methods A convenience sampling method was used,and a self-designed questionnaire on practice and cognition of intra-abdominal pressure monitoring was used to survey ICU nurses from tertiary general hospitals in 16 prefecture-level cities in Shandong Province from September to November 2022.Results A total of 627 valid questionnaires were collected,involving 31 tertiary general hospitals(24 tertiary A hospitals,77.42%;7 tertiary B hospitals,22.58%).The operation rate of intra-abdominal pressure monitoring was low(73.37%),and the main reasons were that they had not received intra-abdominal pressure monitoring related training(61.08%),with only 111(24.94%)nurses choosing the intersection of the mid-axillary line and the iliac crest as the reference zero point measurement,274(61.57%)nurses not taking an reading at the end of expiration.The intra-abdominal pressure monitoring cognition score was 0～16(7.88±2.79)points,and only 5 questions had a correct answer rate of≥50%.Conclusion The standardization of intra-abdominal pressure monitoring practice by ICU nurses in tertiary general hospitals in Shandong Province needs to be strengthened,and their cognition needs further training.It is suggested to unify and implement the standards and procedures of intra-abdominal pressure monitoring,further accelerate the training of intra-abdominal pressure monitoring technology,and improve the standard execution rate and cognitive level of ICU nurses on intra-abdominal pressure monitoring.

Predictive value of diaphragm thickening fraction and intra-abdominal pressure monitoring-oriented risk prediction model for weaning failure in patients with severe acute pancreatitis / 中华危重病急救医学

Objective:To establish a risk prediction model dominated by diaphragm thickening fraction (DTF) and intra-abdominal pressure (IAP) monitoring, and to explore the predictive value of the model for weaning failure in patients with severe acute pancreatitis (SAP).Methods:A prospective research was conducted. Sixty-three patients undergoing invasive mechanical ventilation treatment who diagnosed with SAP admitted to intensive care unit of the First Affiliated Hospital of Jinzhou Medical University from August 2020 to October 2021 were enrolled. The spontaneous breathing trial (SBT) was carried out when the clinical weaning criteria was met. The stable cardiovascular status, good pulmonary function, no chest and abdominal contradictory movement, and adequate oxygenation were defined as successful weaning. Otherwise, it was defined as failure weaning. The clinical indicators such as SBT 30-minure DTF, IAP, tidal volume (VT), respiratory rate (RR), body mass index (BMI), and blood lactic acid (Lac) were compared between the weaning success group and the weaning failure group. The indicators with statistically significant differences in the single-factor analysis were included in the secondary multivariable Logistic regression analysis to establish a risk prediction model. The correlation between the DTF and IAP at 30 minutes of SBT was analyzed. Receiver operator characteristic curve (ROC curve) was drawn to analyze the predictive value of the risk prediction model for SAP patient withdrawal failure at 30 minutes of SBT.Results:Finally, 63 patients with SAP were enrolled. Among the 63 patients, 42 were successfully weaned and 21 failed. There were no significant differences in age, gender, and oxygenation index (PaO 2/FiO 2), sequential organ failure assessment (SOFA) score, acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score at admission between the two groups, indicating that the data in the two groups were comparable. Compared with the weaning success group, IAP, RR, BMI and Lac at 30 minutes of SBT in the weaning failure group were significantly increased [IAP (mmHg, 1 mmHg≈0.133 kPa): 14.05±3.79 vs. 12.12±3.36, RR (times/min): 25.43±8.10 vs. 22.02±5.05, BMI (kg/m 2): 23.71±2.80 vs. 21.74±3.79, Lac (mmol/L): 5.27±1.69 vs. 4.55±1.09, all P < 0.05], while DTF and VT were significantly decreased [DTF: (29.76±3.45)% vs. (31.86±3.67)%, VT (mL): 379.00±98.74 vs. 413.60±33.68, both P < 0.05]. Secondary multivariable Logistic regression analysis showed that DTF [odds ratio ( OR) = 0.758, 95% confidence interval (95% CI) was 0.584-0.983, P = 0.037], IAP ( OR = 1.276, 95% CI was 1.025-1.582, P = 0.029), and RR ( OR = 1.145, 95% CI was 1.014-1.294, P = 0.029) were independent risk factors for SBT withdrawal failure in 30 minutes in SAP patients. The above risk factors were used to establish the risk prediction model of aircraft withdrawal failure at 30 minutes of SBT: Logit P = -0.237-0.277×DTF+0.242×IAP+0.136×RR. Pearson correlation analysis showed that SBT 30-minute DTF was significantly correlated with IAP in SAP patients, and showed a significant positive correlation ( r = 0.313, P = 0.012). The ROC curve analysis results showed that area under the ROC curve (AUC) of the risk prediction model for SAP patient withdrawal failure at 30 minutes of SBT was 0.716, 95% CI was 0.559-0.873, P = 0.003, with the sensitivity of 85.7% and the specificity of 78.6%. Conclusions:DTF, IAP and RR were independent risk factors for SBT withdrawal failure in 30 minutes in SAP patients. The DTF and IAP monitoring-oriented risk prediction model based on the above three variables has a good predictive value for weaning failure in patients with SAP.

Intra-abdominal Pressure as a Prognostic Factor in Severe Acute Pancreatitis

Objective:To assess the prognos?c value of Intraabdominal Pressure in severe acute pancrea??s, compare it to APACHE II, to determine when to intervene based on intra abdominal pressure. Materials and Methods:We studied the role of intraabdominal pressure measurement as a prognos?c index and its applicability to determine the ?ming of interven?on in cases of severe acute pancrea??s as a prospec?ve cohort study from 2010- 2012, at Kamineni Hospital, L.B Nagar, Hyderabad. All pa?ents who were admi?ed with severe acute pancrea??s and consented to take part in the study were enrolled. All pa?ents were evaluated clinically, radiologically, biochemically and by the prognos?c indices – APACHE II, Ranson criteria and intra-abdominal pressure measurement. A total of 55 pa?ents were enrolled in this study. Intra-abdominal pressure was measured by intravesical technique using a Foley catheter.Intra-abdominal pressure was measured every 12 hours. Within 24 hours of admission, APACHE II score was obtained. Mul?variate analysis was u?lised for sta?s?cs. Results:Males comprised 73% of study popula?on. Mean age was 41.23± 13.74 years (17- 83 years). Ten pa?ents (18.81%) died. Among the non-survivors, the intraabdominal pressure (20.1± 3.1073 Vs 8.97± 4.39) and the APACHE II (17.5 ±4.09 Vs3.93 ±4.345),were significantly greater, P value <0.0001. The AUC for intra-abdominal pressureat 24 hours and at 72 hours was >0.7, which is highly significant. The sensi?vity for intra-abdominal pressure(>13 mm Hg) at 72 hours as a marker for mortality was 100%. Conclusion:The Intra-abdominal pressure monitoring is rapid, reproducible, inexpensive and minimally invasive, and can be used as a marker of the severity and prognosis of severe acute pancrea??s. Intra-abdominal pressure could poten?ally be used to guide the ?ming of interven?on. Compared to APACHE II, which is inclusive of mul?ple parameters, intra-abdominal pressure can serve the same purpose as a single prognos?c index. Further, we recommend a large, mul?centric studies to conclusively establish the predic?ve power of intra-abdominal pressure in acute pancrea??s and whether interven?ons known to reduce intraabdominal pressure, can alter the ul?mate outcome.

Evidence summary of intra-abdominal pressure-guided enteral nutrition in patients with intra-abdominal hypertension / 中国实用护理杂志

Objective:To retrieve and obtain relevant evidence of intra-abdominal pressure-oriented enteral nutrition assessment and management in patients with intra-abdominal hypertension, in order to provide evidence-based evidence for clinical medical staff to make enteral nutrition-related clinical decisions for patients with intra-abdominal hypertension.Methods:Systematic retrieval of Chinese National Knowledge Infrastructure, Wanfang, Chinese Biomedical Literature, UpToDate, PubMed, Cochrane Library, BMJ Best Practice and other English data, as well as domestic and foreign guidelines such as American Society for Parenteral and Enteral Nutrition, Scottish Intercollegiate Guidelines Network, etc. All evidence available on the Internet in both Chinese and English on intra-abdominal pressure-guided enteral nutrition strategies in adults with intra-abdominal hypertension, study types including clinical decision-making, systematic reviews/meta-analyses, evidence summaries, expert consensus, guidelines or related to the subject of this study closely related high-quality original research. The retrieval time was from the establishment of the database to November 2021. The literature evaluation tool was selected according to the research type. Two researchers trained in the evidence-based system independently evaluate the quality of the included literature, fully considering the clinical situation and expert opinions, and completed the evidence. Extracted and summarized.Results:Totally 13 articles were finally included, including 5 guidelines, 3 expert consensuses, 1 evidence summary and 4 original studies, and 29 evidence-based practice evidence of enteral nutrition in patients with intra-abdominal hypertension were collected, including the monitoring timing of enteral pressure, the pressure of enteral high pressure and the way of enteral nutrition, the pressure measurement of the abdominal cavity, the setting of abdominal pressure, the temperature conditions for early start of enteral nutrition, the selection of enteral pressure, the temperature setting of enteral nutrition nine aspects such as speed and regulation of internal nutrition and abdominal compartment syndrome prevention.Conclusions:This study summarizes the best evidence of intra-abdominal pressure management and enteral nutrition therapy in patients with intra-abdominal hypertension, and provides evidence-based basis for risk management, standardizing clinical practice, and ensuring treatment safety. In the stage of evidence transformation, clinical medical staff need to comprehensively weigh the benefits and risks of early enteral nutrition, and integrate evidence in combination with clinical practical application scenarios, so as to form a standardized early enteral nutrition management plan suitable for patients with intra-abdominal hypertension.

Clinical effect of fluid resuscitation guided by intra-abdominal pressure and oxygenation index for severe acute pancreatitis patients / 中华危重病急救医学

Objective:To investigate the effect of the liquid resuscitation therapy strategy using intra-abdominal pressure (IAP) and oxygenation index (PaO 2/FiO 2) as the end point in patients with severe acute pancreatitis (SAP). Methods:A retrospective study was performed, including 84 patients with SAP in emergency intensive care unit of Qingzhou Hospital Affiliated to Shandong First Medical University from January 2018 to August 2021. According to the status of fluid balance at admission, all patients were divided into the positive fluid balance group (43 cases) and the negative fluid balance group (41 cases). The clinical data including gender, age, etiology, underlying disease, acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) and sequential organ failure assessment (SOFA) of all patients were collected. Fluid balance, PaO 2/FiO 2, IAP, compliance rate, new mechanical ventilation rate and overall hospital stay of 1 week after admission were recorded and compared between the two groups. Results:After 72 hours of treatment, the cumulative fluid balance was (5 219.5±1 038.4) mL in the positive fluid balance group; IAP was higher than that before treatment [mmHg (1 mmHg≈0.133 kPa): 11.9±2.0 vs. 11.7±2.1], but no significant difference was found ( P > 0.05); PaO 2/FiO 2 was significantly higher than that before treatment (mmHg: 299.8±51.4 vs. 220.5±50.4, P < 0.05). After 72 hours of treatment, the cumulative fluid balance in negative fluid balance group was (-3 542.4±1 310.6) mL; IAP was significantly lower than before treatment (mmHg: 11.4±1.8 vs. 15.2±1.9, P < 0.05); PaO 2/FiO 2 was significantly higher than that before treatment (mmHg: 309.9±50.9 vs. 215.4±49.7, P < 0.05). In the fluid resuscitation goals, after 72 hours of treatment, the compliance rate in the negative fluid balance group was significantly higher than that in the positive fluid balance group [82.93% (34/41) vs. 62.79% (27/43), P < 0.05]; 1 week after admission, the new mechanical ventilation rate in the negative fluid balance group was significantly lower than that in the positive fluid balance group [21.95% (9/41) vs. 41.86% (18/43), P < 0.05]; however, there was no significant difference in overall hospital stay between the two groups (days: 41.2±10.9 vs. 39.1±11.5, P > 0.05). After treatment, 70 patients survived and 14 patients died (including 9 cases in the positive fluid balance group and 5 cases in the negative fluid balance group). Conclusions:Using IAP and PaO 2/FiO 2 to guide liquid therapy could result in effective fluid resuscitation in SAP. The treatment strategy effectively improved prognosis of patients with SAP.

Assessment of effects of intra-abdominal pressure monitoring on evaluating early enteral nutrition in patients with acute pancreatitis / 中华危重病急救医学

Objective:To explore the role of intra-abdominal pressure (IAP) monitoring in evaluating the efficacy of early enteral nutrition (EN) in patients with acute pancreatitis (AP).Methods:The clinical data were collected from the AP patients in department of criticle care medicine of Baoshan Branch of Huashan Hospital Affiliated to Fudan University from July 2020 to June 2021. The patients were divided into three groups according to their treatments: no gastrointestinal decompression with fasting group, gastrointestinal decompression with fasting group, gastrointestinal decompression with indwelling jejunal tube within 24 hours group. The data of white blood cell (WBC), procalcitonin (PCT), serum amylase (AMY) and IAP were analyzed before and after treatment, the initiation time oral feeding were also analyzed.Results:The decrease of WBC, PCT, AMY, and IAP in gastrointestinal decompression with indwelling jejunal tube within 24 hours group were significantly greater than those in the other groups [WBC (×10 9/L): -1.72±0.74 vs. -0.68±0.36, -1.23±86.97; PCT (μg/L): -3.14±5.19 vs. 0.06±0.48, -1.57±0.78; AMY (U): -148.43±75.89 vs. -74.85±78.84, -93.78±1.17; IAP (cmH 2O, 1 cmH 2O≈0.098 kPa): -4.82±1.66 vs. 0.36±1.32, -3.22±4.36, all P < 0.05]. There were no correlation between the changes of IAP and the changes of WBC, PCT or AMY in the non-gastrointestinal decompression with fasting group and the gastrointestinal decompression with indwelling jejunal tube within 24 hours group (all P > 0.05). The decreasing trend of IAP in patients with gastrointestinal decompression with fasting group was positively correlated with the change of AMY ( r = 0.65, P < 0.001). The initiation time of oral feeding in gastrointestinal decompression with indwelling jejunal tube within 24 hours group was significantly shorter than that in the other groups (hours: 89.538 vs. 111.273, 109.714), the difference was statistically significant ( P < 0.05). Conclusions:IAP monitoring, as an emergency means of monitoring the efficacy of early EN in AP patients, has the advantages of simplicity, efficiency and rationality, which has a more objective basis than the previous empirical treatment and open oral feeding.

The role of intra-abdominal pressure in human testicular migration

ABSTRACT Objectives: This review aims to study the role of the abdominal wall in testicular migration process during the human fetal period. Materials and Methods: We performed a descriptive review of the literature about the role of the abdominal wall in testicular migration during the human fetal period. Results: The rise in intra-abdominal pressure is a supporting factor for testicular migration. This process has two phases: the abdominal and the inguinal-scrotal stages. The passage of the testis through the inguinal canal occurs very quickly between 21 and 25 WPC. Bilateral cryptorchidism in Prune Belly syndrome is explained by the impaired contraction of the muscles of the abdominal wall; mechanical obstruction due to bladder distention and structural alteration of the inguinal canal, which hampers the passage of the testis during the inguinoscrotal stage of testicular migration. Abdominal wall defects as gastroschisis and omphaloceles are associated with undescended testes in around 30 to 40% of the cases. Conclusions: Abdominal pressure wound is an auxiliary force in testicular migration. Patients with abdominal wall defects are associated with undescendend testis in more than 30% of the cases probably due to mechanical factors; the Prune Belly Syndrome has anatomical changes in the anterior abdominal wall that hinder the increase of intra-abdominal pressure which could be the cause of cryptorchidism in this syndrome.

Intra-abdominal hypertension secondary to chronic diaphragmatic rupture in a dog / Hipertensão intra-abdominal secundária à ruptura diafragmática crônica em um cão

ABSTRACT: Intra-abdominal hypertension (IAH) is the persistent increase of intra-abdominal pressure (IAP) that could be caused by several pathologies. It is capable of promoting organ dysfunction, thereby increasing the mortality rate of human patients. As for cats and dogs, there are still few reports on how this pressure can be monitored and treated as a routine for admitted and hospitalized animals and on its relationship with the mortality of the patients. Therefore, the objective of this paper was to report a case of IAH secondary to chronic diaphragmatic rupture in a dog, which was treated with a temporary abdominal closure (TAC). A bitch was admitted to the veterinary hospital to undergo an elective ovariohysterectomy when it was diagnosed with a diaphragmatic rupture and displacement of the liver and intestinal loops in the chest. After repositioning these structures in the abdominal cavity, tension was observed in the abdomen. A temporary abdominal closure was then performed with a Bogota bag. Immediately after the surgery, the IAP was measured, presenting a value of 15 mmHg, indicating that there was an increase in intra-abdominal pressure. The animal was hospitalized, and IAP was monitored. After 24 hours, IAP was 5.8 mmHg when the Bogota bag was removed, and definitive celiorraphy was performed. The patient showed satisfactory clinical progress and was discharged 72 hours after the surgical procedure. The treatment used for IAH proved to be effective and contributed to the quick and satisfactory recovery of the patient.

RESUMO: A hipertensão intra-abdominal (HIA) é o aumento persistente da pressão intra-abdominal (PIA), podendo ser causada por diversas afecções e caraterizada por promover disfunções orgânicas, aumentando a taxa de mortalidade no homem. Em cães e gatos, ainda há poucos relatos da monitoração dessa pressão e do seu tratamento na rotina dos animais admitidos e internados, e sua relação com a mortalidade dos pacientes. Assim, objetivou-se relatar um caso de HIA secundária à ruptura diafragmática crônica em cão, a qual foi tratada com o fechamento abdominal temporário (FAT). Uma cadela foi admitida no hospital veterinário para realização de uma cirurgia de ovário-histerectomia eletiva, quando foi diagnosticada com ruptura diafragmática com fígado e alças intestinais deslocadas para o interior do tórax. Após reposicionamento dessas estruturas na cavidade abdominal, observou-se tensão no abdômen. Realizou-se então o fechamento abdominal temporário com bolsa de Bogotá. Imediatamente após o término da cirurgia, a PIA foi aferida e seu valor era de 15 mmHg, indicando aumento da mesma. O animal foi mantido internado e sua PIA monitorada. Após 24 horas seu valor era de 5,8 mmHg, quando a bolsa de Bogotá foi removida e realizada a celiorrafia definitiva. O paciente teve evolução clínica satisfatória e 72h após a cirurgia recebeu alta hospitalar. O tratamento utilizado para a HIA se mostrou eficaz, contribuindo para a rápida e satisfatória recuperação da paciente.

Intracranial Hypertension and Intra-abdominal Pressure. Is it Worth Measuring?

Patients with refractory intracranial hypertension who have already undergone all the measures recommended by the current guidelines can benefit from having their intraabdominal pressure monitored since its increase generates hemodynamic repercussions and secondary elevation of intracranial pressure. In this context, a bibliographic research was performed on PubMed with the terms intra-abdominal pressure, abdominal compartment syndrome, intracranial pressure, intracranial hypertension. Altogether, 146 articles were observed, 87 of which were from the year 2000, and only 15 articles were considered relevant to the topic. These studies indicate that patients with refractory intracranial hypertension can benefit fromthe measurement of intraabdominal pressure, since there is evidence that an increase in this pressure leads to organic dysfunctions with an indirect impact on cerebral venous return and, consequently, an increase in intracranial pressure. In thosewho underwent decompression laparotomy, direct effectswere observed in reducing intracranial hypertension and survival.

Hipertensión intraabdominal y síndrome compartimental abdominal en el paciente grave / Intra-abdominal hypertension and abdominal compartment syndrome in the severe patient / Hipertensão intra-abdominal e síndrome do compartimento abdominal no paciente grave

RESUMEN Introducción: La hipertensión intraabdominal y el síndrome compartimental abdominal implican un grave pronóstico. Objetivo: Sistematizar contenidos esenciales relacionados con el diagnóstico y el tratamiento de estas emergencias médicas. Método: En la Facultad de Ciencias Médicas Guantánamo, entre enero y julio de 2019 se hizo una revisión narrativa sobre el tema a través de una búsqueda en bases de datos electrónicas (Biblioteca Virtual en Salud): LILACS, PubMed, SciELO, ClinicalKey, REDALYC, Scopus, Cochrane. Resultados: Se localizaron 125 documentos, y se eligieron 25 relevantes para el objetivo de la revisión. La información se estructuró en los siguientes aspectos: definición, fisiopatología, etiología, diagnóstico y tratamiento. Conclusiones: Se elaboró un referente teórico útil a estudiantes y médicos generales para prepararse sobre el tema. Se identificaron controversias sobre la efectividad del uso de fármacos sedantes, analgésicos, procinéticos, albúmina y diuréticos, la terapia de reemplazo renal y la descompresión gástrica y colónica para el tratamiento médico, el impacto de los tratamientos quirúrgicos en la supervivencia de pacientes y el efecto de la comorbilidad del paciente, la enfermedad causal, la ventana temporal diagnóstico-tratamiento en los resultados terapéuticos de estas emergencias médicas.

ABSTRACT Introduction: Intra-abdominal hypertension and abdominal compartment syndrome imply a serious prognosis. Objective: Systematize essential contents related to the diagnosis and treatment of these medical emergencies. Method: In the Faculty of Medical Sciences Guantanamo, between January and July 2019, a narrative review on the subject was made through a search in electronic databases (Virtual Health Library): LILACS, PubMed, SciELO, ClinicalKey, REDALYC, Scopus, Cochrane. Results: 125 documents were located, and 25 relevant for the purpose of the review were chosen. The information was structured in the following aspects: definition, pathophysiology, etiology, diagnosis and treatment. Conclusions: A useful theoretical reference to students and general practitioners was prepared to prepare on the subject. Controversies were identified about the effectiveness of the use of sedative, analgesic, prokinetic, albumin and diuretic drugs, renal replacement therapy and gastric and colonic decompression for medical treatment, the impact of surgical treatments on patient survival and the effect of the patient's comorbidity, the causative disease, the diagnostic-treatment time window in the therapeutic results of these medical emergencies.

RESUMO Introdução: Hipertensão intra-abdominal e síndrome do compartimento abdominal implicam um prognóstico sério. Objetivo: Sistematizar conteúdos essenciais relacionados ao diagnóstico e tratamento dessas emergências médicas. Método: Na Faculdade de Ciências Médicas de Guantánamo, entre janeiro e julho de 2019, foi realizada uma revisão narrativa sobre o assunto, através de uma busca em bases de dados eletrônicas (Biblioteca Virtual em Saúde): LILACS, PubMed, SciELO, ClinicalKey, REDALYC, Scopus, Cochrane. Resultados: Foram localizados 125 documentos e escolhidos 25 relevantes para a finalidade da revisão. As informações foram estruturadas nos seguintes aspectos: definição, fisiopatologia, etiologia, diagnóstico e tratamento. Conclusões: Foi preparado um referencial teórico útil para estudantes e médicos de clínica geral para se preparar sobre o assunto. Foram identificadas controvérsias sobre a eficácia do uso de medicamentos sedativos, analgésicos, procinéticos, albumina e diuréticos, terapia de reposição renal e descompressão gástrica e colônica para tratamento médico, o impacto dos tratamentos cirúrgicos na sobrevida dos pacientes e o efeito da comorbidade do paciente, da doença causadora, da janela do tempo de diagnóstico e tratamento nos resultados terapêuticos dessas emergências médicas.

Effects of pneumoperitoneum and trendelenburg position on intraocular pressure (IOP) in isofluorane anesthetised cats / Efeitos do pneumoperitônio e da posição de trendelenburg sobre a pressão intraocular em gatos anestesiados com isoflurano

The aim of this study was to determine whether a pneumoperitoneum of 10 mmHg combined or not with the Trendelenburg position could lead to significant changes in intraocular pressure (IOP), ocular pressure perfusion (OPP), and cardiorespiratory variables; as well as determine whether a correlation exists between IOP and mean arterial blood pressure (MAP), and/or partial pressure of carbon dioxide in arterial blood (PaCO2) in cats. Animals were allocated in two groups (n=7/group): GC (without inclination) and GTREN (Trendelenburg position). The variables were recorded before (baseline) and during 30 minutes (T5-T30) after insufflation. In GTREN, a reduction in heart rate was observed at T5 and in respiratory rate at T5 and T15. There was an increase in IOP at T5-T30 in comparison to baseline. There was a reduction in potential of hydrogen in arterial blood in both groups at all times in comparison to baseline. Partial pressure of carbon dioxide in arterial blood was increased at T15-T30 in GC and at T5-T30 in GTREN. In conclusion, the pneumoperitoneum of 10mmHg CO2 did not significantly affect IOP or OPP in cats anaesthetised with isofluorane and kept under spontaneous ventilation. However, induced pneumoperitoneum combined with Trendelenburg position resulted in an increase in IOP in cats subjected to the same anaesthetic conditions, but did not affect OPP.

O objetivo deste estudo foi determinar se o pneumoperitônio de 10 mmHg associado, ou não, à posição de Trendelenburg poderia levar a alterações significativas na Pressão Intraocular (PIO), Pressão de Perfusão Ocular (PPO) e variáveis cardiorrespiratórias, bem como determinar se havia correlação entre a PIO e a Pressão Arterial Média (PAM) e/ou Pressão Parcial de Dióxido de Carbono no Sangue Arterial (PaCO2) em gatos. Os animais foram alocados em dois grupos (n = 7/grupo): GC (sem inclinação) e GTREN (posição de Trendelenburg). As variáveis foram registradas antes (linha de base) e durante 30 minutos (T5-T30) após a insuflação. No GTREN, foi observada redução na frequência cardíaca em T5 e, na frequência respiratória, em T5 e T15. Houve aumento da PIO no T5-T30 comparativamente ao valor basal. Houve redução no Potencial de Hidrogênio no sangue arterial em ambos os grupos em todos os momentos comparativamente à linha de base. A Pressão Parcial de Dióxido de Carbono no sangue arterial aumentou em T15-T30 no GC e em T5-T30 no GTREN. Concluiu-se que o pneumoperitônio de 10mmHg CO2 não afetou significativamente a PIO ou a PPO em gatos anestesiados com isofluorano e mantidos sob ventilação espontânea. No entanto, o pneumoperitônio induzido combinado à posição de Trendelenburg resultou em aumento da PIO em gatos submetidos às mesmas condições anestésicas, mas não afetou a PPO.

Clinical trials of acupuncture of Jiaji (EX-B2) for treatment of gastrointestinal dysfunction in sepsis patients / 针刺研究

OBJECTIVE: To observe the clinical therapeutic effect of acupuncture of Huatuo Jiaji (EX-B2) in the treatment of gastrointestinal dysfunction in sepsis patients, aiming at providing new clinical approach and evidence for improving septic gastrointestinal activity. METHODS: A total of 40 patients with septic gastrointestinal dysfunction who met our inclusive criteria were randomly divided into control group and treatment group (n＝20 cases in each). Patients in the control group received routine treatment of nasogastric mosapride citrate (5 mg/time, three times a day) and tifidobacterium triple viable capsules (420 mg, twice a day), intravenous infusion of omeprazole (40 mg, twice a day), rational dose of antibiotics, maintenance treatment of functions of the heart, lung, brain, kidney and other important organs and water electrolyte balance, as well as symptomatic treatment. Patients of the treatment group were treated by acupuncture of EX-B2 on the basis of routine treatment mentioned above in the control group. The acupuncture needle was inserted into EX-B2, twirled for a while and retained for 30 min, once a day for 10 successive days. The acute physiology and chronic health evaluation (APACHE II) score was given according to Knaus and colleagues' method, the intra-abdominal pressure was detected by using a manometer which was connected to an inserted canal in the urinary bladder, and the intragatric residul volume detected by using an injection syriange pumping via a nasal feeding tube. RESULTS: After the treatment, the APACHE II score, intra-abdominal pressure and intragastric residual volume on day 10 were significantly decreased in both groups in comparison with their own pre-treatment (P<0.05), while the borborygmus levels on day 10 were considerably increased in both groups relevant to their own pre-treatment (P<0.05). The APACHE II scores, intra-abdominal pressure and intragastric residual volume on day 3, 6 and 10 were significantly lower in the treatment group than those in the control group (P<0.05), whereas the borborygmus levels at the 3rd , 6th and 10th day in the treatment group were apparently higher than those of the control group (P<0.05)．. CONCLUSION: Acupuncture stimulation of EX-B2 has a good curative effect in improving gastrointestinal dysfunction in sepsis patients.

Effects of Clostridium butyricum on the function of intestinal mucosal barrier and flora in acute necrotizing pancreatitis rats with intra-abdominal hypertension / 中华胰腺病杂志

Objective To explore the effect of Clostridium butyricum ( C. butyricum ) and its metabolite butyrate on the function of intestinal mucosal barrier and intestinal flora in acute necrotizing pancreatitis ( ANP) rats with intra-abdominal hypertension ( IAH) . Methods Eighty SD rats were randomly divided into normal control group (A group, n=20), ANP with IAH group(B group, n=20), ANP with IAH and C. butyricum treated group ( C group, n=20 ) , ANP with IAH and sodium butyrate treated group ( D group, n=20). Rats of C and D group were given intragastric administration of C. butyricum 1 × 109 CFU once a day or 100 mg/kg sodium butyrate once a day from 10 days before modeling. Sodium taurocholate injection method via pancreatobiliary ducts was used to establish ANP with IAH rat model, and the intra-abdominal pressure was measured by direct puncture of left lower belly 24 h after modeling. Blood samples were collected for detecting serum amylase(AMY), tumor necrosis factor alpha (TNF-α), diamine oxidase( DAO ) , lipopolysaccharide ( LPS ) and D-Lactate, and the pathological changes of terminal ileum was observed. Real-time quantitative PCR was used to detect the populations of 6 bacteria in ileum mucosa. Results The levels of AMY, TNF-α, LPS,DAO, D-Lactate and ileum mucosa score were obviously higher in B, C and D group than those in A group, but the number of piobiotic flora in ileum mucosa was lower than that in A group, while the number of pathogenic bacteria was higher than that in A group. The levels of LPS, DAO, D-Lactate and ileum mucosa pathological score were lower in C group and D group than those in B group, but the number of piobiotic flora in ileum mucosa was lower than that in B group, while the number of pathogenic bacteria was higher than that in B group. All the differences above were statistically different (P<0.05). Conclusions C. butyricum and butyrate can maintain the function of intestinal mucosal barrier in ANP rats with IAH, and also readjust the imbalance of intestinal flora.

The early diagnostic value of IAP combined with IFABP for patients with mechanical ventilation complicated with AGI / 中华急诊医学杂志

Objective To investigate the early diagnostic value of intra-abdominal pressure (IAP) combined with intestinal fatty acid binding protein (IFABP) for patients with mechanical ventilation complicated with acute gastrointestinal injury (AGI).Methods From August 2015 to December 2015,1 19 patients with mechanical ventilation were admitted to ICU in our hospital,with 78 cases of AGI patients and 41 cases of non-AGI patients.Multiple physiological indexes and laboratory indexes of the two groups were recorded and compared.Results There was no statistical difference in sex,age,APACHE Ⅱ score,BMI index,Lac and mean arterial pressure (MAP) between the two groups (P ＞0.05);the OR values of mechanical ventilation time,oxygenation index,end-expiratory positive pressure (PEEP),CIT,IFABP and IAP were more than 1,so these indicators were all risk factors for AGI in patients with mechanical ventilation.The area under the curve of IAP,IFABP,mechanical ventilation and PEEP were more than 0.5,indicating that these indicators have a certain predictive value for AGI patients with mechanical ventilation.The sensitivity and specificity of IAP were 95％ and 80％ respectively,and the sensitivity and specificity of IFABP were 87.5％ and 50％,respectively.IAP was correlated with IFABP (r =0.621,P =0.031).Conclusions Mechanical ventilation time,oxygenation index,PEEP,CIT,IFABP,and IAP are risk factors for AGI patients with mechanical ventilation.IAP,IFABP,mechanical ventilation time and PEEP have a certain predictive value for AGI patients with mechanical ventilation.The diagnostic value of IAP and IFABP is high,and the two are closely related.Combined application can provide a certain objective basis for clinical AGI diagnosis.

High Intra-Abdominal Pressure Secondary to Obesity as a Determining Factor for Ventriculoperitoneal Shunt Malfunction

The ventriculoperitoneal shunt (VPS) is an established treatment for hydrocephalus. The functioning of the system requires a pressure difference between the cranial and abdominal cavities. The VPS can be particularly problematic in patients with increased intra-abdominal pressure (IAP). We report the case of a 16-year-old girl with VPS since she was 2 months old due to hydrocephalus secondary to myelomeningocele. The patient had been asymptomatic ever since, but she sought the emergency service with intermittent headache and vomiting. A non-enhanced brain tomography, a shunt trajectory X-ray and an abdominal ultrasound revealed no cause of system malfunction. In view of the persistent clinical picture, a revision of the shunt was performed, which revealed adequate intraoperative functioning. She returned with the same symptoms two weeks after surgery. The patient was obese (body mass index [BMI]: 48). We hypothesized intermittent valve malfunction due to increased intra-abdominal pressure. She underwent a ventriculoatrial shunt, without intercurrences. In the postoperative period, the patient presented transient tachycardia and was asymptomatic at the 6-month follow-up. Obesity should be considered an important variable for the inadequate functioning of the VPS due to increased IAP and catheter dystocia to the extraperitoneal cavity. Studies have already correlated the IAP with the BMI, which reaches between 8 mm Hg and 12 mm Hg in obese individuals. Therefore, the BMI can be considered during the selection of valve pressure in systems with non-adjustable valves to prevent insufficient drainage. The recognition of obesity as a cause of VPS malfunction is fundamental to avoid unnecessary surgeries and intermittent malfunction of the system.

A derivação ventriculoperitoneal (DVP) é um tratamento estabelecido para a hidrocefalia; contudo, algumas variáveis podem influenciar na eficácia desta modalidade. O funcionamento do sistema requer uma diferença de pressão entre as cavidades craniana e abdominal. A DVP pode ser particularmente problemática em pacientes com aumento da pressão intra-abdominal (PIA). Neste artigo, relatamos o caso de uma paciente do sexo feminino, de 16 anos, portadora de DVP desde os 2 meses de idade por hidrocefalia secundária a mielomeningocele. Desde então assintomática, procurou o pronto-socorro com queixa de cefaleia e vômitos intermitentes. Uma tomografia de crânio sem contraste, um raio X (RX) do trajeto do cateter distal, e uma ultrassonografia (USG) abdominal não evidenciaram a causa do mau funcionamento do sistema. Diante do quadro persistente, realizou-se uma revisão da derivação, que mostrou funcionamento adequado no período intraoperatório. A paciente retornou com os mesmos sintomas duas semanas após a cirurgia. A paciente era obesa (índice de massa corporal [IMC]: 48). Aventou-se possível funcionamento intermitente da válvula pelo aumento da PIA. A paciente foi submetida a uma derivação ventrículo-atrial, que foi realizada sem intercorrências. No pós-operatório, ela apresentou quadro transitório de taquicardia, e não apresentou sintomas no acompanhamento feito depois de 6 meses. A obesidade deve ser considerada uma variável importante para o funcionamento inadequado da DVP, pelo aumento da PIA e pela associação com distocia do cateter para a cavidade extraperitoneal. Estudos já correlacionaram a PIA com o IMC, que pode atingir entre8 mm Hg e 12 mm Hg em obesos. Logo, o IMC pode ser considerado na seleção da pressão da válvula em sistemas com válvulas não ajustáveis, para prevenir a drenagem insuficiente. O reconhecimento da obesidade de risco para o mau funcionamento da DVP é fundamental para evitar cirurgias desnecessárias e o mau funcionamento intermitente do sistema.

Effect of retension sutures on abdominal pressure after abdominal surgery / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>To evaluate the effect of retention sutures on abdominal pressure and postoperative prognosis in abdominal surgery patients.</p><p><b>METHODS</b>This prospective cohort study included patients who were admitted to Daping Hospital from May 15, 2014 to October 11, 2014. A total of 57 patients were enrolled, including 18 patients in the "U" type retention suture group, 17 patients in the intermittent retention suture group, and 22 patients in non-retention suture group. The demographic data, clinical data and risk factors for abdominal wound dehiscence were recorded. The bladder pressure (IVP) was monitored preoperatively, intraoperatively, and four days postoperatively. Additionally, the incidence of abdominal wound dehiscence and infection 14 days after the operation was recorded.</p><p><b>RESULTS</b>During the operation, the IVP decreased and then increased; it was at its lowest 1 h after the start of the operation (5.3 mmHg ± 3.2 mmHg) and peaked after tension-reducing (8.8 mmHg ± 4.0 mmHg). The IVP values in the "U" type retention suture group and intermittent retention suture group were higher than in the non-retention suture group 4 days after operation (p < 0.005). The Visual Analogue Scale (VAS) pain scores were 3.9 ± 2.2, 3.8 ± 2.0, and 3.0 ± 1.0 in the retention suture group, intermittent retention suture group and non-retention suture group, respectively. The VAS pain scores in the "U" type tension-reducing group and intermittent tension-reducing group were higher than in the non-tension-reducing group (p < 0.005).</p><p><b>CONCLUSION</b>Although retention sutures may reduce the incidence of postoperative wound dehiscence in abdominal surgery patients, they can increase the IVP and postoperative pain.</p>

The Effect of Pneumoperitoneum and Trendelenburg position on respiratory mechanics under general anesthesia during gynecological laparoscopic surgery / Монголын Анагаах Ухаан

Background@#Gynecological laparoscopic surgery requires pneumoperitoneum(PP) with CO₂ gas insufflation and Trendelenburg position. Pneumoperitoneum and Trendelenburg position may impact intraoperative respiratory mechanics in anesthetic management.The goal of this study was to evaluate the influence of Pneumoperitoneum and Trendelenburg position on respiratory mechanics and ventilation. @*Methods@#Twenty one patients scheduled for elective gynecological laparoscopy were evaluated. The patients had no preexisting lung and heart disease or pathologic lung function. Conventional general anesthesia with thiopental sodium, fentanyl, аtracrium and isoflurane was administered. The peak inspiratory pressure, plateau pressure, and end-tidal CO₂ were compared before after creation of pneumoperitoneum with an intraabdominal pressure of 15 mmH₂O, then after PP10, PP20, PP30 minutes in the 20° Trendelenburg position, and after deflation of pneumoperitoneum. The dynamic lung compliance was calculated.@*Results@#During of pneumoperitoneum, there were a significant increase in peak inspiratory pressure by 6 cmH₂O, plateau pressure by 5 cmH₂O, while dynamic lung compliance decreased by 11 ml/cmH₂O. General, the Trendelenburg position induced no significant hemodynamic and pulmonary changes.@*Conclusion@#The effects of pneumoperitoneum significantly reduced dynamic lung compliance and increased peak inspiratory and plateau pressures. The Tredelenburg position did not change these parameters. The end-tidal CO₂ significantly increased after pneumoperitoneum and CO₂ deflation.

Vadilidation of respirophasic variation in carotid artery blood flow peak velocity as predictors of fluid responsiveness in patients undergoing laparoscopic surgery / 临床麻醉学杂志

Objective To assess the accuracy and feasibility of respirophasic variation in carotid artery blood flow peak velocity (△Vpeak-CA) as predictors of fluid responsiveness in laparoscopic surgery.Methods Fifty-five patients undergoing laparoscopic surgeries,29 males and 26 females,aged 45-75 years,ASA physical status Ⅰ-Ⅲ,with body mass index 20-24 kg/m2,were enrolled.When intra-abdominal pressure was steady at the level of 13-15 mm Hg,6％ hydroxyethylstarch (HES 130/0.4) 500 ml was infused at the speed of 7 ml/kg within 20 minutes.After volume expansion,subjects were classified as responders (group R,n =32) if cardiac index increased (△CI) was≥ 15％ and no responders (group NR,n =23) as △CI＜15％.The receiver operating characteristic curve (ROC) curve for △Vpeak-CA in determining the volume expansion responsiveness was plotted,and the diagnostic threshold was determined.The area under curve (AUC) and 95 ％ confidence interval (CI) was calculated.Cardiac index (CI),△Vpeak-CA and stroke volume variation (SW) were independently recorded at 5 minutes after induction (T1),5 minutes after intra-abdominal pressure were stable at the level of 13-15 mm Hg (T2) and 5 minutes after volume expansion (T3).Results △Vpeak-CA is highly negatively correlated with CI (r=-0.843,P＜0.001).The results of ROC curve analysis showed,△Vpeak-CA threshold discriminated between responders and non-responders with a sensitivity of 81.3％ and a specificity of 91.3％,and the AUC was 0.884 (95％ CI 0.793-0.975).Conclusion △Vpeak-CA seems to be a highly feasible and reliable predictor for fluid responsiveness in laparoscopic surgery patients.

Impact of increasing intra-abdominal pressure on digestive system during colorectal cancer patients under minimally invasive surgical procedure / 中国内镜杂志

Objective To investigate the impact of intraoperative intra-abdominal pressure increasing on digestive system.Methods A retrospective analysis of clinical data of 132 cases of colorectal cancer patients from January 2013 to June 2016 was made. Patients were divided into groups A, B and C according to the intra-abdominal pressure, 46 cases in each group. Group A: 46 patients, 10 mmHg (1 mmHg = 0.133 kPa), group B: 45 patients, 12 mmHg, group C: 41 patients, 15mmHg. Comparison of postoperative recovery time, complications, serum cytokine levels was made among the three groups.ResultsThe number of postoperative 6h nasogastric tube pulled out, bowel recovery time, ifrst lfatus or a bowel movement, tolerance semi-liquid diet, postoperative duration of diarrhea, postoperative hospitalization time among the three groups show no statistically difference (P > 0.05). The difference of acute gastric injury (AGI), chyle leakage, anastomotic fistula, surgical bleeding, intestinal paralysis, vomiting incidence of postoperative among the three groups has no statistically differences (P > 0.05). While postoperative IL-6 level and MAP were signiifcantly increased compare with preoperative level, the difference was statistically signiifcant (P 0.05). Postoperative serum IL-6 levels in 25 patients with intestinal paralysis was (10.71 ± 4.37) ng/L, 107 cases had high serum IL-6 levels in patients did not occur intestinal paralysis was (10.66 ± 4.13) ng/L, the difference was not statistically significance (P > 0.05).Conclusion Intra-abdominal pressure increasing during minimally invasive surgical procedure has no signiifcant effect on the digestive system in colorectal cancer patients.