1
|
Wiegandt P, Jack T, von Gise A, Seidemann K, Boehne M, Koeditz H, Beerbaum P, Sasse M, Kaussen T. Awareness and diagnosis for intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) in neonatal (NICU) and pediatric intensive care units (PICU) - a follow-up multicenter survey. BMC Pediatr 2023; 23:82. [PMID: 36800953 PMCID: PMC9936744 DOI: 10.1186/s12887-023-03881-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 02/02/2023] [Indexed: 02/19/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Paul Wiegandt
- grid.10423.340000 0000 9529 9877Department of Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Carl-Neuberg-Street 1, 30625 Hannover, Germany
| | - Thomas Jack
- grid.10423.340000 0000 9529 9877Department of Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Carl-Neuberg-Street 1, 30625 Hannover, Germany
| | - Alexander von Gise
- grid.10423.340000 0000 9529 9877Department of Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Carl-Neuberg-Street 1, 30625 Hannover, Germany
| | - Kathrin Seidemann
- grid.10423.340000 0000 9529 9877Department of Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Carl-Neuberg-Street 1, 30625 Hannover, Germany
| | - Martin Boehne
- grid.10423.340000 0000 9529 9877Department of Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Carl-Neuberg-Street 1, 30625 Hannover, Germany
| | - Harald Koeditz
- grid.10423.340000 0000 9529 9877Department of Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Carl-Neuberg-Street 1, 30625 Hannover, Germany
| | - Philipp Beerbaum
- grid.10423.340000 0000 9529 9877Department of Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Carl-Neuberg-Street 1, 30625 Hannover, Germany
| | - Michael Sasse
- grid.10423.340000 0000 9529 9877Department of Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Carl-Neuberg-Street 1, 30625 Hannover, Germany
| | - Torsten Kaussen
- Department of Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Carl-Neuberg-Street 1, 30625, Hannover, Germany.
| |
Collapse
|
2
|
Qutob R, Alkhannani AHA, Alassaf TY, Alhokail SO, Bagazi GA, Alsaleh AA, alqarni MK, Alammari Y, Al Harbi K, Elhazmi A, Bukhari AI, Alaryni A, Alghamdi A, Hakami OA. Physicians' Knowledge of Abdominal Compartment Syndrome and Intra-Abdominal Hypertension in Saudi Arabia: An Online Cross-Sectional Survey Study. Int J Gen Med 2022; 15:8509-8526. [PMID: 36514743 PMCID: PMC9741814 DOI: 10.2147/ijgm.s393300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 11/18/2022] [Indexed: 12/12/2022] Open
Abstract
Objective To determine physicians' knowledge of abdominal compartment syndrome and intra-abdominal hypertension in Saudi Arabia. Methods A cross-sectional online survey study was conducted on physicians in Saudi Arabia between March and August 2022. A previously developed questionnaire was adapted and used in this study. The survey instrument investigated the knowledge and management of intra-abdominal hypertension and abdominal compartment syndrome among physicians. Logistic regression was used to identify predictors of being knowledgeable about abdominal compartment syndrome and intra-abdominal hypertension. Results A total of 266 physicians participated in this study. Around one-fifth (21.8%) the study participants were ICU physicians and 25.0% reported that they practice internal medicine. Intra-abdominal hypertension (IAH) and the impact of increased intra-abdominal pressure (IAP) on organ function were terms that the majority of research participants (70.3%) reported they were familiar with. A similar percentage (73.7%) reported that they are familiar with abdominal compartment syndrome (ACS). Around 43.0% of the study participants reported that they do not know how to measure IAP. The most frequently reported (13.5%) intervention in the treatment of IAH and ACS was the use of inotropes or vasopressors. The study participants showed a weak level of knowledge of ACS and IAH with a median score of 3.00 (IQR: 5.00-2.00), which represents 27.3% of the maximum attainable score. Physicians working at hospitals with 20-50 ICU beds were 41.0% (odds ratio: 0.59 (CI: 0.37-0.96)) less likely to be knowledgeable about intra-abdominal hypertension and abdominal compartment syndrome (p≤0.05). Conclusion Physicians demonstrated a low level of IAP and ACS knowledge. To increase the safety of medical practices and enhance clinical outcomes for patients, awareness should be raised about the proper diagnosis and management of IAP and ACS. Future research should focus on developing effective educational strategies to improve physicians' understanding of IAP and ACS.
Collapse
Affiliation(s)
- Rayan Qutob
- Faculty of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia,Adult Critical Care Department, Dr. Sulaiman Al-Habib Medical Group, Riyadh, Saudi Arabia
| | - Alanoud Hassan A Alkhannani
- Faculty of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia,Correspondence: Alanoud Hassan A Alkhannani, Faculty of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia, Tel +966 545436837, Email
| | - Turki Yazeed Alassaf
- Faculty of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Saad Othman Alhokail
- Faculty of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | | | | | - Mashael kamel alqarni
- Faculty of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Yousef Alammari
- Faculty of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Khalid Al Harbi
- Faculty of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Alyaa Elhazmi
- College of Medicine, AlFaisal University, Riyadh, Saudi Arabia
| | | | - Abdullah Alaryni
- Faculty of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Abdullah Alghamdi
- Faculty of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Osamah A Hakami
- Faculty of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| |
Collapse
|
3
|
Intra-abdominal hypertension and abdominal compartment syndrome. Curr Probl Surg 2021; 58:100971. [PMID: 34836571 DOI: 10.1016/j.cpsurg.2021.100971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 02/10/2021] [Indexed: 11/21/2022]
|
4
|
Superior primary fascial closure rate and lower mortality after open abdomen using negative pressure wound therapy with continuous fascial traction. J Trauma Acute Care Surg 2021; 89:1136-1142. [PMID: 32701909 DOI: 10.1097/ta.0000000000002889] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Open abdomen (OA) is a useful option for treatment strategy in many acute abdominal catastrophes. A number of temporary abdominal closure (TAC) methods are used with limited number of comparative studies. The present study was done to examine risk factors for failed delayed primary fascial closure (DPFC) and risk factors for mortality in patients treated with OA. METHODS This study was a multicenter retrospective analysis of the hospital records of all consecutive patients treated with OA during the years 2009 to 2016 at five tertiary referral hospitals and three secondary referral centers in Finland. RESULTS Six hundred seventy-six patients treated with OA were included in the study. Vacuum-assisted closure with continuous mesh-mediated fascial traction (VACM) was the most popular TAC method used (N = 398, 59%) followed by VAC (N = 128, 19%), Bogota bag (N = 128, 19%), and self-designed methods (N = 22, 3%). In multivariate analysis, enteroatmospheric fistula and the number of needed TAC changes increased the risk for failed DPFC (odds ratio [OR], 8.9; 95% confidence interval [CI], 6.2-12.8; p < 0.001 and OR, 1.1; 95% CI, 1.0-1.3; p < 0.001, respectively). Instead, VACM and ruptured abdominal aortic aneurysm as cause for OA both decreased the risk for failed DPFC (OR, 0.1; 95% CI, 0.0-0.3; p < 0.001 and OR, 0.2; 95% CI, 0.1-0.7; p = 0.012). The overall mortality rate was 30%. In multivariate analysis for mortality, multiorgan dysfunction (OR, 2.4; 95% CI, 1.6-3.6; p < 0.001), and increasing age (OR, 4.5; 95% CI, 2.0-9.7; p < 0.001) predicted increased mortality. Institutional large annual patient volume (OR, 0.4; 95% CI, 0.3-0.6; p < 0.001) and ileus and postoperative peritonitis in comparison to severe acute pancreatitis associated with decreased mortality (OR, 0.2; 95% CI, 0.1-0.4; p < 0.001; OR, 0.5; 95% CI, 0.3-0.8; p = 0.009). Kaplan-Meier analysis showed increased survival in patients treated with VACM in comparison with other TAC methods (LogRank p = 0.019). CONCLUSION We report superior role for VACM methodology in terms of successful primary fascial closure and increased survival in patients with OA. LEVEL OF EVIDENCE Therapeutic/care management, level IV.
Collapse
|
5
|
Caldas BS, Ascenção AMDS. PROTOCOLS FOR DIAGNOSIS AND MANAGEMENT OF INTRA-ABDOMINAL HYPERTENSION IN INTENSIVE CARE UNITS. ACTA ACUST UNITED AC 2020; 47:e20202378. [PMID: 32294690 DOI: 10.1590/0100-6991e-20202415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 12/27/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Intra-abdominal hypertension (IAH) is a common morbid condition in critically ill patients. Abdominal compartment syndrome (ACS) is a severe condition that requires surgical treatment, and it is an evolution of undiagnosed and untreated IAH. This study aims to highlight the importance of clinical evidence, and proposes screening as well as medical protocols for IAH and ACS, in intensive care units. METHODS Database searches were performed and the recommended World Society of the Abdominal Compartment Syndrome standards and protocols were used. RESULTS Protocols for IAH and ACS investigation, measurements, management and control, tailored for the Brazilian ICU reality, were indicated. CONCLUSION We extensively detailed IAH medical evidence, using the most up-to-date literature about IAH care and how to measure intra-abdominal pressure (IAP), which can be easily reproduced in any intensive care unit.
Collapse
Affiliation(s)
- Bruno Souza Caldas
- Universidade Federal do Estado do Rio de Janeiro, Hospital Universitário Gaffrée e Guinle, DECIGE - Rio de janeiro - RJ - Brasil
| | | |
Collapse
|
6
|
Khot Z, Murphy PB, Sela N, Parry NG, Vogt K, Ball IM. Incidence of Intra-Abdominal Hypertension and Abdominal Compartment Syndrome: A Systematic Review. J Intensive Care Med 2019; 36:197-202. [PMID: 31808368 DOI: 10.1177/0885066619892225] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To determine the contemporary prevalence of intra-abdominal hypertension (IAH) and abdominal compartment syndrome in critically ill patients. DATA SOURCES Medline, Embase, and Central databases. STUDY SELECTION Studies reporting on the prevalence of IAH in consecutively admitted critically ill patients using the World Society of Abdominal Compartment Syndrome (WSACS) consensus guidelines for intra-abdominal pressure (IAP) measurement. DATA EXTRACTION Duplicate independent review and data abstraction. DATA SYNTHESIS The search identified 2428 titles with 6 eligible studies (n = 1965). Reported prevalence ranged from 30% to 49%. Despite abiding by the WSACS guidelines for IAP measurement, studies varied in their definition of IAH, frequency and duration of IAP measurement, and reporting of outcomes. Three of 6 studies reported that IAH, especially at higher grades, was an independent predictor of mortality. CONCLUSIONS Intra-abdominal hypertension is a common finding in critically ill patients and may be associated with increased mortality, especially at higher grades. Further prospective research is required to examine the effect of screening and treatment of IAH on patient outcomes.
Collapse
Affiliation(s)
- Zaid Khot
- Division of General Surgery, Department of Surgery, 70384Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Patrick B Murphy
- Division of General Surgery, Department of Surgery, 70384Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Division of Acute Care Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Nathalie Sela
- Division of General Surgery, Department of Surgery, 70384Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Division of Transplantation Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA
| | - Neil G Parry
- Division of General Surgery, Department of Surgery, 70384Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Division of Critical Care, Department of Medicine, 215470Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Trauma Program, London Health Sciences Centre, London, Ontario, Canada
| | - Kelly Vogt
- Division of General Surgery, Department of Surgery, 70384Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Trauma Program, London Health Sciences Centre, London, Ontario, Canada
| | - Ian M Ball
- Division of Critical Care, Department of Medicine, 215470Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Trauma Program, London Health Sciences Centre, London, Ontario, Canada
| |
Collapse
|
7
|
Evaluation and Management of Abdominal Compartment Syndrome in the Emergency Department. J Emerg Med 2019; 58:43-53. [PMID: 31753758 DOI: 10.1016/j.jemermed.2019.09.046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 09/25/2019] [Accepted: 09/28/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Abdominal compartment syndrome is a potentially deadly condition that can be missed in the emergency department setting. OBJECTIVE The purpose of this narrative review article is to provide a summary of the background, pathophysiology, diagnosis, and management of abdominal compartment syndrome with a focus on emergency clinicians. DISCUSSION Abdominal compartment syndrome is caused by excessive pressure within the abdominal compartment due to diminished abdominal wall compliance, increased intraluminal contents, increased abdominal contents, or capillary leak/fluid resuscitation. History and physical examination are insufficient in isolation, and the gold standard is intra-abdominal pressure measurement. Abdominal compartment syndrome is defined as an intra-abdominal pressure >20 mm Hg with evidence of end-organ injury. Management involves increasing abdominal wall compliance (e.g., analgesia, sedation, and neuromuscular blocking agents), evacuating gastrointestinal contents (e.g., nasogastric tubes, rectal tubes, and prokinetic agents), avoiding excessive fluid resuscitation, draining intraperitoneal contents (e.g., percutaneous drain), and decompressive laparotomy in select cases. Patients are critically ill and often require admission to a critical care unit. CONCLUSIONS Abdominal compartment syndrome is an increasingly recognized condition with the potential for significant morbidity and mortality. It is important for clinicians to be aware of the current evidence regarding the diagnosis, management, and disposition of these patients.
Collapse
|
8
|
STOJANOVIC M, SVORCAN P, KARAMARKOVIC A, LADJEVIC N, JANKOVIC R, STEVANOVIC P. Mortality predictors of patients suffering of acute pancreatitis and development of intraabdominal hypertension. Turk J Med Sci 2019; 49:506-513. [PMID: 30997789 PMCID: PMC7018200 DOI: 10.3906/sag-1809-15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background/aim Intraabdominal hypertension (IAH) occurs frequently in patients with acute pancreatitis and adds to their morbidity and mortality. The main aim of the study was to identify the determination of the predictive factors connected to IAH that influence the evolution of acute pancreatitis. Materials and methods The prospective cohort study was conducted on 100 patients who had acute pancreatitis. According to obtained intraabdominal pressure (IAP) values, the patients were divided into two groups: one group (n = 40) with normal IAP values and the other (IAH group, n = 60) with increased IAP values. Deceased patients were specially analyzed within the IAH group in order to determine mortality predictors. Results Statistical significance of IAP (P = 0.048), lactates (P = 0.048), peak pressure (P = 0.043), abdominal perfusion pressure (P = 0.05), and mean arterial pressure (P = 0.041) was greater for deceased than for surviving patients in the IAH group. High mortality appears for patients younger than 65 years old, with lactate level higher than 3.22 mmol/L and filtration gradient (GF) lower than 67 mmHg. Conclusion Age, lactates, GF, and APACHE II score are determined as mortality predictors for patients suffering from acute pancreatitis who developed IAH. The mortality rate is higher when the level of GF is decreasing and the level of lactate increasing.
Collapse
Affiliation(s)
- Maja STOJANOVIC
- Department of Anesthesiology and Intensive Care, “Zvezdara” University Medical Center, BelgradeSerbia
- * To whom correspondence should be addressed. E-mail:
| | - Petar SVORCAN
- Faculty of Medicine, University of Belgrade, BelgradeSerbia
- Department of Gastroenterology and Hepatology, “Zvezdara” University Medical Center, BelgradeSerbia
| | - Aleksandar KARAMARKOVIC
- Faculty of Medicine, University of Belgrade, BelgradeSerbia
- Department of Surgery, “Zvezdara” University Medical Center, BelgradeSerbia
| | - Nebojsa LADJEVIC
- Faculty of Medicine, University of Belgrade, BelgradeSerbia
- Department of Anesthesiology and Intensive Care, Clinical Center of Serbia, BelgradeSerbia
| | - Radmilo JANKOVIC
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, University of Niš, NišSerbia
| | - Predrag STEVANOVIC
- Faculty of Medicine, University of Belgrade, BelgradeSerbia
- Department of Anesthesiology and Intensive Care, Clinical Center of “Dr Dragiša Mišović”, BelgradeSerbia
| |
Collapse
|
9
|
Bouveresse S, Piton G, Badet N, Besch G, Pili-Floury S, Delabrousse E. Abdominal compartment syndrome and intra-abdominal hypertension in critically ill patients: diagnostic value of computed tomography. Eur Radiol 2019; 29:3839-3846. [PMID: 30737569 DOI: 10.1007/s00330-018-5994-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 12/05/2018] [Accepted: 12/28/2018] [Indexed: 12/11/2022]
Abstract
AIMS The aims of the present work were to reevaluate, prospectively, the diagnostic value of already-described computed tomography (CT) landmarks of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) and to study the diagnostic value of some undescribed CT signs for the diagnosis of IAH and ACS. MATERIALS AND METHODS Consecutive patients admitted to the intensive care unit (ICU) in shock for whom an abdominal CT was clinically indicated were included. CT examinations were reviewed and scored by two reviewers for the 12 proposed CT features of IAH and ACS. Intravesical pressure (IVP) was measured for each patient. Imaging features and clinical data of patients with IAH (IVP ≥ 12 mmHg) were compared to those of patients with normal intra-abdominal pressure (IVP < 12 mmHg). RESULTS Forty-one patients were included. Twenty-one patients (51%) presented IAH with an IVP value ≥ 12 mmHg. Four patients (10%) were considered to have ACS (10%). Only an increased peritoneal-to-abdominal height ratio (PAR) was associated with the presence of IAH (PAR = 0.45 [0.40-0.49] in patients with IVP < 12 mmHg and PAR = 0.52 [0.48-0.53] in patients with IVP ≥ 12 mmHg; p < 0.001). Increased PAR ≥ 0.52 had a specificity of 85% for IAH diagnosis. CONCLUSION The present study suggests that a PAR ≥ 0.52 could help radiologists to identify IAH on abdominal CT scan and could lead to adequate identification and/or treatment, even at early stages of IAH. KEY POINTS • CT is an efficient first-intention procedure to evaluate and follow up underlying conditions in critically ill patients at risk of IAH and ACS overcome. • Raising the possibility of an IAH on a CT examination is relevant information for the clinician. • The only factors associated with intra-abdominal hypertension were the peritoneal-to-abdominal height ratio (PAR) and the ratio of maximal anteroposterior to transverse abdominal diameter (which define the round belly sign when > 0.8).
Collapse
Affiliation(s)
- S Bouveresse
- Department of Radiology, University Hospital, 3 Boulevard Fleming, 25030, Besançon, France
| | - G Piton
- Department of Medical Intensive Care, University Hospital, 3 Boulevard Fleming, 25030, Besançon, France
| | - N Badet
- Department of Radiology, University Hospital, 3 Boulevard Fleming, 25030, Besançon, France
| | - G Besch
- Department of Surgical Intensive Care, University Hospital, 3 Boulevard Fleming, 25030, Besançon, France
| | - S Pili-Floury
- Department of Surgical Intensive Care, University Hospital, 3 Boulevard Fleming, 25030, Besançon, France
| | - E Delabrousse
- Department of Radiology, University Hospital, 3 Boulevard Fleming, 25030, Besançon, France.
- EA 4662 Nanomedicine Lab, Imagery and Therapeutics, University of Franche-Comté, Besançon, France.
- Service de Radiologie Viscérale, CHRU Besançon, Hôpital Jean Minjoz, 3 Boulevard Fleming, 25030, Besançon, France.
| |
Collapse
|
10
|
Kim JH, Kim JY, Park S. Successful case of veno-venous extracorporeal membrane oxygenation in an abdominal trauma patient - A case report -. Anesth Pain Med (Seoul) 2019. [DOI: 10.17085/apm.2019.14.1.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Jun Hyun Kim
- Department of Anesthesiology and Pain Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Ji Yeon Kim
- Department of Anesthesiology and Pain Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Sunghyeok Park
- Department of Anesthesiology and Pain Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| |
Collapse
|
11
|
Effect of abdominal negative-pressure wound therapy on the measurement of intra-abdominal pressure. J Surg Res 2018; 227:112-118. [PMID: 29804842 DOI: 10.1016/j.jss.2018.02.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 01/14/2018] [Accepted: 02/14/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND In critically ill surgical patients undergoing abdominal negative-pressure wound therapy (NPWT), it remains uncertain whether or not intra-abdominal pressure (IAP) measurements should be obtained when NPWT is activated. We aimed to determine agreement between IAP measured with and without NPWT. METHODS In this analytic cross-sectional study, critically ill surgical adults (≥18 y) requiring abdominal NPWT for temporary abdominal closure after a damage control laparotomy were selected. Patients with urinary tract injuries or with pelvic packing were excluded. Paired IAP measures were performed in the same patient, with and without NPWT; two different operators performed the measures unaware of the other's result. Bland-Altman methods assessed the agreement between the two measures. Subgroup analyses (trauma and nontrauma) were performed. RESULTS There were 198 IAP measures (99 pairs) in 38 patients. Mean IAP with and without NPWT were 8.33 (standard deviation 4.01) and 8.65 (standard deviation 4.04), respectively. Mean IAP difference was -0.323 (95% confidence interval -0.748 to 0.101), and reference range for difference was -4.579 to 3.932 (P = 0.864). From 112 IAP measures (56 pairs) in 21 trauma patients, mean IAP difference was -0.268 (95% confidence interval -0.867 to 0.331), and reference range for the difference was -4.740 to 4.204 (P = 0.427). CONCLUSIONS There was no statistically significant disagreement in IAP measures. IAP could be measured with or without NPWT. In critically ill surgical patients with abdominal NPWT for temporary abdominal closure, monitoring and management of IAP either with or without NPWT is recommended.
Collapse
|