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Kelm M, Pistorius R, Germer CT, Reibetanz J. [Abdominal compartment syndrome in visceral surgery and intensive care medicine : Causes, prevention, detection, treatment]. CHIRURGIE (HEIDELBERG, GERMANY) 2024; 95:520-525. [PMID: 38639826 DOI: 10.1007/s00104-024-02079-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/18/2024] [Indexed: 04/20/2024]
Abstract
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.
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Affiliation(s)
- M Kelm
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Transplantations‑, Gefäß- und Kinderchirurgie, Zentrum Operative Medizin (ZOM), Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland
| | - R Pistorius
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Transplantations‑, Gefäß- und Kinderchirurgie, Zentrum Operative Medizin (ZOM), Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland
| | - C-T Germer
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Transplantations‑, Gefäß- und Kinderchirurgie, Zentrum Operative Medizin (ZOM), Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland
| | - J Reibetanz
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Transplantations‑, Gefäß- und Kinderchirurgie, Zentrum Operative Medizin (ZOM), Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland.
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Godo ZA, Peto K, Balog K, Deak A, Vanyolos E, Fazekas LA, Szentkereszty Z, Nemeth N. A Custom-Tailored Multichannel Pressure Monitoring System Designed for Experimental Surgical Model of Abdominal Compartment Syndrome. SENSORS (BASEL, SWITZERLAND) 2024; 24:524. [PMID: 38257617 PMCID: PMC10819495 DOI: 10.3390/s24020524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/11/2024] [Accepted: 01/13/2024] [Indexed: 01/24/2024]
Abstract
In experimental medicine, a wide variety of sensory measurements are used. One of these is real-time precision pressure measurement. For comparative studies of the complex pathophysiology and surgical management of abdominal compartment syndrome, a multichannel pressure measurement system is essential. An important aspect is that this multichannel pressure measurement system should be able to monitor the pressure conditions in different tissue layers, and compartments, under different settings. We created a 12-channel positive-negative sensor system for simultaneous detection of pressure conditions in the abdominal cavity, the intestines, and the circulatory system. The same pressure sensor was used with different measurement ranges. In this paper, we describe the device and major experiences, advantages, and disadvantages. The sensory systems are capable of real-time, variable frequency sampling and data collection. It is also important to note that the pressure measurement system should be able to measure pressure with high sensitivity, independently of the filling medium (gas, liquid). The multichannel pressure measurement system we developed was well suited for abdominal compartment syndrome experiments and provided data for optimizing the method of negative pressure wound management. The system is also suitable for direct blood pressure measurement, making it appropriate for use in additional experimental surgical models.
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Affiliation(s)
- Zoltan Attila Godo
- Department of Information Technology, Faculty of Informatics, University of Debrecen, Kassai Str. 26, H-4028 Debrecen, Hungary;
| | - Katalin Peto
- Department of Operative Techniques and Surgical Research, Faculty of Medicine, University of Debrecen, Moricz Zsigmond Str. 22, H-4032 Debrecen, Hungary; (A.D.); (E.V.); (L.A.F.); (N.N.)
| | - Klaudia Balog
- Department of Surgery, Faculty of Medicine, University of Debrecen, Moricz Zsigmond Str. 22, H-4032 Debrecen, Hungary; (K.B.); (Z.S.)
| | - Adam Deak
- Department of Operative Techniques and Surgical Research, Faculty of Medicine, University of Debrecen, Moricz Zsigmond Str. 22, H-4032 Debrecen, Hungary; (A.D.); (E.V.); (L.A.F.); (N.N.)
| | - Erzsebet Vanyolos
- Department of Operative Techniques and Surgical Research, Faculty of Medicine, University of Debrecen, Moricz Zsigmond Str. 22, H-4032 Debrecen, Hungary; (A.D.); (E.V.); (L.A.F.); (N.N.)
| | - Laszlo Adam Fazekas
- Department of Operative Techniques and Surgical Research, Faculty of Medicine, University of Debrecen, Moricz Zsigmond Str. 22, H-4032 Debrecen, Hungary; (A.D.); (E.V.); (L.A.F.); (N.N.)
| | - Zsolt Szentkereszty
- Department of Surgery, Faculty of Medicine, University of Debrecen, Moricz Zsigmond Str. 22, H-4032 Debrecen, Hungary; (K.B.); (Z.S.)
| | - Norbert Nemeth
- Department of Operative Techniques and Surgical Research, Faculty of Medicine, University of Debrecen, Moricz Zsigmond Str. 22, H-4032 Debrecen, Hungary; (A.D.); (E.V.); (L.A.F.); (N.N.)
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Sameera S, Mohammad T, Liao K, Shahid H, Sarkar A, Tyberg A, Kahaleh M. Management of Pancreatic Fluid Collections: An Evidence-based Approach. J Clin Gastroenterol 2023; 57:346-361. [PMID: 36040932 DOI: 10.1097/mcg.0000000000001750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Managing pancreatic fluid collections (PFCs) remains a challenge for many clinicians. Recently, significant progress has been made in the therapy of PFCs, including improvements in technology and devices, as well as in the development of minimally invasive endoscopic techniques, many of which are proven less traumatic when compared with surgical options and more efficacious when compared with percutaneous techniques. This review will explore latest developments in the management of PFCs and how they incorporate into the current treatment algorithm.
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Affiliation(s)
- Sohini Sameera
- Department of Gastroenterology & Hepatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
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VIEJO MARTÍNEZ E, YAGÜE RIGOPOULOU N, RUIZ DE LA HERMOSA GARCÍA PARDO A, DE FUENMAYOR VALERA ML, PASEIRO CRESPO G. Abdominal compartment syndrome. Chirurgia (Bucur) 2022. [DOI: 10.23736/s0394-9508.22.05399-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Zhou H, Zhang Z, Yang S, Gong X, Liu Y, Du G, Chen J. Logistic regression analysis of risk factors for intra-abdominal hypertension after giant ventral hernia repair: a retrospective cohort study. Hernia 2022; 27:305-309. [PMID: 36169738 DOI: 10.1007/s10029-022-02667-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/17/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Intra-abdominal hypertension (IAH) is a classical complication after giant ventral hernia surgery and may lead to abdominal compartment syndrome (ACS). Assessment of risk factors and prevention of IAH/ACS are essential for hernia surgeons. METHODS We performed a retrospective study including 58 giant ventral hernia patients in our center between Jan 1, 2017, and Mar 1, 2022, we recorded age, gender, chronic obstructive pulmonary disease (COPD), coronary heart disease (CHD), hypertension, type 2 diabetes mellitus (T2DM), hypoproteinemia, body mass index (BMI), the ratio of hernia sac volume to abdominal cavity volume (HSV/ACV), defect width, tension reduction procedure (TRP), positive fluid balance (PFB) and IAH of these patients and analyzed the data using univariate and multivariate logistic regression to screen the risk factors for IAH after surgery. RESULTS The multivariate analysis showed that HSV/ACV ≥ 25%, hypoproteinemia, and PFB were independent risk factors for the occurrence of IAH after giant ventral hernia repair (P = 0.025, 0.016, 0.017, respectively). We did not find any correlation between postoperative IAH and the patient's age, gender, COPD, CHD, hypertension, T2DM, BMI, defect width, TRP, and PFB. CONCLUSION Identifying risk factors is of great significance for the early identification and prevention of IAH/ACS. We found that HSV/ACV ≥ 25%, hypoproteinemia, and PFB were independent risk factors for IAH after giant ventral hernia repair.
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Affiliation(s)
- H Zhou
- The Third Clinical Medical School of Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Z Zhang
- The Third Clinical Medical School of Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - S Yang
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, No. 5 JingYuan Road, Shijingshan District, Beijing, 100043, China
| | - X Gong
- Department of Radiology, Beijing Chao-Yang Hospital, No. 5 JingYuan Road, Shijingshan District, Beijing, 100043, China
| | - Y Liu
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, No. 5 JingYuan Road, Shijingshan District, Beijing, 100043, China
| | - G Du
- Department of Radiology, Lin Yi Geriatric Hospital, Lanshan District, Linyi, 276003, China
| | - J Chen
- The Third Clinical Medical School of Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China.
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, No. 5 JingYuan Road, Shijingshan District, Beijing, 100043, China.
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Bright RA, Bright-Ponte SJ, Palmer LAM, Rankin SK, Blok SV. Use of Diagnosis Codes to Find Blood Transfusion Adverse Events in Electronic Health Records. J Patient Saf 2022; 18:e823-e866. [PMID: 35195113 DOI: 10.1097/pts.0000000000000946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Electronic health records (EHRs) and big data tools offer the opportunity for surveillance of adverse events (patient harm associated with medical care). We used International Classification of Diseases, Ninth Revision, codes in electronic records to identify known, and potentially novel, adverse reactions to blood transfusion. METHODS We used 49,331 adult admissions involving critical care at a major teaching hospital, 2001-2012, in the Medical Information Mart for Intensive Care III EHRs database. We formed a T (defined as packed red blood cells, platelets, or plasma) group of 21,443 admissions versus 25,468 comparison (C) admissions. The International Classification of Diseases, Ninth Revision, Clinical Modification , diagnosis codes were compared for T versus C, described, and tested with statistical tools. RESULTS Transfusion adverse events (TAEs) such as transfusion-associated circulatory overload (TACO; 12 T cases; rate ratio [RR], 15.61; 95% confidence interval [CI], 2.49-98) were found. There were also potential TAEs similar to TAEs, such as fluid overload disorder (361 T admissions; RR, 2.24; 95% CI, 1.88-2.65), similar to TACO. Some diagnoses could have been sequelae of TAEs, including nontraumatic compartment syndrome of abdomen (52 T cases; RR, 6.76; 95% CI, 3.40-14.9) possibly being a consequence of TACO. CONCLUSIONS Surveillance for diagnosis codes that could be TAE sequelae or unrecognized TAE might be useful supplements to existing medical product adverse event programs.
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Affiliation(s)
- Roselie A Bright
- From the Office of the Commissioner, Food and Drug Administration, Silver Spring
| | - Susan J Bright-Ponte
- Center for Veterinary Medicine, Food and Drug Administration, Rockville, Maryland
| | - Lee Anne M Palmer
- Center for Veterinary Medicine, Food and Drug Administration, Rockville, Maryland
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Chuang FJJ, Lim AEW, Cooper ML, Townend P, Parker DJ. An unusual case of abdominal compartment syndrome from a massive faecaloma. J Surg Case Rep 2022; 2022:rjac348. [PMID: 35949645 PMCID: PMC9359701 DOI: 10.1093/jscr/rjac348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 07/02/2022] [Indexed: 12/02/2022] Open
Abstract
Severe constipation is a frequent presentation but progression into a life-threatening acute compartment syndrome (ACS) is few and far between. This case highlights the typical physiological manifestations of ACS and the immediate benefits of correcting these physiological imbalances through the disimpaction of a massive faecaloma. Furthermore, in adult patients with a history of colonic dysmotility, adult Hirschsprung’s disease should be considered.
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Affiliation(s)
- Fred Jui-Ju Chuang
- General Surgical Department, Gold Coast University Hospital , 1 Hospital Blvd, Southport, QLD , Australia
| | - Aaron Er-Wynn Lim
- General Surgical Department, Gold Coast University Hospital , 1 Hospital Blvd, Southport, QLD , Australia
| | - Michelle Louise Cooper
- General Surgical Department, Gold Coast University Hospital , 1 Hospital Blvd, Southport, QLD , Australia
| | - Phillip Townend
- General Surgical Department, Gold Coast University Hospital , 1 Hospital Blvd, Southport, QLD , Australia
| | - David James Parker
- General Surgical Department, Gold Coast University Hospital , 1 Hospital Blvd, Southport, QLD , Australia
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Successful Endovascular Surgery for Iatrogenic Common Iliac Artery Injury during Lumbar Spine Surgery: A Case Report. Medicina (B Aires) 2022; 58:medicina58070927. [PMID: 35888646 PMCID: PMC9323261 DOI: 10.3390/medicina58070927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/24/2022] [Accepted: 07/09/2022] [Indexed: 11/17/2022] Open
Abstract
An 80-year-old man was admitted with an L5 compression fracture, L4/5 spondylolisthesis, and L5 radiculopathy and underwent a TLIF procedure. Refractory hypotension occurred, though it indicated a possible great vessel injury with vasopressor and fluid infusion. Emergent intraoperative angiography was performed, which showed extravasation at the right common iliac artery. Resuscitative endovascular balloon occlusion of the aorta followed by right common iliac artery stenting was successfully performed to arrest the bleeding. The iatrogenic right common iliac artery laceration was complicated with abdomen compartment syndrome and acute kidney injury. The patient received supportive care, including continuous venovenous hemofiltration (CVVH) for a week, after which the patient’s condition improved. The patient did not have any residual complications at the one-month follow-up. Great vessel injury during the TLIF procedure is rare but fatal. Refractory hypotension is indicative of a great vessel injury. Endovascular intervention is a fast and promising method to diagnose and treat arterial injury.
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Chryseobacterium Indologenes Sepsis and Acute Renal Failure Secondary to Abdominal Compartment Syndrome in a Confirmed COVID-19 Patient. Case Rep Crit Care 2022; 2022:7946158. [PMID: 35433055 PMCID: PMC9008491 DOI: 10.1155/2022/7946158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 04/04/2022] [Indexed: 11/17/2022] Open
Abstract
Sepsis due to nosocomial pathogens markedly increases morbidity and mortality in the critically ill patient. The SARS-CoV-2 (COVID-19) pandemic has increased the number of patients requiring intensive care unit (ICU) in-patient management. Chryseobacterium indologenes (C. indologenes) is a group of multiresistant gram-negative bacteria associated with in-hospital environment and catheter-associated infections of increasing importance in the ICU. SARS-CoV-2 severe infection in the critically ill patient increases the risk of abdominal compartment syndrome (ACS) and acute kidney injury (AKI). We hereby report a case of a patient with SARS-CoV-2 severe infection, C. indologenes sepsis, abdominal compartment syndrome, and secondary renal failure.
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Shiomura R, Tara S, Ito N, Watanabe M, Arai T, Kobayashi N, Wakita M, Fujimoto Y, Matsuda J, Nakata J, Yamamoto T, Shimizu W. Hemodynamic Collapse Caused by Cardiac Dysfunction and Abdominal Compartment Syndrome in a Patient with Mitochondrial Disease. Intern Med 2022; 61:489-493. [PMID: 34393167 PMCID: PMC8907761 DOI: 10.2169/internalmedicine.7729-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We herein report a case of mitochondrial disease with heart and intestinal tract involvement resulting in hemodynamic collapse. A 66-year-old woman was transferred to our hospital because of cardiogenic shock. Vasopressors were administered, and a circulatory support device was deployed. However, her hemodynamics did not improve sufficiently, and we detected abdominal compartment syndrome caused by the aggravation of chronic intestinal pseudo-obstruction as a complication. Insertion of a colorectal tube immediately decreased the intra-abdominal pressure, improving the hemodynamics. Finally, we diagnosed her with mitochondrial disease, concluding that the resulting combination of acute heart failure and abdominal compartment syndrome had aggravated the hemodynamics.
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Affiliation(s)
- Reiko Shiomura
- Division of Cardiovascular Intensive Care, Nippon Medical School, Japan
| | - Shuhei Tara
- Division of Cardiovascular Intensive Care, Nippon Medical School, Japan
| | - Nobuaki Ito
- Department of Cardiovascular Medicine, Nippon Medical School, Japan
| | - Makoto Watanabe
- Division of Cardiovascular Intensive Care, Nippon Medical School, Japan
| | - Toshiki Arai
- Division of Cardiovascular Intensive Care, Nippon Medical School, Japan
| | | | - Masaki Wakita
- Division of Cardiovascular Intensive Care, Nippon Medical School, Japan
| | - Yuhi Fujimoto
- Division of Cardiovascular Intensive Care, Nippon Medical School, Japan
| | - Junya Matsuda
- Division of Cardiovascular Intensive Care, Nippon Medical School, Japan
| | - Jun Nakata
- Division of Cardiovascular Intensive Care, Nippon Medical School, Japan
| | - Takeshi Yamamoto
- Division of Cardiovascular Intensive Care, Nippon Medical School, Japan
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Japan
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Kongkatong M, Patel M, Thom C, Moak J. Fatal Abdominal Compartment Syndrome Due to Constipation: A Case Report. Clin Pract Cases Emerg Med 2022; 6:8-12. [PMID: 35226838 PMCID: PMC8885236 DOI: 10.5811/cpcem.2021.7.53295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 07/26/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction Abdominal compartment syndrome (ACS) is a rare condition in which increased
intra-abdominal pressure causes multiorgan dysfunction through decreased
perfusion. Causes of this condition are variable, and early recognition is
critical for favorable patient outcomes. Measurement of bladder pressure is
recommended for diagnosis. Case Report A 64-year-old female on clozapine with a two-year history of chronic
constipation presented to the emergency department in extremis with a
protuberant abdomen. After resuscitative measures, computed tomography
showed a dilated, stool-filled colon with a decompressed inferior vena cava
and decreased perfusion. She died despite surgical decompression. Conclusion Severe constipation is a rare cause of ACS, and there is a lack of
evidence-based guidelines. Options for bedside decompression are limited. To
reduce morbidity and mortality in this population, early recognition of ACS
is imperative. Initial interventions should support hemodynamics and
respiration. Definitive management is surgical decompression.
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Affiliation(s)
- Matthew Kongkatong
- University of Virginia Medical Center, Department of Emergency Medicine, Charlottesville, Virginia
| | - Malav Patel
- University of Virginia Medical Center, Department of Emergency Medicine, Charlottesville, Virginia
| | - Christopher Thom
- University of Virginia Medical Center, Department of Emergency Medicine, Charlottesville, Virginia
| | - James Moak
- University of Virginia Medical Center, Department of Emergency Medicine, Charlottesville, Virginia
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Karpavičiūtė J, Skarupskienė I, Balčiuvienė V, Vaičiūnienė R, Žiginskienė E, Bumblytė IA. Assessment of Fluid Status by Bioimpedance Analysis and Central Venous Pressure Measurement and Their Association with the Outcomes of Severe Acute Kidney Injury. ACTA ACUST UNITED AC 2021; 57:medicina57060518. [PMID: 34067299 PMCID: PMC8224573 DOI: 10.3390/medicina57060518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 05/12/2021] [Accepted: 05/19/2021] [Indexed: 11/19/2022]
Abstract
Background and Objectives: Fluid disbalance is associated with adverse outcomes in critically ill patients with acute kidney injury (AKI). In this study, we intended to assess fluid status using bioimpedance analysis (BIA) and central venous pressure (CVP) measurement and to evaluate the association between hyperhydration and hypervolemia with the outcomes of severe AKI. Materials and Methods: A prospective study was conducted in the Hospital of the Lithuanian University of Health Sciences Kauno Klinikos. Forty-seven patients treated at the Intensive Care Unit (ICU) with severe AKI and a need for renal replacement therapy (RRT) were examined. The hydration level was evaluated according to the ratio of extracellular water to total body water (ECW/TBW) of bioimpedance analysis and volemia was measured according to CVP. All of the patients were tested before the first hemodialysis (HD) procedure. Hyperhydration was defined as ECW/TBW > 0.39 and hypervolemia as CVP > 12 cm H2O. Results: According to bioimpedance analysis, 72.3% (n = 34) of patients were hyperhydrated. According to CVP, only 51.1% (n = 24) of the patients were hypervolemic. Interestingly, 69.6% of hypovolemic/normovolemic patients were also hyperhydrated. Of all study patients, 57.4% (n = 27) died, in 29.8% (n = 14) the kidney function improved, and in 12.8% (n = 6) the demand for RRT remained after in-patient treatment. A tendency of higher mortality in hyperhydrated patients was observed, but no association between hypervolemia and outcomes of severe AKI was established. Conclusions: Three-fourths of the patients with severe AKI were hyperhydrated based on bioimpedance analysis. However, according to CVP, only half of these patients were hypervolemic. A tendency of higher mortality in hyperhydrated patients was observed.
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Affiliation(s)
- Justina Karpavičiūtė
- Department of Nephrology, Medical Academy, Lithuanian University of Health Sciences, Eivenių 2, LT-50161 Kaunas, Lithuania; (I.S.); (R.V.); (E.Ž.); (I.A.B.)
- Correspondence:
| | - Inga Skarupskienė
- Department of Nephrology, Medical Academy, Lithuanian University of Health Sciences, Eivenių 2, LT-50161 Kaunas, Lithuania; (I.S.); (R.V.); (E.Ž.); (I.A.B.)
- Hospital of Lithuanian University of Health Sciences, Eivenių 2, LT-50161 Kaunas, Lithuania;
| | - Vilma Balčiuvienė
- Hospital of Lithuanian University of Health Sciences, Eivenių 2, LT-50161 Kaunas, Lithuania;
| | - Rūta Vaičiūnienė
- Department of Nephrology, Medical Academy, Lithuanian University of Health Sciences, Eivenių 2, LT-50161 Kaunas, Lithuania; (I.S.); (R.V.); (E.Ž.); (I.A.B.)
- Hospital of Lithuanian University of Health Sciences, Eivenių 2, LT-50161 Kaunas, Lithuania;
| | - Edita Žiginskienė
- Department of Nephrology, Medical Academy, Lithuanian University of Health Sciences, Eivenių 2, LT-50161 Kaunas, Lithuania; (I.S.); (R.V.); (E.Ž.); (I.A.B.)
- Hospital of Lithuanian University of Health Sciences, Eivenių 2, LT-50161 Kaunas, Lithuania;
| | - Inga Arūnė Bumblytė
- Department of Nephrology, Medical Academy, Lithuanian University of Health Sciences, Eivenių 2, LT-50161 Kaunas, Lithuania; (I.S.); (R.V.); (E.Ž.); (I.A.B.)
- Hospital of Lithuanian University of Health Sciences, Eivenių 2, LT-50161 Kaunas, Lithuania;
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Leon M, Chavez L, Surani S. Abdominal compartment syndrome among surgical patients. World J Gastrointest Surg 2021; 13:330-339. [PMID: 33968300 PMCID: PMC8069070 DOI: 10.4240/wjgs.v13.i4.330] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/25/2021] [Accepted: 03/22/2021] [Indexed: 02/06/2023] Open
Abstract
Abdominal compartment syndrome (ACS) develops when organ failure arises secondary to an increase in intraabdominal pressure. The abdominal pressure is determined by multiple factors such as blood pressure, abdominal compliance, and other factors that exert a constant pressure within the abdominal cavity. Several conditions in the critically ill may increase abdominal pressure compromising organ perfusion that may lead to renal and respiratory dysfunction. Among surgical and trauma patients, aggressive fluid resuscitation is the most commonly reported risk factor to develop ACS. Other conditions that have also been identified as risk factors are ascites, hemoperitoneum, bowel distention, and large tumors. All patients with abdominal trauma possess a higher risk of developing intra-abdominal hypertension (IAH). Certain surgical interventions are reported to have a higher risk to develop IAH such as damage control surgery, abdominal aortic aneurysm repair, and liver transplantation among others. Close monitoring of organ function and intra-abdominal pressure (IAP) allows clinicians to diagnose ACS rapidly and intervene with target-specific management to reduce IAP. Surgical decompression followed by temporary abdominal closure should be considered in all patients with signs of organ dysfunction. There is still a great need for more studies to determine the adequate timing for interventions to improve patient outcomes.
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Affiliation(s)
- Monica Leon
- Department of Medicine, Centro Medico ABC, Ciudad de Mexico 01120, Mexico
| | - Luis Chavez
- Department of Medicine, University of Texas, El Paso, TX 79905, United States
| | - Salim Surani
- Department of Medicine, Texas A&M University, Corpus Christi, TX 78405, United States
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Evola G, Ferrara F, Scravaglieri M, Trusso Zirna E, Sarvà S, Piazza L. Idiopathic giant pancreatic pseudocyst presenting in emergency with abdominal compartment syndrome and intestinal occlusion: Case report and review of the literature. Int J Surg Case Rep 2021; 81:105812. [PMID: 33887838 PMCID: PMC8049989 DOI: 10.1016/j.ijscr.2021.105812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 03/20/2021] [Indexed: 11/08/2022] Open
Abstract
Idiopathic giant pancreatic pseudocyst (IGPP) is a rare pancreatic disease. Diagnosis of IGPP in emergency [[1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19]] is a challenge because of its rarity, the absence of history of pancreatitis and specific symptoms and signs. IGPP may cause intestinal obstruction, intra-abdominal hypertension and abdominal compartment syndrome requiring a decompressive laparotomy. Distal pancreaticosplenectomy may be the correct treatment of undiagnosed IGPP if there is suspicion or inability to exclude a malignant cystic pancreatic neoplasm.
Introduction and importance This is the first case of idiopathic giant pancreatic pseudocyst (IGPP) causing intestinal occlusion, intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) reported in the literature. Diagnosis of IGPP in emergency is a challenge because of its rarity and the absence of a history of pancreatitis or pancreatic trauma and specific clinical presentation. Abdominal contrast-enhanced computed tomography (CECT) represents the gold standard in diagnosing of pancreatic cyst (PP). Different types of treatment of PP are reported in the literature. Case presentation A 52-year-old Caucasian female was admitted to the Emergency Department with a three-day history of abdominal pain, inability to pass gas or stool, nausea and vomiting, oliguria and a seven-day history of abdominal swelling and swollen legs. Physical examination revealed abdominal distention, abdominal pain, swelling in the legs. CECT showed a voluminous cystic pancreatic mass suspected of neoplasm. Laboratory tests reported high serum levels of BUN, creatinine and C-reactive protein and neutrophilic leukocytosis. After preoperative diagnosis of ACS, the patient was taken to the operating room for pancreatic resection. The postoperative course was uneventful. Diagnosis of IGPP was made by histopathological examination. Clinical discussion IGPP is difficult to diagnose in emergency. Although different types of drainage of IGPP are described in the literature, pancreatic resection represents the treatment of choice when a cystic pancreatic neoplasm cannot be excluded. Conclusion IGPP is a rare disease that may cause intestinal occlusion, IAH and ACS. Pancreatic resection if necessary is safe and therapeutic with acceptable morbidity and mortality.
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Affiliation(s)
- Giuseppe Evola
- General and Emergency Surgery Department, Garibaldi Hospital, Piazza Santa Maria di Gesù 5, 95100, Catania, Italy.
| | - Francesco Ferrara
- General and Emergency Surgery Department, Garibaldi Hospital, Piazza Santa Maria di Gesù 5, 95100, Catania, Italy
| | - Mario Scravaglieri
- General and Emergency Surgery Department, Garibaldi Hospital, Piazza Santa Maria di Gesù 5, 95100, Catania, Italy
| | - Ezio Trusso Zirna
- General and Emergency Surgery Department, Garibaldi Hospital, Piazza Santa Maria di Gesù 5, 95100, Catania, Italy
| | - Salvatore Sarvà
- General and Emergency Surgery Department, Garibaldi Hospital, Piazza Santa Maria di Gesù 5, 95100, Catania, Italy
| | - Luigi Piazza
- General and Emergency Surgery Department, Garibaldi Hospital, Piazza Santa Maria di Gesù 5, 95100, Catania, Italy
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Patel A, Davis C, Davis T. Percutaneous catheter drainage of secondary abdominal compartment syndrome: A case report. Radiol Case Rep 2021; 16:670-672. [PMID: 33488896 PMCID: PMC7809214 DOI: 10.1016/j.radcr.2021.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 12/30/2020] [Accepted: 01/02/2021] [Indexed: 11/06/2022] Open
Abstract
Abdominal compartment syndrome can be a lethal entity when not treated in a timely fashion. Current standard of care involves emergent decompressive laparotomy by the surgical team. In this case, a 52-year-old male who developed abdominal compartment syndrome secondary to hemoperitoneum underwent emergent drain placement as decompressive laparotomy was not an optimal option for management. Little literature exists on the utility of drain placement or paracentesis for decompression in overall patient morbidity and mortality. However, when necessary, drain placement shows similar outcomes when compared to the standard of care. Interventional radiologists are uniquely positioned to provide drainage guided management for abdominal compartment syndrome in emergent settings.
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Montalvo-Jave E, Espejel-Deloiza M, Chernitzky-Camaño J, Peña-Pérez C, Rivero-Sigarroa E, Ortega-León L. Abdominal compartment syndrome: Current concepts and management. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2020. [DOI: 10.1016/j.rgmxen.2020.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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17
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Samartsev VA, Gavrilov VA, Pushkarev BS. INTRAABDOMINAL HYPERTENSION SYNDROME: CURRENT STATE OF THE PROBLEM. SURGICAL PRACTICE 2020. [DOI: 10.38181/2223-2427-2020-2-35-42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Syndrome of intra-abdominal hypertension (SIAH) is a dangerous complication that can occur in patients with a surgical profile after surgery in the abdominal cavity. Only in the past 25 years has the SIAH been recognized. According to W. Ertel et al., In one third of patients with peritonitis, pancreatic necrosis, injuries of the abdominal cavity and after extensive surgery, there is an increase in intra-abdominal pressure (IAP), while SIAH develops in 5.5% of such patients. Mortality in SIAH is 42–68%. The reason for the development of so many deaths is the presence of diagnostic, preventive and therapeutic measures, as well as differences in the interpretation of terms. Today, much attention is paid to the study of SIAH, official attempts are being made to standardize and define terms and recommended methods of treatment, but this problem needs further study. The review presents data on the current state of the problem, current trends in the diagnosis, prevention and treatment of patients with IAP and SIAH, their use in practical research.
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Montalvo-Jave EE, Espejel-Deloiza M, Chernitzky-Camaño J, Peña-Pérez CA, Rivero-Sigarroa E, Ortega-León LH. Abdominal compartment syndrome: Current concepts and management. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2020; 85:443-451. [PMID: 32847726 DOI: 10.1016/j.rgmx.2020.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 02/05/2020] [Accepted: 03/06/2020] [Indexed: 11/24/2022]
Abstract
Abdominal compartment syndrome occurs when 2 or more anatomic compartments have a sustained intra-abdominal pressure >20mmHg, associated with organ failure. Incidence is 2% and prevalence varies from 0% to 36.4%. A literature search was conducted utilizing different databases. Articles published from 1970 to 2018 were included, in English or Spanish, to provide the concepts, classifications, and comprehensive management in the approach to abdominal compartment syndrome, for its treatment and the prevention of severe complications associated with the entity. Intravesical pressure measurement is the standard diagnostic method. Treatment is based on evacuation of the intraluminal content, identification and treatment of intra-abdominal lesions, improvement of abdominal wall compliance, and optimum administration of fluids and tissue perfusion. Laparotomy is generally followed by temporary abdominal wall closure 5 to 7 days after surgery. Reconstruction is performed 6 to 12 months after the last operation. Abdominal compartment syndrome should be diagnosed and operated on before organic damage from the illness occurs. Kidney injury can frequently progress and is a parameter for considering abdominal decompression. Having a biomarker for early damage would be ideal. Surgical treatment is successful in the majority of cases. A multidisciplinary focus is necessary for the intensive care and reconstructive needs of the patient. Thus, efforts must be made to define and implement strategies for patient quality of life optimization.
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Affiliation(s)
- E E Montalvo-Jave
- Departamento de Cirugía, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México; Clínica de Cirugía Hepato-Pancreato-Biliar, Hospital General de México «Dr. Eduardo Liceaga», Ciudad de México, México; Clínica de Gastroenterología, Hospital Médica Sur, Ciudad de México, México.
| | - M Espejel-Deloiza
- Clínica de Cirugía Hepato-Pancreato-Biliar, Hospital General de México «Dr. Eduardo Liceaga», Ciudad de México, México
| | - J Chernitzky-Camaño
- Departamento de Cirugía, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - C A Peña-Pérez
- Unidad de Terapia Intensiva, Hospital Médica Sur, Ciudad de México, México
| | - E Rivero-Sigarroa
- Departamento de Terapia Intensiva, Instituto Nacional de Ciencias Médicas y Nutrición «Salvador Zubirán», Ciudad de México, México
| | - L H Ortega-León
- Clínica de Cirugía Hepato-Pancreato-Biliar, Hospital General de México «Dr. Eduardo Liceaga», Ciudad de México, México
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Gardecki J, Parikh N, Baird JF. Massive pneumoperitoneum causing abdominal compartment syndrome. Am J Emerg Med 2020; 38:1700.e5-1700.e6. [DOI: 10.1016/j.ajem.2020.04.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 04/06/2020] [Accepted: 04/20/2020] [Indexed: 02/07/2023] Open
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Successful management of a rare and fatal complication of cardiac catheterization: Abdominal compartment syndrome. Anatol J Cardiol 2020; 23:187-188. [PMID: 32120370 PMCID: PMC7222635 DOI: 10.14744/anatoljcardiol.2019.96049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Current Approach to the Evaluation and Management of Abdominal Compartment Syndrome in Pediatric Patients. Pediatr Emerg Care 2019; 35:874-878. [PMID: 31800499 DOI: 10.1097/pec.0000000000001992] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Abdominal compartment syndrome is an emergent condition caused by increased pressure within the abdominal compartment. It can be caused by a number of etiologies, which are associated with decreased abdominal wall compliance, increased intraluminal or intraperitoneal contents, or edema from capillary leak or fluid resuscitation. The history and physical examination are of limited utility, and the criterion standard for diagnosis is intra-abdominal pressure measurement, which is typically performed via an intravesical catheter. Management includes increasing abdominal wall compliance, evacuating gastrointestinal or intraperitoneal contents, avoiding excessive fluid resuscitation, and decompressive laparotomy in select cases.
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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.
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