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Xu M, Zhang W, Sheng L, Hu M, Xu X. Biomimetic urine flow control can preserve bladder function in patients with indwelling catheterization. Medicine (Baltimore) 2023; 102:e36444. [PMID: 38050238 PMCID: PMC10695515 DOI: 10.1097/md.0000000000036444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 11/13/2023] [Indexed: 12/06/2023] Open
Abstract
For patients with long-term indwelling catheterization, bladder function will be affected. It is necessary to explore whether biomimetic urine flow control (BUFC) can improve bladder function in patients undergoing indwelling catheterization. A retrospective, data-only, cohort study was carried out. The patients admitted to the intensive care unit, who had retained catheter and been continuously using a urodynamic monitoring system for over 30 days were selected. They were divided into 2 groups based on whether they were using BUFC function. The urodynamic monitoring data of the 2 groups were compared and analyzed. A total of 30 patients were included in the final analysis, including 15 in the BUFC group and 15 in the unobstructed group. The Urinary Volume and maximal urinary flow rate of the unobstructed group showed a continuous downward trend, while the BUFC group remained stable, and there was a statistical difference (P < .05) between the 2 groups since day 20. The bladder ultrasound imaging showed that the bladder volume of the BUFC group did not decrease significantly on the 30th day. BUFC technology, which provided by a urodynamic monitoring system, has potential protective effects of the bladder function after indwelling catheterization.
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Affiliation(s)
- Minrong Xu
- Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Wei Zhang
- Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Lingxiang Sheng
- Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Mahong Hu
- Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Xiujuan Xu
- Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, China
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Preliminary study of reliability of transcutaneous sensors in measuring intraabdominal pressure. Sci Rep 2022; 12:8268. [PMID: 35585106 PMCID: PMC9117299 DOI: 10.1038/s41598-022-12388-x] [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: 01/31/2021] [Accepted: 04/25/2022] [Indexed: 11/11/2022] Open
Abstract
Early recognition of elevated intraabdominal pressure (IAP) in critically ill patients is essential, since it can result in abdominal compartment syndrome, which is a life-threatening condition. The measurement of intravesical pressure is currently considered the gold standard for IAP assessment. Alternative methods have been proposed, where IAP assessment is based on measuring abdominal wall tension, which reflects the pressure in the abdominal cavity. The aim of this study was to evaluate the feasibility of using patch-like transcutaneous sensors to estimate changes in IAP, which could facilitate the monitoring of IAP in clinical practice. This study was performed with 30 patients during early postoperative care. All patients still had an indwelling urinary catheter postoperatively. Four wearable sensors were attached to the outer surface of the abdominal region to detect the changes in abdominal wall tension. Additionally, surface EMG was used to monitor the activity of the abdominal muscles. The thickness of the subcutaneous tissue was measured with ultrasound. Patients performed 4 cycles of the Valsalva manoeuvre, with a resting period in between (the minimal resting period was 30 s, with a prolongation as necessary to ensure that the fluid level in the measuring system had equilibrated). The IAP was estimated with intravesical pressure measurements during all resting periods and all Valsalva manoeuvres, while the sensors continuously measured changes in abdominal wall tension. The association between the subcutaneous thickness and tension changes on the surface and the intraabdominal pressure was statistically significant, but a large part of the variability was explained by individual patient factors. As a consequence, the predictions of IAP using transcutaneous sensors were not biased, but they were quite variable. The specificity of detecting intraabdominal pressure of 20 mmHg and above is 88%, with an NPV of 96%, while its sensitivity and PPV are currently far lower. There are inherent limitations of the chosen preliminary study design that directly caused the low sensitivity of our method as well as the poor agreement with the gold standard method; in spite of that, we have shown that these sensors have the potential to be used to monitor intraabdominal pressure. We are planning a study that would more closely resemble the intended clinical use and expect it to show more consistent results with a far smaller error.
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Molitoris BA. Low-Flow Acute Kidney Injury: The Pathophysiology of Prerenal Azotemia, Abdominal Compartment Syndrome, and Obstructive Uropathy. Clin J Am Soc Nephrol 2022; 17:1039-1049. [PMID: 35584927 PMCID: PMC9269622 DOI: 10.2215/cjn.15341121] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
AKI is a syndrome, not a disease. It results from many different primary and/or secondary etiologies and is often multifactorial, especially in the hospitalized patient. This review discusses the pathophysiology of three etiologies that cause AKI, those being kidney hypoperfusion, abdominal compartment syndrome, and urinary tract obstruction. The pathophysiology of these three causes of AKI differs but is overlapping. They all lead to a low urine flow rate and low urine sodium initially. In all three cases, with early recognition and correction of the underlying process, the resulting functional AKI can be rapidly reversed. However, with continued duration and/or increased severity, cell injury occurs within the kidney, resulting in structural AKI and a longer and more severe disease state with increased morbidity and mortality. This is why early recognition and reversal are critical.
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Affiliation(s)
- Bruce A Molitoris
- Division of Nephrology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, and Department of Anatomy, Cell Biology and Integrative Physiology, Indiana University School of Medicine, Indianapolis, Indiana
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Factors associated with increased intra-abdominal pressure in patients undergoing cardiac surgery. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 28:134-142. [PMID: 32175154 DOI: 10.5606/tgkdc.dergisi.2020.18662] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 12/03/2019] [Indexed: 11/21/2022]
Abstract
Background The aim of this study was to investigate the intra-abdominal pressure changes and risk factors associated with increased intra-abdominal pressure in patients undergoing cardiac surgery. Methods Between July 2016 and January 2017, a total of 100 patients (74 males, 26 females; mean age 55.9±14.3 years; range, 19 to 75 years) who underwent cardiac surgery under cardiopulmonary bypass were included in the study. Patients" data including demographic and clinical characteristics and intra- and postoperative data were recorded. Intra-abdominal pressure was measured via a urinary catheter after anesthesia induction, on admission to the intensive care unit, and at postoperative 12 and 24 h. The patients were divided into two groups according to the intraabdominal pressure as Group 1 (≥12 mmHg; n=49) and Group 2 (<12 mmHg; n=51). Results In the univariate regression analysis, high intra-abdominal pressure was related to intra-abdominal pressure measured after anesthesia induction (Odds Ratio =0.70, p=0.001), age (odds ratio=0.95, p=0.004), hypertension (odds ratio=4.51, p=0.0001), duration of cardiopulmonary bypass (odds ratio=0.97, p=0.0001), intraoperative lactate levels (odds ratio=0.53, p=0.0001), use of red blood cells (odds ratio=0.24, p=0.0001), use of dopamine (odds ratio=0.21, p=0.002), dobutamine (odds ratio=0.28, p=0.005), use of noradrenaline (odds ratio=0.25, p=0.016), postoperative lactate levels (odds ratio=0.60, p=0.0001), duration of cross-clamp (odds ratio=0.97, p=0.0001), atrial fibrillation (odds ratio=5.89, p=0.004), and acute kidney injury (odds ratio=8.33, p=0.048). In the multivariate analysis, the intra-abdominal pressure at baseline (odds ratio=0.70, p=0.045), age (odds ratio=0.93, p=0.032), hypertension (odds ratio=6.87, p=0.023), duration of cardiopulmonary bypass (odds ratio=0.98, p=0.062), intraoperative lactate levels (odds ratio=0.57, p=0.035), and use of red blood cells (odds ratio=0.19, p=0.003) remained statistically significant. Conclusion Our study results suggest that age, hypertension, duration of cardiopulmonary bypass, intraoperative lactate levels, and use of red blood cells are risk factors associated with elevated intra-abdominal pressure in patients undergoing cardiac surgery. Increased awareness of these risk factors and the addition of intra-abdominal pressure measurement to the standard follow-up scheme in patients with variable hemodynamics, low cardiac output, and high lactate levels in the intensive care unit may be useful in early diagnosis of complications and in decreasing morbidity.
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Tayari H, Cuypers C, Schäffler L, Proost K, Schauvliege S. Fatal cardiac arrest in a calf with uroperitoneum. VETERINARY RECORD CASE REPORTS 2019. [DOI: 10.1136/vetreccr-2018-000730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
| | - Charlotte Cuypers
- Department of Surgery and Anaesthesia of Domestic AnimalsUniversiteit Gent Faculteit DiergeneeskundeMerelbekeBelgium
| | - Lisa Schäffler
- Department of Large Animal Internal MedicineUniversiteit Gent Faculteit DiergeneeskundeMerelbekeBelgium
| | - Kirsten Proost
- Department of Surgery and AnaesthesiologyGhent UniversityMerelbekeBelgium
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Weiner L, Willis G, Dezman Z, Bontempo L. 52-Year-Old Jehovah’s Witness Female with Weakness. Clin Pract Cases Emerg Med 2018; 2:103-108. [PMID: 29849222 PMCID: PMC5965104 DOI: 10.5811/cpcem.2018.3.37699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 03/19/2018] [Accepted: 03/21/2018] [Indexed: 11/11/2022] Open
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Zhang D, Fu R, Li Y, Li H, Li Y, Li H. Comparison of the clinical characteristics and prognosis of primary versus secondary acute gastrointestinal injury in critically ill patients. J Intensive Care 2017; 5:26. [PMID: 28435684 PMCID: PMC5397695 DOI: 10.1186/s40560-017-0221-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 04/10/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND This prospective study compared clinical characteristics and prognosis between primary (P) and secondary (S) acute gastrointestinal injury (AGI) (P-AGI)/(S-AGI) in critically ill patients. METHODS This was a prospective, single-center observational study. Patients were included if they had been hospitalized for at least 72 h before the AGI diagnosis. Patients were classified according to severity of gastrointestinal dysfunction, while P-AGI or S-AGI were defined according to whether the gastrointestinal system was directly or indirectly involved. Clinical characteristics, Acute Physiology and Chronic Health Evaluation (APACHE) II score, and Sepsis-related Organ Failure Assessment (SOFA) scores after inclusion and 28-day mortality were recorded. RESULTS Altogether, 282 patients were included: P and S groups enrolled 100 and 182 patients, respectively. The S group patients were older and showed increased morbidities and higher APACHE II and SOFA scores. Compared to the S group, the P group had a higher prevalence in abdominal distention and enteroparalysis and fewer patients at AGI grade I, while more patients at grade III or IV. The S group patients had the higher 28-day mortality. Multiple logistic regression analysis showed AGI grades, APACHE II score, and S-AGI independently predicted the odds of 28-day mortality. CONCLUSIONS Comparing to the P-AGI patients, the S group patients were older, with higher APACHE II and SOFA scores. AGI grade, APACHE II score, and S-AGI independently predicted the odds of 28-day mortality in AGI patients.
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Affiliation(s)
- Dong Zhang
- ICU, The First Hospital of Jilin University, No. 71 Xinmin Street, Changchun, China
| | - Rao Fu
- ICU, The First Hospital of Jilin University, No. 71 Xinmin Street, Changchun, China
| | - Yanhua Li
- ICU, The First Hospital of Jilin University, No. 71 Xinmin Street, Changchun, China
| | - Hongyan Li
- ICU, The First Hospital of Jilin University, No. 71 Xinmin Street, Changchun, China
| | - Yuting Li
- ICU, The First Hospital of Jilin University, No. 71 Xinmin Street, Changchun, China
| | - Hongxiang Li
- ICU, The First Hospital of Jilin University, No. 71 Xinmin Street, Changchun, China
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Chiaka Ejike J, Humbert S, Bahjri K, Mathur M. Outcomes of children with abdominal compartment syndrome. Acta Clin Belg 2014; 62 Suppl 1:141-8. [PMID: 24881711 DOI: 10.1179/acb.2007.62.s1.018] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
INTRODUCTION Abdominal compartment syndrome (ACS) is a problem across all critical care scenarios and is associated with a high mortality. It has not been well described in pediatric populations. OBJECTIVE To describe the occurrence of ACS in a subset of critically ill pediatric patients and determine its effects on mortality and length of pediatric intensive care stay (PICU LOS). We also aimed to find predictors of mortality and development of ACS. SETTING 25 bed tertiary pediatric intensive care unit. PATIENTS PATIENTS less than 50 kg on mechanical ventilation and a urethral catheter. MEASUREMENTS Intra-abdominal pressures (IAP) were monitored using the intra-vesical technique. ACS was defined as IAP of >12mmHg associated with new organ dysfunction or failure. Demographics, physiologic measures of organ dysfunction, PICU LOS and mortality were monitored. MAIN RESULTS 14 (4.7%) of 294 eligible patients had ACS. Mortality was 50% among those with ACS versus 8.2% without (p<.001). PICU LOS stay did not differ between groups. No difference in mortality or PICU LOS was seen in primary versus secondary ACS or in patients who underwent abdominal decompression compared to those without decompression. IAP and ACS were independent predictors of mortality (odds ratio 1.53, 95% CI, 1.17 - 1.99 and 9.09, 95% CI, 1.07 - 76.84) respectively. IAP and a PRISM score of ≥17 were predictive of developing ACS. CONCLUSIONS ACS is a clinical problem that increases the risk of mortality in critically ill children. IAP and PRISM scores may help identify children likely to develop ACS.
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[To go in-depth in the knowledge of the device to control fecal elimination in the critical patient]. ENFERMERIA INTENSIVA 2013; 24:23-35. [PMID: 23347729 DOI: 10.1016/j.enfi.2012.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Revised: 11/02/2012] [Accepted: 11/16/2012] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To describe the general characteristics of the patient and device use. To know retention balloon pressure (RBP) and related factors. To identify rate of leakage incidence, relocation and perineal damage due to the device (PSD) and related risk factors. MATERIAL AND METHODS An analytical observational, cross-sectional study conducted in a polyvalent ICU from June-December 2010 was performed. The sample included Flexi-Seal(®) carriers. Variables evaluated were patient and device use characteristics, RBP, leakage and quantity, relocation and reason, PSD, sedoanalgesia infusion, neuromuscular block, patient position, Flexi-Seal type catheter, ventilatory mode (VM), intra-abdominal pressure (IAP), mean intrathoracic pressure (MITP), PEEP, Glasgow, color-aspect, fecal consistency and volume. Significance P<.05. RESULTS Twenty-one patients were included, 52% male, aged 54±17 with 30 insertion episodes, Flexi-Seal-Signal(®) 33%, 10±8 days permanency, main indication 33% «diarrhea and injured skin»," 30% device removal «intolerance and/or spontaneous expulsion». Median (Me) PGR =40; RI (61-19) cmH2O. Factors associated to higher PGR: SCI absence, prone-decubitus position, leakage, relocation, conventional Flexi-Seal(®), MV, lower PEEP and IMP, Color-aspect, higher MITP. Leakage, relocation and PSD incidence density 43, 30 and 2 cases/100 days of catheter, respectively. Leakage and relocation risk factors: higher PGR, Glasgow and fecal volume, lower MITP, MV, assisted-spontaneous mode OR 2.5 CI (1.6-3.8) and OR 1.7(1.1-2.7), absence SCI OR 3.3 (2.2-5.1) and OR 2.4(1.5-3.8), absence neuromuscular block OR 2.4 (1.4-3.9) and OR 1.8 (1.1-3.1), Flexi-Seal(®) conventional OR 2.7(1.7-4.1) and OR 2 (1.2-3.3), respectively. Leakage risk factors: color-aspect, supine position, lower IMP and PEEP. CONCLUSIONS Monitoring RBP may alert us about leakage presence and relocation need. Knowing associated risk factors to RBP, leakage and relocation would help to develop strategies to reduce their high incidence rate such as decreasing RBP by reducing inflated volume.
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Na Q, Liu CX, Cui H, Chen J, Liu SS, Li QL. Successful Treatment of Two Patients with Postpartum Disseminated Intravascular Coagulation Complicated by Abdominal Compartment Syndrome. Gynecol Obstet Invest 2012; 73:337-40. [DOI: 10.1159/000335922] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Accepted: 12/14/2011] [Indexed: 01/30/2023]
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Ejike JC, Newcombe J, Baerg J, Bahjri K, Mathur M. Understanding of Abdominal Compartment Syndrome among Pediatric Healthcare Providers. Crit Care Res Pract 2010; 2010:876013. [PMID: 20981270 PMCID: PMC2958672 DOI: 10.1155/2010/876013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Accepted: 07/13/2010] [Indexed: 01/17/2023] Open
Abstract
Background. The sparse reporting of abdominal compartment syndrome (ACS) in the pediatric literature may reflect inadequate awareness and recognition among pediatric healthcare providers (HCP). Purpose. To assess awareness of ACS, knowledge of the definition and intraabdominal pressure (IAP) measurement techniques used among pediatric HCP. Method. A written survey distributed at two pediatric critical care conferences. Results. Forty-seven percent of 1107 questionnaires were completed. Participants included pediatric intensivists, pediatric nurses, and others. Seventy-seven percent (n = 513) of participants had heard of ACS. Only 46.8% defined ACS correctly. The threshold IAP value used to define ACS was variable among participants. About one-quarter of participants (83/343), had never measured IAP. Conclusion. Twenty-three percent of HCP surveyed were unaware of ACS. Criteria used to define ACS were variable. Focused education on recognition of ACS and measuring IAP should be promoted among pediatric HCP.
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Affiliation(s)
- J. Chiaka Ejike
- Department of Pediatrics, Division of Pediatric Critical Care, School of Medicine, Loma Linda University, 11175 Campus Street, Suite A1117, Coleman Pavilion, Loma Linda, CA 92354, USA
| | - Jennifer Newcombe
- Department of Nursing, Loma Linda University Children's Hospital, Loma Linda, CA 92354, USA
| | - Joanne Baerg
- Department of Surgery, School of Medicine, Loma Linda University, Loma Linda, CA 92354, USA
| | - Khaled Bahjri
- Department of Epidemiology and Biostatistics, School of Public Health, Loma Linda University, Loma Linda, CA 92354, USA
| | - Mudit Mathur
- Department of Pediatrics, Division of Pediatric Critical Care, School of Medicine, Loma Linda University, 11175 Campus Street, Suite A1117, Coleman Pavilion, Loma Linda, CA 92354, USA
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Thomson A. A window into the belly: lessons from a pioneering surgeon. ANZ J Surg 2009; 79:512-4. [PMID: 19694656 DOI: 10.1111/j.1445-2197.2009.04978.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Andrew Thomson
- Gastroenenterology and Hepatology Unit, The Canberra Hospital, The Australian National University, Canberra, Australia
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Joglar F, Agosto E, Marrero D, Canario QM, Rodríguez P. Dynamic retention suture closure: modified Bogotá bag approach. J Surg Res 2009; 162:274-8. [PMID: 19592037 DOI: 10.1016/j.jss.2009.03.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2008] [Revised: 03/09/2009] [Accepted: 03/16/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Management of patients with abdominal compartment syndrome requires abdominal decompression and the use of the open abdomen technique. Various options exist for the management of the open abdomen including expensive, commercially available devices to aid in the gradual closure of the abdominal wall. A previously described temporary closure technique using dynamic retention sutures was modified and used in eleven trauma injured patients at the Puerto Rico Trauma Center. METHODS Retrospective case series of 11 trauma patients, seven blunt and four penetrating, treated at the Puerto Rico Trauma Center with the modified Bogotá bag (MBB) approach from October 2005 to November 2006. RESULTS The MBB approach was applied in 11 out of 43 trauma patients (26%) who had undergone a Bogotá bag closure during an initial damage control surgery. Patients' average age was 27.5 (2-65) y old, including 8 males and 3 females, with an injury severity score (ISS) of 23.3 (9-38). The MBB placement allowed serial approximation in the Trauma ICU with subsequent delayed primary abdominal closure. The procedure was used for an average of 7.3 (4-12) d. Abdominal closure was achieved in 10 out of 11 patients (91%). CONCLUSIONS The MBB technique has preliminarily proven to be effective, allowing delayed primary closure in 91% of the cases. The MBB approach represents an inexpensive and useful alternative in the management of the open abdomen.
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Affiliation(s)
- Fernando Joglar
- University of Puerto Rico-Medical Sciences Campus, Department of Surgery, Puerto Rico Trauma Center, San Juan, Puerto Rico.
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Ejike JC, Bahjri K, Mathur M. What is the normal intra-abdominal pressure in critically ill children and how should we measure it? Crit Care Med 2008; 36:2157-62. [PMID: 18552691 DOI: 10.1097/ccm.0b013e31817b8c88] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The intravesical method has been validated and is considered the gold standard for indirect intra-abdominal pressure (IAP) measurements. In adults, a standard volume (25 mL) is instilled into the bladder to measure IAP. However, the optimal volume for accurate IAP measurements in children has not been well studied and using inappropriate volumes could give erroneous IAP readings. OBJECTIVE To determine the normal IAP in critically ill children and the optimal volume for IAP measurement by the intravesical method in this population. DESIGN Prospective observational study. SETTING Tertiary pediatric intensive care unit. PATIENTS Ninety-six mechanically ventilated children younger than 18 yrs of age with no clinical evidence of intra-abdominal hypertension. MEASUREMENTS AND RESULTS Graduated volumes of normal saline in increments of 3-50 mL were instilled in the bladder via a urethral catheter. IAP was recorded by using the AbViser device (WolfeTory Medical, Inc., Salt Lake City, UT) with each instillation. A pressure-volume curve was generated for every patient, and the minimum and mean optimal volumes were determined from this curve. Data were analyzed by stratification of patients according to weights 0-10 kg, >10-20 kg, and >20-50 kg. Descriptive statistics was used for statistical analysis. Normal IAP for critically ill children was 7 +/- 3 and was similar in the different weight groups (p = .745). Although the mean optimal volume to measure accurate IAP was variable in the different weight groups, the minimum optimal volume was 3 mL irrespective of weight. CONCLUSIONS Mean IAP in critically ill children is 7 +/- 3 mm Hg. The minimum optimal volume needed to accurately measure IAP by the intravesical method in children is 3 mL. We recommend that 3 mL be the standard instillation volume for IAP measurement by the intravesical method in children. IAP >10 mm Hg should be considered elevated in children.
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Affiliation(s)
- J Chiaka Ejike
- Department of Pediatrics, Division of Pediatric Critical Care, Loma Linda University, School of Medicine, Loma Linda, California, USA.
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Use of Near-Infrared Spectroscopy as a Physiologic Monitor for Intra-abdominal Hypertension. ACTA ACUST UNITED AC 2008; 64:1165-8. [DOI: 10.1097/ta.0b013e31814695dd] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Regueira T, Bruhn A, Hasbun P, Aguirre M, Romero C, Llanos O, Castro R, Bugedo G, Hernandez G. Intra-abdominal hypertension: incidence and association with organ dysfunction during early septic shock. J Crit Care 2008; 23:461-7. [PMID: 19056007 DOI: 10.1016/j.jcrc.2007.12.013] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2007] [Revised: 12/15/2007] [Accepted: 12/15/2007] [Indexed: 01/11/2023]
Abstract
PURPOSE The objective of this article is to study the cumulative incidence of intra-abdominal hypertension (IAH) in septic shock (SS) patients during the first 72 hours of intensive care unit (ICU) admission and to determine if the presence and severity of IAH are associated with sepsis morbidity and mortality. MATERIALS AND METHODS Eighty-one consecutive SS patients admitted to a surgical-medical ICU of an academic university hospital (January 2005 to January 2006) were included. Intra-abdominal pressure (IAP) and abdominal perfusion pressure (APP) were measured every 6 h (intermittently) for 72 h. Intra-abdominal pressure was registered as minimal, mean, and maximal values per day, during shock and throughout the study period. Intra-abdominal hypertension was diagnosed if IAP remained 12 mm Hg or higher on 2 consecutive measurements and stratified according to the most recent consensus definition (www.wsacs.org). RESULTS According to maximal and mean IAP values, 67 (82.7%) and 62 (76.5%) of the patients developed IAH during the study period, respectively. Mean IAP values remained stable throughout the study period. Surgical patients had a higher incidence of IAH than medical patients (93% vs 73%, P < .009). Maximal IAPs were normally distributed, with nonsurvivors exhibiting significantly higher IAP levels during shock (survivors, 17.2 +/- 5.3; nonsurvivors, 19.9 +/- 5.6 mm Hg; P < .04). Patients with IAH exhibited significantly lower values of APP and diuresis, higher values of lactate and creatinine, and higher maximal norepinephrine doses, and were more frequently mechanically ventilated (P < .05 for all). Increasing degrees of IAH and the development of the abdominal compartment syndrome were associated with lower APP and higher maximal serum creatinine levels (P < .03 for both). CONCLUSIONS Septic shock patients have a very high incidence of IAH, which seems to be associated with the severity of shock and could be related to the development of organ dysfunctions, particularly renal dysfunction. Intra-abdominal pressure should be routinely monitored during the course of SS.
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Affiliation(s)
- Tomas Regueira
- Department of Intensive Care Medicine, Pontificia Universidad Católica De Chile, Santiago, Chile
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Abstract
OBJECTIVE There has been an increased awareness of the presence and clinical importance of abdominal compartment syndrome. It is now appreciated that elevations of abdominal pressure occur in a wide variety of critically ill patients. Full-blown abdominal compartment syndrome is a clinical syndrome characterized by progressive intra-abdominal organ dysfunction resulting from elevated intra-abdominal pressure. This review provides a current, clinically focused approach to the diagnosis and management of abdominal compartment syndrome, with a particular emphasis on intensive care. METHODS Source data were obtained from a PubMed search of the medical literature, with an emphasis on the time period after 2000. PubMed "related articles" search strategies were likewise employed frequently. Additional information was derived from the Web site of the World Society of the Abdominal Compartment Syndrome (http://www.wsacs.org). SUMMARY AND CONCLUSIONS The detrimental impact of elevated intra-abdominal pressure, progressing to abdominal compartment syndrome, is recognized in both surgical and medical intensive care units. The recent international abdominal compartment syndrome consensus conference has helped to define, characterize, and raise awareness of abdominal compartment syndrome. Because of the frequency of this condition, routine measurement of intra-abdominal pressure should be performed in high-risk patients in the intensive care unit. Evidence-based interventions can be used to minimize the risk of developing elevated intra-abdominal pressure and to aggressively treat intra-abdominal hypertension when identified. Surgical decompression remains the gold standard for rapid, definitive treatment of fully developed abdominal compartment syndrome, but nonsurgical measures can often effectively affect lesser degrees of intra-abdominal hypertension and abdominal compartment syndrome.
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Affiliation(s)
- Gary An
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Spencer P, Kinsman L, Fuzzard K. A critical care nurse's guide to intra abdominal hypertension and abdominal compartment syndrome. Aust Crit Care 2008; 21:18-28. [DOI: 10.1016/j.aucc.2007.10.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2007] [Revised: 10/23/2007] [Accepted: 10/30/2007] [Indexed: 12/16/2022] Open
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Ball CG, Kirkpatrick AW. Intra-abdominal hypertension and the abdominal compartment syndrome. Scand J Surg 2008; 96:197-204. [PMID: 17966744 DOI: 10.1177/145749690709600303] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- C G Ball
- Department of Trauma, Grady Memorial Hospital, Emory University, Atlanta, Georgia, United States
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21
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Regueira T, Hasbun P, Rebolledo R, Galindo J, Aguirre M, Romero C, Castillo L, Bugedo G, Hernandez G. Intraabdominal Hypertension in Patients with Septic Shock. Am Surg 2007. [DOI: 10.1177/000313480707300907] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Intraabdominal hypertension (IAH) develops frequently in patients with septic shock. Even a moderate increase in intraabdominal pressure (IAP) in this setting could be associated with high lactate levels. The authors conducted a prospective, observational, nonrandomized control trial in the surgical intensive care unit of an academic tertiary center. Twenty-seven patients with septic shock (septic shock group), and 19 patients undergoing abdominal surgery with more than two risk factors for IAH (postoperative control group) were admitted consecutively to the intensive care unit. IAP was measured every 6 hours during the first 48 hours. IAH was diagnosed with two consecutive measurements greater than 20 mm Hg. The main outcome measures were prevalence of IAH in septic shock and control groups; and comparative lactate levels, norepinephrine requirements and organ dysfunctions in patients with and without IAH in both groups. Fifty-one per cent of patients with septic shock and 31 per cent of control patients developed IAH. Patients with septic shock with and without IAH were comparable in peak norepinephrine dose, sequential organ failure assessment score, and mortality. However, peak lactate levels were significantly higher in patients with septic shock and IAH compared with those without IAH (3.5 mmol/L versus 1.9 mmol/L, P < 0.04). There was a significant positive temporal correlation between IAP and lactate levels in patients with septic shock with IAH. Peak levels of both occurred early and decreased progressively over time. Control patients with and without IAH exhibited comparable peak lactate levels. Intraabdominal hypertension is very common in septic shock and appears to be related to high lactate levels, which diminish as IAP decreases. Future studies should address the usefulness of IAP monitoring in patients with septic shock.
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Affiliation(s)
- Tomas Regueira
- Departamento de Medicina Intensiva, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pablo Hasbun
- Departamento de Medicina Intensiva, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rolando Rebolledo
- Departamento de Medicina Intensiva, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Jose Galindo
- Departamento de Medicina Intensiva, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Marcia Aguirre
- Departamento de Medicina Intensiva, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Carlos Romero
- Departamento de Medicina Intensiva, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Luis Castillo
- Departamento de Medicina Intensiva, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Guillermo Bugedo
- Departamento de Medicina Intensiva, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Glenn Hernandez
- Departamento de Medicina Intensiva, Pontificia Universidad Católica de Chile, Santiago, Chile
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Al-Bahrani AZ, Abid GH, Sahgal E, O'shea S, Lee S, Ammori BJ. A prospective evaluation of CT features predictive of intra-abdominal hypertension and abdominal compartment syndrome in critically ill surgical patients. Clin Radiol 2007; 62:676-82. [PMID: 17556037 DOI: 10.1016/j.crad.2006.11.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2006] [Revised: 11/09/2006] [Accepted: 11/21/2006] [Indexed: 11/24/2022]
Abstract
AIM The aim of this study was to validate the computed tomography (CT) features of intra-abdominal hypertension (IAH) by relating them to the clinical measurement of intra-abdominal pressure (IAP) in critically ill surgical patients. MATERIALS AND METHODS The intra-vesical pressure was measured to reflect IAP in 24 critically ill patients. CT examinations obtained within 24h of IAP measurement were reviewed and scored independently by two consultant radiologists. Each CT examination was scored for the seven proposed features of IAH. Images obtained during the presence of IAH were compared with those obtained in the absence of IAH. RESULTS Forty-eight abdominal CT examinations were evaluated, of which 18 (38%) were obtained in the presence of IAH, whereas eight (17%) were obtained in the presence of abdominal compartment syndrome (ACS). At CT, the round belly sign (RBS) and bowel wall thickening with enhancement (BWTE) were significantly more frequently detected during the presence of IAH than when the IAP was less than 12 mmHg (78 versus 20% of examinations, p<0.001 and 39 versus 3% of examinations, p=0.003, respectively), but only BWTE was significantly associated with the presence of ACS (40 versus 11% of examinations, p=0.047). CONCLUSION The presence of RBS and BWTE on CT images of critically ill surgical patients should alert clinicians to the possibility of presence of IAH and ACS, and prompt measurement of the IAP and consideration of suitable interventions.
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Affiliation(s)
- A Z Al-Bahrani
- Department of Surgery, Manchester Royal Infirmary, Manchester, UK
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23
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Síndrome compartimental abdominal en el postoperatorio de un paciente con aneurisma de aorta abdominal infrarrenal fisurado. Caso clínico y revisión de la bibliografía. ANGIOLOGIA 2007. [DOI: 10.1016/s0003-3170(07)75074-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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24
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Castellanos G, Piñero A, Fernández JA. La hipertensión intraabdominal y el síndrome compartimental abdominal: ¿qué debe saber y cómo debe tratarlos el cirujano? Cir Esp 2007; 81:4-11. [PMID: 17263951 DOI: 10.1016/s0009-739x(07)71249-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Correct monitoring of medicosurgical critically-ill patients aids the early diagnosis and appropriate treatment of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS). The abdominal cavity and the retroperitoneum act sealed compartments and any change in the volume of their contents can increase intraabdominal pressure (IAP). IAH is only one measure of elevated IAP, and ACS represents the end result of sustained IAH with the appearance of organ dysfunction. To diagnose IAH and ACS, measurement of IAP, abdominal perfusion pressure and intramucous gastric pH must be performed and the results correlated with signs of clinical deterioration in the patient. Medical therapeutic measures in ACS are limited and abdominal decompression is the established symptomatic treatment of this entity.
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Affiliation(s)
- Gregorio Castellanos
- Servicio de Cirugía General y del Aparato Digestivo I, Hospital Universitario Virgen de la Arrixaca, Murcia, España.
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Chiumello D, Tallarini F, Chierichetti M, Polli F, Li Bassi G, Motta G, Azzari S, Carsenzola C, Gattinoni L. The effect of different volumes and temperatures of saline on the bladder pressure measurement in critically ill patients. Crit Care 2007; 11:R82. [PMID: 17655744 PMCID: PMC2206509 DOI: 10.1186/cc6080] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2007] [Revised: 05/16/2007] [Accepted: 07/26/2007] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Intra-abdominal hypertension is common in critically ill patients and is associated with increased severity of organ failure and mortality. The techniques most commonly used to estimate intra-abdominal pressure are measurements of bladder and gastric pressures. The bladder technique requires that the bladder be infused with a certain amount of saline, to ensure that there is a conductive fluid column between the bladder and the transducer. The aim of this study was to evaluate the effect of different volumes and temperatures of infused saline on bladder pressure measurements in comparison with gastric pressure. METHODS Thirteen mechanically ventilated critically ill patients (11 male; body mass index 25.5 +/- 4.6 kg/m2; arterial oxygen tension/fractional inspired oxygen ratio 225 +/- 48 mmHg) were enrolled. Bladder pressure was measured using volumes of saline from 50 to 200 ml at body temperature (35 to 37 degrees C) and room temperature (18 to 20 degrees C). RESULTS Bladder pressure was no different between 50 ml and 100 ml saline (9.5 +/- 3.7 mmHg and 13.7 +/- 5.6 mmHg), but it significantly increased with 150 and 200 ml (21.1 +/- 10.4 mmHg and 27.1 +/- 15.5 mmHg). Infusion of saline at room temperature caused a significantly greater bladder pressure compared with saline at body temperature. The lowest difference between bladder and gastric pressure was obtained with a volume of 50 ml. CONCLUSION The bladder acts as a passive structure, transmitting intra-abdominal pressure only with saline volumes between 50 ml and 100 ml. Infusion of a saline at room temperature caused a higher bladder pressure, probably because of contraction of the detrusor bladder muscle.
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Affiliation(s)
- Davide Chiumello
- Dipartimento di Anestesia e Rianimazione, Fondazione IRCCS – 'Ospedale Maggiore Policlinico, Mangiagalli, Regina Elena', Via F Sforza 35, 20122 Milan, Italy
| | - Federica Tallarini
- Istituto di Anestesia e Rianimazione Università degli Studi di Milano, 'Ospedale Maggiore Policlinico, Mangiagalli, Regina Elena', Via F Sforza 35, 20122 Milan, Italy
| | - Monica Chierichetti
- Istituto di Anestesia e Rianimazione Università degli Studi di Milano, 'Ospedale Maggiore Policlinico, Mangiagalli, Regina Elena', Via F Sforza 35, 20122 Milan, Italy
| | - Federico Polli
- Istituto di Anestesia e Rianimazione Università degli Studi di Milano, 'Ospedale Maggiore Policlinico, Mangiagalli, Regina Elena', Via F Sforza 35, 20122 Milan, Italy
| | - Gianluigi Li Bassi
- Istituto di Anestesia e Rianimazione Università degli Studi di Milano, 'Ospedale Maggiore Policlinico, Mangiagalli, Regina Elena', Via F Sforza 35, 20122 Milan, Italy
| | - Giuliana Motta
- Istituto di Anestesia e Rianimazione Università degli Studi di Milano, 'Ospedale Maggiore Policlinico, Mangiagalli, Regina Elena', Via F Sforza 35, 20122 Milan, Italy
| | - Serena Azzari
- Istituto di Anestesia e Rianimazione Università degli Studi di Milano, 'Ospedale Maggiore Policlinico, Mangiagalli, Regina Elena', Via F Sforza 35, 20122 Milan, Italy
| | - Cristian Carsenzola
- Istituto di Anestesia e Rianimazione Università degli Studi di Milano, 'Ospedale Maggiore Policlinico, Mangiagalli, Regina Elena', Via F Sforza 35, 20122 Milan, Italy
| | - Luciano Gattinoni
- Istituto di Anestesia e Rianimazione Università degli Studi di Milano, 'Ospedale Maggiore Policlinico, Mangiagalli, Regina Elena', Via F Sforza 35, 20122 Milan, Italy
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Sun ZX, Huang HR, Zhou H. Indwelling catheter and conservative measures in the treatment of abdominal compartment syndrome in fulminant acute pancreatitis. World J Gastroenterol 2006; 12:5068-70. [PMID: 16937509 PMCID: PMC4087416 DOI: 10.3748/wjg.v12.i31.5068] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2006] [Revised: 03/05/2006] [Accepted: 03/10/2006] [Indexed: 02/06/2023] Open
Abstract
AIM To study the effect of combined indwelling catheter, hemofiltration, respiration support and traditional Chinese medicine (e.g. Dahuang) in treating abdominal compartment syndrome of fulminant acute pancreatitis. METHODS Patients with fulminant acute pancreatitis were divided randomly into 2 groups of combined indwelling catheter celiac drainage and intra-abdominal pressure monitoring and routine conservative measures group (group 1) and control group (group 2). Routine non-operative conservative treatments including hemofiltration, respiration support, gastrointestinal TCM ablution were also applied in control group patients. Effectiveness of the two groups was observed, and APACHE II scores were applied for analysis. RESULTS On the second and fifth days after treatment, APACHE II scores of group 1 and 2 patients were significantly different. Comparison of effectiveness (abdominalgia and burbulence relief time, hospitalization time) between groups 1 and 2 showed significant difference, as well as incidence rates of cysts formation. Mortality rates of groups 1 and 2 were 10.0% and 20.7%, respectively. For patients in group 1, celiac drainage quantity and intra-abdominal pressure, and hospitalization time were positively correlated (r = 0.552, 0.748, 0.923, P<0.01) with APACHE II scores. CONCLUSION Combined indwelling catheter celiac drainage and intra-abdominal pressure monitoring, short veno-venous hemofiltration (SVVH), gastrointestinal TCM ablution, respiration support have preventive and treatment effects on abdominal compartment syndrome of fulminant acute pancreatitis.
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Affiliation(s)
- Zhao-Xi Sun
- Department of General Surgery, Affiliated Hospital of Hainan Medical College, Haikou 570102, Hainan Province, China.
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Suominen PK, Pakarinen MP, Rautiainen P, Mattila I, Sairanen H. Comparison of direct and intravesical measurement of intraabdominal pressure in children. J Pediatr Surg 2006; 41:1381-5. [PMID: 16863841 DOI: 10.1016/j.jpedsurg.2006.04.030] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PURPOSE The aim of this study was to compare directly measured intraabdominal pressure with the pressure measured indirectly via urinary catheter using different bladder-filling volumes in children. METHODS Prospective observational study in pediatric intensive care unit at a university children's hospital. Three simultaneous measurements of intraabdominal pressure were performed in 14 children, mean age 1.6 months (range, 0.2-56), after cardiac surgery requiring cardiopulmonary bypass directly via an intraperitoneal dialysis catheter and indirectly via indwelling urinary catheter with bladder volumes of 1, 1.5, 2, 2.5, and 3 mL/kg of physiological saline. Of the 14 patients, 9 were mechanically ventilated at the time of the intraabdominal pressure measurements. RESULTS Directly measured intraabdominal pressure ranged between 0 and 10 mm Hg and showed the highest correlation (r = 0.971, P < .0001) with the pressure measured via urinary catheter using bladder-filling volume of 1 mL/kg. The higher the bladder-filling volume, the higher was the overestimation of the intraabdominal pressure and the weaker was the correlation with the direct measurement. Overestimation of intraabdominal pressure was 1.3, 2.0, and 2.9 mm Hg, with bladder volume of 1, 2, and 3 mL/kg, respectively. CONCLUSION These data suggest that intravesical pressure closely correlates with intraabdominal pressure in children. A bladder-filling volume of 1 mL/kg is recommended for the measurement of intraabdominal pressure in children with a risk of abdominal compartment syndrome.
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Affiliation(s)
- Pertti K Suominen
- Department of Anaesthesia and Intensive Care, Hospital for Children and Adolescents, Helsinki University Central Hospital, P.O. Box 281, FIN-00029 HUCS Helsinki, Finland.
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Manion S, Tobias JD. Abdominal Compartment Syndrome After Sepsis in an Infant With Congenital Heart Disease. J Cardiothorac Vasc Anesth 2006; 20:71-5. [PMID: 16458218 DOI: 10.1053/j.jvca.2004.11.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2004] [Indexed: 11/11/2022]
Affiliation(s)
- Smith Manion
- University of Missouri School of Medicine, Columbia, MO, USA
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Kirkpatrick AW, Balogh Z, Ball CG, Ahmed N, Chun R, McBeth P, Kirby A, Zygun DA. The secondary abdominal compartment syndrome: iatrogenic or unavoidable? J Am Coll Surg 2006; 202:668-79. [PMID: 16571439 DOI: 10.1016/j.jamcollsurg.2005.11.020] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2005] [Accepted: 11/16/2005] [Indexed: 12/20/2022]
Affiliation(s)
- Andrew W Kirkpatrick
- Department of Critical Care Medicine, School of Medicine, Foothills Hospital, University of Calgary, Calgary, Alberta, Canada.
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N/A, 孙 诚. N/A. Shijie Huaren Xiaohua Zazhi 2005; 13:1797-1799. [DOI: 10.11569/wcjd.v13.i14.1797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Brooks AJ, Simpson A, Delbridge M, Beckingham IJ, Girling KJ. Validation of direct intraabdominal pressure measurement using a continuous indwelling compartment pressure monitor. ACTA ACUST UNITED AC 2005; 58:830-2. [PMID: 15824663 DOI: 10.1097/01.ta.0000141887.22660.24] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND According to recommendations, intraabdominal pressure should be monitored every 8 hours for patients at high risk of abdominal compartment syndrome. Continuous intraabdominal pressure monitoring may be valuable for these patients. METHODS For 15 patients undergoing laparoscopic surgery, a pressure monitor was introduced after formation of pneumoperitoneum. During the procedure, the laparoscopic insufflator pressure was varied. The pressure monitor values and the time to equilibrium were recorded. RESULTS Altogether, 152 pressure recordings were taken for the patients studied. The measurements from the insufflator and pressure monitor were compared using a Bland-Altman plot. The mean difference between the techniques was 0.04 +/- 3.8, and 95% of the points from the pressure monitor were within two standard deviations of the mean difference. Pressure changes were essentially "real time." CONCLUSIONS The intracompartmental pressure monitor provides accurate, rapid, and direct measurement of intraabdominal pressure, and may be a useful tool for continuous intraabdominal pressure measurement among patients at risk of abdominal compartment syndrome.
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Affiliation(s)
- A J Brooks
- Department of Surgery, Queens Medical Centre, Nottingham, United Kingdom
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Malbrain MLNG, Chiumello D, Pelosi P, Bihari D, Innes R, Ranieri VM, Del Turco M, Wilmer A, Brienza N, Malcangi V, Cohen J, Japiassu A, De Keulenaer BL, Daelemans R, Jacquet L, Laterre PF, Frank G, de Souza P, Cesana B, Gattinoni L. Incidence and prognosis of intraabdominal hypertension in a mixed population of critically ill patients: a multiple-center epidemiological study. Crit Care Med 2005; 33:315-22. [PMID: 15699833 DOI: 10.1097/01.ccm.0000153408.09806.1b] [Citation(s) in RCA: 430] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Intraabdominal hypertension is associated with significant morbidity and mortality in surgical and trauma patients. The aim of this study was to assess, in a mixed population of critically ill patients, whether intraabdominal pressure at admission was an independent predictor for mortality and to evaluate the effects of intraabdominal hypertension on organ functions. DESIGN Multiple-center, prospective epidemiologic study. SETTING Fourteen intensive care units in six countries. PATIENTS A total of 265 consecutive patients admitted for >24 hrs during the 4-wk study period. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Intraabdominal pressure was measured twice daily via the bladder. Data recorded on admission were the patient demographics with Simplified Acute Physiology Score II, Acute Physiology and Chronic Health Evaluation II score, and type of admission; during intensive care stay, Sepsis-Related Organ Failure Assessment score and intraabdominal pressure were measured daily together with fluid balance. Nonsurvivors had a significantly higher mean intraabdominal pressure on admission than survivors: 11.4 +/- 4.8 vs. 9.5 +/- 4.8 mm Hg. Independent predictors for mortality were age (odds ratio, 1.04; 95% confidence interval, 1.01-1.06; p = .003), Acute Physiology and Chronic Health Evaluation II score (odds ratio, 1.1; 95% confidence interval, 1.05-1.15; p < .0001), type of intensive care unit admission (odds ratio, 2.5 medical vs. surgical; 95% confidence interval, 1.24-5.16; p = .01), and the presence of liver dysfunction (odds ratio, 2.5; 95% confidence interval, 1.06-5.8; p = .04). The occurrence of intraabdominal hypertension during the intensive care unit stay was also an independent predictor of mortality (relative risk, 1.85; 95% confidence interval, 1.12-3.06; p = .01). Patients with intraabdominal hypertension at admission had significantly higher Sepsis-Related Organ Failure Assessment scores during the intensive care unit stay than patients without intraabdominal hypertension. CONCLUSIONS Intraabdominal hypertension on admission was associated with severe organ dysfunction during the intensive care unit stay. The mean intraabdominal pressure on admission was not an independent risk factor for mortality; however, the occurrence of intraabdominal hypertension during the intensive care unit stay was an independent outcome predictor.
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Affiliation(s)
- Manu L N G Malbrain
- Intensive Care Unit Director, Medical Intensive Care Unit, Ziekenhuis Netwerk Antwerpen, Campus Stuivenberg, Lange Beeldekensstraat 267, B-2060 Antwerpen 6, Belgium.
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Rutherford EJ, Skeete DA, Brasel KJ. Management of the patient with an open abdomen: techniques in temporary and definitive closure. Curr Probl Surg 2005; 41:815-76. [PMID: 15685140 DOI: 10.1067/j.cpsurg.2004.08.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Edmund J Rutherford
- Surgical Intensive Care Unit, University of North Carolina, Chapel Hill, North Carolina, USA
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Etzion Y, Barski L, Almog Y. Malignant ascites presenting as abdominal compartment syndrome. Am J Emerg Med 2004; 22:430-1. [PMID: 15490389 DOI: 10.1016/j.ajem.2004.06.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Chorbadjian M, Bown M, Graham C, Sayers R. Laparostomy healing by secondary intention after ruptured abdominal aortic aneurysm repair. J Tissue Viability 2004; 14:24-7. [PMID: 14768131 DOI: 10.1016/s0965-206x(04)41003-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Abdominal compartment syndrome resulting from intra-abdominal hypertension can be prevented or treated with the formation of a laparostomy. In the majority of cases this is followed by delayed abdominal wall reconstruction involving the use of prosthetic materials and split-skin grafts. The authors present a case study involving a patient who underwent repair of a ruptured abdominal aortic aneurysm and required a laparostomy to prevent abdominal compartment syndrome. He also had significant perioperative morbidity and poor nutritional status. Despite this, satisfactory wound healing was achieved without the need for split-skin grafting, thus avoiding further surgery and its associated complications.
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Affiliation(s)
- Mary Chorbadjian
- Department of Vascular Surgery, University Hospitals of Leicester NHS Trust, Leicester
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Mizuguchi T, Mukaiya M, Imaizumi H, Kimura Y, Masuda Y, Katsuramaki T, Asai Y, Hirata K. Successful management of severe acute pancreatitis with multiple organ failure. Pancreas 2004; 28:211-3. [PMID: 15028955 DOI: 10.1097/00006676-200403000-00014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Toru Mizuguchi
- Department of Surgery I, Sapporo Medical University Hospital, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan.
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Abstract
OBJECTIVE Many aspects of the care and underlying pathologies in patients suffering critical illness can detrimentally influence the normal healing processes of skin and soft tissues. Although a great diversity of pathologies exists, some aspects of the diseases and their treatments are common in critically ill patients. We aimed to identify some features, both common and specific, that could influence wound healing and the mechanisms by which they may do so. DESIGN In this review, we first outline the biology of normal skin and muscle healing and then explore how critical illness may influence the normal healing cascade. FINDINGS The healing of skin and skeletal muscle in critical illness is influenced by both underlying disease processes and the intensive care environment. Local and systemic factors can contribute to impaired healing, with the potential to prolong functional disability and increase the likelihood of wound complications. The frequency and number of soft tissue injuries derived from accidental injury, surgical intervention, and the need for invasive monitoring and therapies in the intensive care unit setting are likely to compromise the innate immunity and potentially further jeopardize the patient's ability to heal. Alterations in coagulation, tissue perfusion, inflammation, immune functioning, metabolism, nutrition, and drug therapies will influence healing responses by modifying the biological responses to tissue disruption. Locally, wound contamination, sepsis, tissue hypoxia, edema, and excessive or prolonged local pressure all have the potential to compromise soft tissue healing. One or more of these factors may be present at any time. CONCLUSION The skin and soft tissues are vulnerable to both injury and compromised healing when a patient is critically ill and exposed to a critical care environment. The identification of risk factors may aid in forming and modifying treatment strategies when caring for the critically ill patient with soft tissue injuries.
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Affiliation(s)
- Dean Thomas Williams
- Wound Healing Research Unit, University of Wales College of Medicine, Cardiff, UK
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Loftus IM, Thompson MM. The abdominal compartment syndrome following aortic surgery. Eur J Vasc Endovasc Surg 2003; 25:97-109. [PMID: 12552469 DOI: 10.1053/ejvs.2002.1828] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND multi-organ failure is a leading cause of death following aneurysm surgery, especially in the emergency setting. Intra-abdominal hypertension is an important factor in the development of multi-organ failure. Prevention, early recognition and prompt treatment of abdominal hypertension and the abdominal compartment syndrome may reduce mortality following aneurysm surgery. METHODS a descriptive review of the literature from a Medline search. RESULTS AND CONCLUSIONS the abdominal compartment syndrome is the result of diverse physiological effects caused by increased intra-abdominal pressure. The syndrome has been most widely described in trauma victims, but occurs in patients following aortic surgery, particularly following ruptured aneurysm repair. Preventative therapy should be instituted to minimise its development in patients at risk, and monitoring of intra-abdominal pressure may allow prompt treatment of this condition.
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Affiliation(s)
- I M Loftus
- Department of Surgery, Leicester University, RKCSB, PO Box 65, Leicester LE2 7LX, U.K
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40
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Abstract
Multiple trauma is more than the sum of the injuries. Management not only of the physiologic injury but also of the pathophysiologic responses, along with integration of the child's emotional and developmental needs and the child's family, forms the basis of trauma care. Multiple trauma in children also elicits profound psychological responses from the healthcare providers involved with these children. This overview will address the pathophysiology of multiple trauma in children and the general principles of trauma management by an integrated trauma team. Trauma is a systemic disease. Multiple trauma stimulates the release of multiple inflammatory mediators. A lethal triad of hypothermia, acidosis, and coagulopathy is the direct result of trauma and secondary injury from the systemic response to trauma. Controlling and responding to the secondary pathophysiologic sequelae of trauma is the cornerstone of trauma management in the multiply injured, critically ill child. Damage control surgery is a new, rational approach to the child with multiple trauma. The selection of children for damage control surgery depends on the severity of injury. Major abdominal vascular injuries and multiple visceral injuries are best considered for this approach. The effective management of childhood multiple trauma requires a combined team approach, consideration of the child and family, an organized trauma system, and an effective quality assurance and improvement mechanism.
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Affiliation(s)
- Randall C Wetzel
- Department of Anesthesiology Critical Care Medicine, Childrens Hospital of Los Angeles, 4650 Sunset Boulevard, MS# 12, Los Angeles, CA 90027-6062, USA
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41
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Moriguchi T, Hirasawa H, Oda S, Shiga H, Nakanishi K, Matsuda KI, Nakamura M, Yokohari K, Hirano T, Hirayama Y, Watanabe E. A patient with severe acute pancreatitis successfully treated with a new critical care procedure. Ther Apher Dial 2002; 6:221-4. [PMID: 12109947 DOI: 10.1046/j.1526-0968.2002.00435.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
It has been accepted widely that excessive humoral mediators play important roles in the pathogenesis of organ failure in patients with severe acute pancreatitis (SAP) and that infection of the pancreas due to bacterial translocation (BT) is the most frequent cause of death in SAP. On the other hand, it has been reported that continuous hemodiafiltration (CHDF) removes humoral mediators on hypercytokinemic patients such as those with systemic inflammatory response syndrome. Furthermore, several clinical studies have demonstrated that selective digestive decontamination (SDD) effectively eliminates aerobic Gram-negative bacteria from the intestinal tract and reduces the incidence of septic complications in SAP. Herein we report a case of SAP who was treated successfully with intensive care including CHDF and SDD. Thus, this case report suggests that CHDF aimed at removing causative humoral mediators and SDD for the prevention of BT are useful new tools for the management of SAP.
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Affiliation(s)
- Takeshi Moriguchi
- Department of Emergency and Critical Care Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan.
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42
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Abstract
Inadequate splanchnic perfusion is associated with increased morbidity and mortality, particularly if liver dysfunction coexists. Heart failure, increased intra-abdominal pressure, haemodialysis and the presence of obstructive sleep apnoea are among the multiple clinical conditions that are associated with impaired splanchnic perfusion in critically ill patients. Total liver blood flow is believed to be relatively protected when gut blood flow decreases, because hepatic arterial flow increases when portal venous flow decreases (the hepatic arterial buffer response [HABR]). However, there is evidence that the HABR is diminished or even abolished during endotoxaemia and when gut blood flow becomes very low. Unfortunately, no drugs are yet available that increase total hepato-splanchnic blood flow selectively and to a clinically relevant extent. The present review discusses old and new concepts of splanchnic vasoregulation from both experimental and clinical viewpoints. Recently published trials in this field are discussed.
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Affiliation(s)
- Stephan M Jakob
- Department of Intensive Care Medicine, University Hospital, Bern, Switzerland.
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