Understanding of Abdominal Compartment Syndrome among Pediatric Healthcare Providers

Knowledge, attitudes, and practices (KAP) regarding intra-abdominal pressure monitoring among pediatric intensive care nurses: A cross-sectional study

Objectives

This study aimed to assess the knowledge, attitudes, and practices (KAP) and the training requirements of pediatric intensive care nurses regarding intra-abdominal pressure (IAP) monitoring, in order to provide a reference for the development of relevant training programs and operational procedures in clinical practice.

Methods

This descriptive cross-sectional survey was conducted from April 2023 to June 2023. A convenience sample was created by recruiting 212 pediatric intensive care nurses in eight hospitals in Zhejiang Province. A self-developed IAP monitoring KAP assessment tool was used for evaluation, which included knowledge (14 items), attitude (6 items), and practice (8 items), three dimensions, 28 items.

Results

The overall KAP score was 60.73 ± 8.35; the knowledge score was 7.84 ± 2.35, with a scoring rate of 56.0%; the attitude score was 25.16 ± 3.23, with a scoring rate of 83.9%; and the practice score was 28.44 ± 6.46, with a scoring rate of 69.3%. Nurses wh-o have received IAP monitoring training have higher KAP score, knowledge score and practice score than those who have not received it (P < 0.05). Nurses aged ≤ 30 showed better knowledge of IAP monitoring than those aged > 30 (P < 0.05). Among the participants, 55.7% of the nurses believed the current knowledge was insufficient to perform IAP measurement effectively. Difficulty in identifying the high-risk population of intra-abdominal hypertension (IAH) (64.6%), unfamiliarity with the operation process of IAP measurement (55.6%), and unreasonable nurse-patient ratio allocation (52.8%) were the main obstacles for nurses to monitor IAP.

Conclusions

Pediatric intensive care nurses have a positive attitude towards IAP monitoring, but the knowledge level and practical behavior still need to be strengthened. In particular, the knowledge of published consensus definitions, measurement techniques, and frequency for IAP monitoring is inadequate. It is necessary to implement tailored IAP monitoring training based on their training needs and potential obstacles to promote the standardization and scientificity of IAP monitoring.

Monitoring and Management of Intra-abdominal Pressure in Critically Ill Children

BACKGROUND

Intra-abdominal hypertension is a comorbid condition in critically ill children, is an independent predictor of mortality, and has harmful effects on multiple organ systems through renal, pulmonary or hemodynamic damage. Intra-abdominal pressure monitoring is widely used in clinical practice because it is a safe, accurate, inexpensive, and rapid method for the clinical diagnosis of intra-abdominal hypertension.

OBJECTIVE

To improve pediatric critical care nurses' understanding of and ability to perform intra-abdominal pressure monitoring and provide a reference for standardizing intra-abdominal pressure monitoring in clinical practice.

METHODS

A literature review was performed using the following keywords: intra-abdominal pressure, bladder pressure, vesicular pressure, measurement, monitoring, critically ill children, pediatric intensive care, pediatric, and children. Four hundred fifty-four articles were initially identified and screened; 24 were included.

RESULTS

The monitoring and management of intra-abdominal pressure should include appropriate and clinically proven intra-abdominal pressure measurement techniques, appropriate patients, the proper frequency of measurement, and a repeatable intra-abdominal pressure measurement method.

CONCLUSIONS

Knowledge of intra-abdominal pressure monitoring in critically ill children enhances the ability of nurses in clinical practice to accurately measure intra-abdominal pressure to improve the timeliness and accuracy of clinical identification of intra-abdominal hypertension and guide decompression interventions.

Physicians' Knowledge of Abdominal Compartment Syndrome and Intra-Abdominal Hypertension in Saudi Arabia: An Online Cross-Sectional Survey Study

Objective

To determine physicians' knowledge of abdominal compartment syndrome and intra-abdominal hypertension in Saudi Arabia.

Methods

A cross-sectional online survey study was conducted on physicians in Saudi Arabia between March and August 2022. A previously developed questionnaire was adapted and used in this study. The survey instrument investigated the knowledge and management of intra-abdominal hypertension and abdominal compartment syndrome among physicians. Logistic regression was used to identify predictors of being knowledgeable about abdominal compartment syndrome and intra-abdominal hypertension.

Results

A total of 266 physicians participated in this study. Around one-fifth (21.8%) the study participants were ICU physicians and 25.0% reported that they practice internal medicine. Intra-abdominal hypertension (IAH) and the impact of increased intra-abdominal pressure (IAP) on organ function were terms that the majority of research participants (70.3%) reported they were familiar with. A similar percentage (73.7%) reported that they are familiar with abdominal compartment syndrome (ACS). Around 43.0% of the study participants reported that they do not know how to measure IAP. The most frequently reported (13.5%) intervention in the treatment of IAH and ACS was the use of inotropes or vasopressors. The study participants showed a weak level of knowledge of ACS and IAH with a median score of 3.00 (IQR: 5.00-2.00), which represents 27.3% of the maximum attainable score. Physicians working at hospitals with 20-50 ICU beds were 41.0% (odds ratio: 0.59 (CI: 0.37-0.96)) less likely to be knowledgeable about intra-abdominal hypertension and abdominal compartment syndrome (p≤0.05).

Conclusion

Physicians demonstrated a low level of IAP and ACS knowledge. To increase the safety of medical practices and enhance clinical outcomes for patients, awareness should be raised about the proper diagnosis and management of IAP and ACS. Future research should focus on developing effective educational strategies to improve physicians' understanding of IAP and ACS.

Awareness and management of intra-abdominal hypertension and abdominal compartment syndrome by paediatric intensive care physicians: a national survey

INTRODUCTION

This study aimed to evaluate the current awareness and management of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) among paediatric intensivists.

MATERIAL AND METHODS

A web-based electronic survey was sent to all physicians working in paedia-tric intensive care units (PICUs) in Saudi Arabia. The survey questions obtained information regarding awareness of ACS and IAH, recognition criteria, monitoring of intra-abdominal pressure (IAP), and experience in managing ACS.

RESULTS

A total of 79 physicians responded to the survey (response rate: 53%). Among respondents 48% were consultants. 85% of respondents were familiar with IAP/IAH/ACS. Only 35% and 10% were aware of the Abdominal Compartment Society consensus definitions for IAH and ACS in the paediatric population, respectively. Most respondents considered the cut-off for IAH to be ≥ 15 mm Hg, and approximately two-thirds thought that the cut-off for ACS was higher than the currently suggested consensus definition (10 mm Hg). More than two-thirds of respondents monitored IAP in the PICU, and it was measured almost exclusively via the bladder (96%); the majority (70%) reported that they instilled volumes well above the current recommendations. Medical management was the most frequent therapeutic approach to treat IAH/ACS, while surgical decompression was the least attempted option. Decisions to decompress the abdomen were predominantly based on the presence of organ dysfunction (74.4%).

CONCLUSIONS

This survey showed that although most responding physicians claim to be familiar with IAH and ACS, their knowledge of published consensus definitions, measurement techniques, and clinical management must be updated.

Abdominal compartment syndrome and decompressive laparotomy in children: a 9-year single-center experience

PURPOSE

Abdominal compartment syndrome (ACS) in children results in 100% mortality if left untreated. Decompressive laparotomy (DL) is the only effective treatment if conservative medical therapies have failed. This study aims to determine the incidence of ACS among pediatric patients who underwent an emergency laparotomy (EL), to describe the effect of DL on clinical and laboratory parameters and, to make a better prediction on fatal outcome, to analyze variables and their association with mortality.

METHODS

This retrospective study includes 418 children up to the age of 16 years who underwent EL between January 2010 and December 2018 at our tertiary pediatric referral center. ACS was defined according to the latest guidelines of the World Society of the Abdominal Compartment Syndrome.

RESULTS

Fourteen patients had emergency DL for ACS. 6 h preoperatively; median intra-abdominal pressure (IAP) and abdominal perfusion pressure (APP) were 22.5 mmHg and 29 mmHg, respectively. After DL, IAP decreased and APP increased, both by an average of 60%. Six patients survived, eight patients had a fatal outcome, resulting in a mortality of 57%. An age under 1 year, weight under the 3rd percentile, an open abdomen treatment, an intestinal resection and an elevated serum lactate > 1.8 mmol/L were associated with an increased relative risk of death.

CONCLUSIONS

Improving the outcome in pediatric patients with ACS by removing or attenuating risk factors is difficult. This emphasizes the need for early diagnosis and prompt DL once the diagnosis of ACS is made.

Paediatric abdominal compartment syndrome and shock associated with gastric volvulus improved rapidly by gastric suction in the emergency department

Abdominal compartment syndrome (ACS) is not rare and has a high mortality in the paediatric intensive care unit. However, there are few reports about this in the emergency department (ED). We report an 8 month-old male patient with ACS in shock associated with gastric volvulus who improved rapidly by a simple procedure in the ED. He had congenital comorbidities, including multiple cranial anomalies and was transferred because of decreased mental status. He had compensated shock with cold and mottled skin of the lower extremities, paediatric Glasgow Coma Scale of E3V5M6 and prominence of the left upper abdomen. The abdominal X-ray showed a considerably distended stomach. Soon after aspiration of gastric contents, shock and mental status improved. Physicians should consider ACS in the differential diagnosis of shock with abdominal distention. ACS may be ameliorated by gastric suction. Gastric volvulus can induce shock and decreased mental status, particularly in patients with comorbidities.

Intra-abdominal hypertension and abdominal compartment syndrome in pediatrics. A review

PURPOSE

To consolidate pediatric intensivists' understanding of the pathophysiology, definition, incidence, monitoring, and management of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS); and to highlight the characteristics related to the pediatric population.

METHODS

This is a narrative review article that utilized a systematic search of the medical literature published in the English language between January 1990 and august 2016. Studies were identified by conducting a comprehensive search of Pub Med databases. Search terms included "intra-abdominal hypertension and child", "intra-abdominal hypertension and pediatrics", "abdominal compartment syndrome and child", and "abdominal compartment syndrome and pediatrics".

RESULTS

Intra-abdominal hypertension and ACS are associated with a number of pathophysiological disturbances and increased morbidity and mortality. These conditions have been well described in critically ill adults. In children, the IAH and the ACS have a reported incidence of 13% and 0.6 to 10% respectively; they carry similar prognostic impact but are still under-diagnosed and under-recognized by pediatric health care providers.

CONCLUSIONS

Intra-abdominal hypertension and ACS are conditions that are regularly encountered in critically ill children. They are associated with an increased morbidity and mortality. Early recognition, prevention and timely management of this critical condition are necessary to improve its outcome.

The Role of Routine Measurement of Intra-abdominal Pressure in Preventing Abdominal Compartment Syndrome

Introduction:

Abdomen, a closed compartment, is prone to raised intra-abdominal pressure (IAP) in the postoperative period. After a critical value of ≥ 15 cm of water, IAP produces abdominal compartment syndrome (ACS). ACS leads to reduced venous return, reduced cardiac output, and domino effect of organ dysfunction, leading to death. Hence, it is the need of hour to monitor IAP to pick up intra-abdominal hypertension (IAH) and ACS. This routine facilitates early institution of treatment measures.

Aims and Objectives:

To study IAP in abdominal operations in neonates, infants, and older children and to promote concept of routine measurement of IAP as standard care.

Materials and Methods:

Intravesical route was used to measure IAP in this prospective observational study. Seventy-nine pediatric abdominal surgeries met with criteria of availability of complete data for analysis and formed the cohort of the study. All major, infective, traumatic, tumor-related abdominal surgeries were included in the study. Outcome, C-reactive protein (CRP), procalcitonin, platelet counts, Simplified Sequential Organ Failure Assessment Score, and Acute Physiology and Chronic Health Evaluation II (APACHE II) score were the parameters analyzed. The World Society of ACS grading was adopted in the study with subdivision of normal into low-normal and high-normal subgroups.

Results:

Extended Mantel–Haenszel Chi-square statistical tool when applied for linear relationship showed a linear relationship with outcome (P < 0.05), CRP (P < 0.05), procalcitonin (P < 0.05), Simplified Sequential organ failure Assessment Score, and APACHE II. Platelet counts (P > 0.05) were not significantly correlated. Decision for laparotomy was delayed in cases of ACS.

Conclusion:

Routine measure of IAP facilitates early recognition of IAH. This facilitates therapeutic measures to be initiated to reduce IAP. Early decision to decompress by laparotomy/laparostomy saves lives. Hence, routine IAP measurement should be a part of standard care in pediatric abdominal surgery.

A survey of critical care nurses' knowledge of intra-abdominal hypertension and abdominal compartment syndrome

BACKGROUND

Intra-abdominal hypertension and abdominal compartment syndrome are potentially life threatening conditions. Critical care nurses need to understand the factors that predispose patients to intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS). Predicting and managing IAH and ACS are important to improve health outcomes.

AIM

The aim of this paper was to (1) assess the knowledge of Australian critical care nurses about current IAH and ACS practice guidelines, measurement techniques, predictors for the development of IAH and ACS and (2) identify barriers in recognizing IAH, ACS and measuring IAP.

METHODS

Between October 2014 and April 2015 86 registered nurses employed in the area of critical care were recruited via the form to participate in an on-line, 19-item questionnaire. The survey was distributed to critical care nurses via the Australian College of Critical Care Nurses (ACCCN) mailing list and directly to intensive care units via The majority of participants were women (n=62) all participants were registered nurses employed in critical care the response rate was 3.2%. The study design was used to establish demographic data, employment data, and individuals' knowledge related to IAH and ACS. Participants had the option to write hand written responses in addition to selecting a closed question response.

RESULTS

The results showed that most survey participants were able to identify some obvious causes of IAH. However, less than 20% were able to recognize less apparent indices of risk. A lack of education related to IAP monitoring was identified by nearly half (44.2%) of respondents as the primary barrier to monitoring IAP.

CONCLUSION

Critical care clinicians' knowledge of IAH and ACS is generally low in the areas of presentation and outcomes of IAH and ACS requiring tailored and targeted educational interventions.

Recognition and management of intra-abdominal hypertension and abdominal compartment syndrome; a survey among Dutch surgeons

Purpose

Intra-abdominal hypertension (IAH) and Abdominal compartment syndrome (ACS) are relatively rare, but severe complications. Although many advances were made in recent years, the recognition and management remain subject of debate. The aim of this study was to determine the current state of awareness, knowledge and use of evidence-based medicine regarding IAH and ACS among Dutch surgeons.

Methods

A literature-based and expert consensus survey was developed. One surgeon in every hospital in The Netherlands was asked to complete the online questionnaire.

Results

Sixty of 87 (69 %) invited surgeons completed the questionnaire. Intra-abdominal pressure (IAP) was measured using intra-vesical methods by 55 (98 %) respondents. Diuretics (N = 38; 63 %) and laparotomy (N = 33; 55 %) were considered useful treatments for IAH or prevention of ACS by a majority. Only 16 (27 %) respondents used these guidelines in daily practice, and 37 (62 %) respondents are willing to do so. Although 35 (58 %) surgeons agreed that IAH is only a symptom, not requiring treatment. Forty-one percent of experienced respondents suggested that prevalence of ACS remained unchanged. Nearly all respondents (N = 59; 98 %) believed that open abdomen management improves patient outcomes, many (N = 46; 77 %) confirm the high complications rate of this treatment.

Conclusion

The definitions of IAH and ACS and the related diagnostic and therapeutic challenges are relatively well known by Dutch surgeons. Despite limited use of the evidence-based guidelines, the willingness to do so is high. Most respondents favor open abdomen treatment for patients with imminent ACS, despite the high complication rates associated with this treatment.

Pressure Measurement Techniques for Abdominal Hypertension: Conclusions from an Experimental Model

Introduction. Intra-abdominal pressure (IAP) measurement is an indispensable tool for the diagnosis of abdominal hypertension. Different techniques have been described in the literature and applied in the clinical setting. Methods. A porcine model was created to simulate an abdominal compartment syndrome ranging from baseline IAP to 30 mmHg. Three different measurement techniques were applied, comprising telemetric piezoresistive probes at two different sites (epigastric and pelvic) for direct pressure measurement and intragastric and intravesical probes for indirect measurement. Results. The mean difference between the invasive IAP measurements using telemetric pressure probes and the IVP measurements was -0.58 mmHg. The bias between the invasive IAP measurements and the IGP measurements was 3.8 mmHg. Compared to the realistic results of the intraperitoneal and intravesical measurements, the intragastric data showed a strong tendency towards decreased values. The hydrostatic character of the IAP was eliminated at high-pressure levels. Conclusion. We conclude that intragastric pressure measurement is potentially hazardous and might lead to inaccurately low intra-abdominal pressure values. This may result in missed diagnosis of elevated abdominal pressure or even ACS. The intravesical measurements showed the most accurate values during baseline pressure and both high-pressure plateaus.

Controlled peritoneal drainage improves survival in children with abdominal compartment syndrome

BACKGROUND

Children with massive ascites can develop abdominal compartment syndrome (ACS), which has been identified as an independent risk factor for mortality.

OBJECTIVES

The objective of this study was to assess the effectiveness of volume-controlled percutaneous catheter drainage (PCD) for treating children with massive ascites and ACS.

METHODS

A retrospective descriptive study was conducted; Comprising 12patients with ACS with massive ascites treated with volume-controlled PCD in a pediatric intensive care unitof a university hospital in southern China from April 2011 to June 2013.

RESULTS

The etiology of ascites in these children included abdominal tumor (8/12), capillary leak after liver or kidney transplantation (2/12) and urine leakage (2/12). Intra-abdominal hypertension was closely associated with multiple organ dysfunction and high mortality. Digestive and pulmonary functions were the most frequently affected by ACS, while the cerebrum was the least involved. Treatment with ultrasound-guided PCD significantly decreased intra-abdominal pressure, abdominal circumference, and indices of organ dysfunction. PCD treatment also significantly improved glomerular filtration rate and PaO2/FiO2. Complications of PCD included abdominal infection (1/12) and electrolyte imbalance (4/12). The mortality rate of patients treated with PCD was 25%, which was lower than previous reports.

CONCLUSIONS

Controlled peritoneal drainage is a minimally invasive and safe decompression method that is effective in patients with ACS, and should be considered in children with massive ascites.

Recognition and management of abdominal compartment syndrome among German anesthetists and surgeons: a national survey

BACKGROUND

Abdominal compartment syndrome (ACS) is a life threatening condition that may affect any critically ill patient. Little is known about the recognition and management of ACS in Germany.

METHODS

A questionnaire was mailed to departments of surgery and anesthesia from German hospitals with more than 450 beds.

RESULTS

Replies (113) were received from 222 eligible hospitals (51%). Most respondents (95%) indicated that ACS plays a role in their clinical practice. Intra-abdominal pressure (IAP) is not measured at all by 26%, while it is routinely done by 30%. IAP is mostly (94%) assessed via the intra-vesical route. Of the respondents, 41% only measure IAP in patients expected to develop ACS; 64% states that a simpler, more standardized application of IAP measurement would lead to increased use in daily clinical practice.

CONCLUSIONS

German anesthesiologists and surgeons are familiar with ACS. However, approximately one fourth never measures IAP, and there is considerable uncertainty regarding which patients are at risk as well as how often IAP should be measured in them.

Recognition and management of abdominal compartment syndrome among German pediatric intensivists: results of a national survey

INTRODUCTION

Several decades ago, the beneficial effects of goal-directed therapy, which include decompressive laparotomy (DL) and open abdomen procedures in cases of intra-abdominal hypertension (IAH) in children, were proven in the context of closures of abdominal wall defects and large-for-size organ transplantations. Different neonatologic and pediatric disease patterns are also known to be capable of increasing intra-abdominal pressure (IAP). Nevertheless, a considerable knowledge transfer regarding such risk factors has hardly taken place. When left undetected and untreated, IAH threatens to evolve into abdominal compartment syndrome (ACS), which is accompanied by a mortality rate of up to 60% in children. Therefore, the present study looks at the recognition and knowledge of IAH/ACS among German pediatric intensivists.

METHODS

In June 2010, a questionnaire was mailed to the heads of pediatric intensive care units of 205 German pediatric hospitals.

RESULTS

The response rate was 62%. At least one case of IAH was reported by 36% of respondents; at least one case of ACS, by 25%. Compared with adolescents, younger critically ill children appeared to develop IAH/ACS more often. Routine measurements of IAP were said to be performed by 20% of respondents. Bladder pressure was used most frequently (96%) to assess IAP. Some respondents (17%) only measured IAP in cases of organ dysfunction and failure. In 2009, the year preceding this study, 21% of respondents claimed to have performed a DL. Surgical decompression was indicated if signs of organ dysfunction were present. This was also done in cases of at least grade III IAH (IAP > 15 mmHg) without organ impairment.

CONCLUSIONS

Although awareness among pediatricians appears to have been increasing over the last decade, definitions and guidelines regarding the diagnosis and management of IAH/ACS are not applied uniformly. This variability could express an ever present lack of awareness and solid prospective data.

Pediatric critical care nurses' experience with abdominal compartment syndrome

BACKGROUND

Abdominal compartment syndrome (ACS) is a syndrome associated with multi-system effects of elevated intra-abdominal pressure (IAP) in critically ill children. It has a 90-100% mortality rate if not recognized and treated promptly. Measuring IAP helps identify patients developing intra-abdominal hypertension (IAH) which allows for timely intervention before progression to ACS. IAP helps identify ACS and guides its medical and surgical management. IAP is often measured by the bedside nurse in the intensive care unit. Pediatric critical care nurses (PCCN) play a key role in managing critically ill patients and recognizing potential causes for clinical deterioration such as ACS therefore should be knowledgeable about this entity.

OBJECTIVE

The aim of this study was to assess the awareness and current knowledge of ACS among PCCN.

METHODS

A ten-item written questionnaire was distributed at a National Critical Care Conference in 2006 and again in 2010. Participants of the conference voluntarily completed and immediately returned the survey. Results from the two questionnaires were compared.

RESULTS

Sixty-two percent of 691 questionnaires were completed. The awareness of ACS improved from 69.3% in 2006 to 87.8% in 2010 (p < 0.001) among PCCN. "Years in practice" influenced awareness of ACS. Nurses working for 5-10 and > 10 years were, respectively, 2.34 and 1.89 times more likely to be aware of ACS than those working for < 5 years. Hands-on experience managing a child with ACS by PCCN also improved from 49.1% to 67.9% (p < 0.001) but remains low. The number of participants who never measured IAP fell from 27.3% to 19.1% (p = 0.101). The most common method being used to measure IAP is the bladder method. Knowledge of the definition of ACS remains poor with only 13.2% associating the definition of ACS with organ dysfunction in 2010 which was even lower than in 2006.

CONCLUSIONS

There is increasing awareness of ACS and experience in its management among PCCN. However, few PCCN correctly understand the definition of ACS. Since recognition of IAH and early intervention can reduce morbidity and mortality in critically ill patients, further educational efforts should be directed toward improving the knowledge and recognition of ACS by PCCN.

Abdominal decompression in children

Abdominal compartment syndrome (ACS) increases the risk for mortality in critically ill children. It occurs in association with a wide variety of medical and surgical diagnoses. Management of ACS involves recognizing the development of intra-abdominal hypertension (IAH) by intra-abdominal pressure (IAP) monitoring, treating the underlying cause, and preventing progression to ACS by lowering IAP. When ACS is already present, supporting dysfunctional organs and decreasing IAP to prevent new organ involvement become an additional focus of therapy. Medical management strategies to achieve these goals should be employed but when medical management fails, timely abdominal decompression is essential to reduce the risk of mortality. A literature review was performed to understand the role and outcomes of abdominal decompression among children with ACS. Abdominal decompression appears to have a positive effect on patient survival. However, prospective randomized studies are needed to fully understand the indications and impact of these therapies on survival in children.

Abdominal compartment syndrome caused by massive pyonephrosis in an infant with primary obstructive megaureter

The authors report a case of abdominal compartment syndrome caused by massive pyonephrosis in an infant with primary obstructive megaureter successfully treated with emergency surgical decompression.