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Li Z, Wang H, Lu F. The development, feasibility and credibility of intra-abdominal pressure measurement techniques: A scoping review. PLoS One 2024; 19:e0297982. [PMID: 38512833 PMCID: PMC10956852 DOI: 10.1371/journal.pone.0297982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/14/2024] [Indexed: 03/23/2024] Open
Abstract
AIM To provide a comprehensive overview on emerging direct and alternative methods for intra-abdominal pressure (IAP) measurement techniques. METHODS This was a scoping review study following Arksey and Malley's framework. The PubMed, EMBASE, Web of Science, EBSCO, Scopus and ProQuest databases were searched, and we only considered studies published from 2000 as we have extended the data from two previous reviews. Original studies that reported on the development, feasibility and credibility of IAP measurement techniques were included. RESULTS Forty-two of 9954 screened articles were included. IAP measurement techniques include three major categories: direct, indirect and less invasive measurement techniques. Agreement analyses were performed in most studies, and some explored the safety, time expenditure and reproducibility of IAP measurement techniques. CONCLUSIONS Clinical data assessing the validation of new IAP measurement techniques or the reliability of established measurement techniques remain lacking. Considering the cost and invasiveness, direct measurement is not recommended as a routine method for IAP measurement and should be preserved for critically ill patients where standard techniques are contraindicated or could be inaccurate. The measurement accuracy, reliability and sensitivity of the transrectal and transfemoral vein methods remain insufficient and cannot be recommended as surrogate IAP measures. Transvesical measurement is the most widely used method, which is the potentially most easy applicable technique and can be used as a reliable method for continuous and intermittent IAP measurement. Wireless transvaginal method facilitates the quantitative IAP measurement during exercise and activity, which laying the foundations for monitoring IAP outside of the clinic environment, but the accuracy of this technique in measuring absolute IAP cannot be determined at present. Less invasive technology will become a new trend to measure IAP and has substantial potential to replace traditional IAP measurement technologies, but further validation and standardization are still needed. Medical professionals should choose appropriate measurement tools based on the advantages and disadvantages of each IAP technique in combination with assessing specific clinical situations.
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Affiliation(s)
- ZhiRu Li
- Nursing Department, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - HuaFen Wang
- Nursing Department, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - FangYan Lu
- Hepatobiliary and pancreatic surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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A Retrospective, Observational Study of Catheter-Associated Urinary Tract Infection Events Post-Implementation of a Novel Urinary Catheter System with Active Drain Line Clearance and Automated Intra-Abdominal Pressure Monitoring. Life (Basel) 2022; 12:life12121950. [PMID: 36556315 PMCID: PMC9782014 DOI: 10.3390/life12121950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 10/30/2022] [Accepted: 11/12/2022] [Indexed: 11/24/2022] Open
Abstract
Objective: A quality improvement study to assess catheter-associated urinary tract infection (CAUTI) rate post-implementation of a bladder catheter with integrated active drain line urine clearance and automated intra-abdominal pressure monitoring in a burn intensive care unit (ICU). DESIGN: Eight-year retrospective before and after study (2015−2022). Setting: A single American Burn Association-verified Burn Center with 14 inpatient beds. Patients: Patients meeting criteria for admission to a Burn Center. Methods: Retrospective cohort study following the implementation of a novel urine output monitoring system with integrated drain line and urine clearance. Data from a 48-month (from January 2015−December 2018) historical control (period 1) were compared to data from a 28-month (from January 2020 to April 2022) post-implementation period (period 2). Pre- and post-implementation CAUTI event incidences were compared. Patients were transferred from outside hospitals with gravity bladder. A distinction in the chart between catheter types was impossible. Charts were reviewed to characterize patients with CAUTI events. Results: A total of 42 CAUTIs in 2243 patients were identified using the National Health and Safety Network (NHSN) definition during the analyzed period. There were 40 CAUTI events in period 1 and two CAUTIs in period 2. The incidence of CAUTI events pre-implementation was 0.030 (mean of 10 CAUTI events per year) compared to 0.002 (mean of 1 CAUTI event per year) post-implementation of an automatic drain line clearing UO monitoring system showing a significant reduction in CAUTI events (p < 0.01, risk ratio novel vs. gravity bladder catheter 0.071, 95% confidence interval: 0.017−0.294). Conclusions: CAUTIs were reduced in the period following the implementation of a novel urinary catheter system with an integrated active drain line and urine clearance in burn patients.
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Rubio-Gracia J, Crespo-Aznarez S, De la Espriella R, Nuñez G, Sánchez-Marteles M, Garcés-Horna V, Yanguas-Barea N, Josa-Laorden C, Cobo-Marcos M, Giménez-López I, Pérez-Calvo JI, Nuñez J. Utility of plasma CA125 as a proxy of intra-abdominal pressure in patients with acute heart failure. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2022; 11:453-460. [PMID: 35512321 DOI: 10.1093/ehjacc/zuac046] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 04/11/2022] [Accepted: 04/12/2022] [Indexed: 06/14/2023]
Abstract
AIMS Increased intra-abdominal pressure (IAP) is now considered a potential contributor to organ damage and disease progression in acute heart failure (AHF). In this work, we aimed to determine if antigen carbohydrate 125 (CA125) is associated with IAP and to identify a cutpoint of CA125 useful for ruling out intra-abdominal hypertension (defined as IAP ≥ 12 mmHg). METHODS AND RESULTS We prospectively evaluated a cohort of 53 patients admitted with AHF in which IAP was measured within the first 24-h of admission. The mean age was 80 ± 8 years, 31 (58.5%) were female, and 31 (58.5%) had left ventricular ejection fraction ≥50%. The median plasma levels of NT-proBNP and CA125 were 3830 pg/mL (2417-8929) and 45.8 U/mL (29.8-114.0), respectively. The median of IAP was 15 mmHg (11-17), and 39 (73%) patients had an IAP ≥ 12 mmHg. The diagnostic performance of CA125 for identifying an IAP ≥ 12 mmHg was tested using the receiving operating characteristic (ROC) curve. The cut-off for CA125 of 17.1 U/mL showed a sensitivity of 92%, a specificity of 50%, and an area under the ROC curve of 0.71. After multivariate adjustment, CA125 remained non-linearly and positively associated with higher IAP (P-value = 0.003), explaining almost 28% of the model's variability (R2: 27.6%). CONCLUSIONS Patients with AHF and intra-abdominal hypertension had higher CA125 plasma levels. A baseline concentration of CA125 below 17.1 U/mL will increase the odds of identifying a subset of patients with normal IAP.
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Affiliation(s)
- Jorge Rubio-Gracia
- Internal Medicine Department, Hospital Clínico Universitario 'Lozano Blesa', Avda. San Juan Bosco no 15, 50009 Zaragoza, Spain
- Instituto Investigación Sanitaria Aragón, Zaragoza, Spain
| | - Silvia Crespo-Aznarez
- Internal Medicine Department, Hospital Clínico Universitario 'Lozano Blesa', Avda. San Juan Bosco no 15, 50009 Zaragoza, Spain
- Instituto Investigación Sanitaria Aragón, Zaragoza, Spain
| | - Rafael De la Espriella
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Departamento de Medicina, Universitat de València, Valencia, Spain
| | - Gonzalo Nuñez
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Departamento de Medicina, Universitat de València, Valencia, Spain
| | - Marta Sánchez-Marteles
- Internal Medicine Department, Hospital Clínico Universitario 'Lozano Blesa', Avda. San Juan Bosco no 15, 50009 Zaragoza, Spain
- Instituto Investigación Sanitaria Aragón, Zaragoza, Spain
| | - Vanesa Garcés-Horna
- Internal Medicine Department, Hospital Clínico Universitario 'Lozano Blesa', Avda. San Juan Bosco no 15, 50009 Zaragoza, Spain
- Instituto Investigación Sanitaria Aragón, Zaragoza, Spain
| | - Nerea Yanguas-Barea
- Radiology Department, Hospital Clínico Universitario 'Lozano Blesa', Zaragoza, Spain
| | - Claudia Josa-Laorden
- Internal Medicine Department, Hospital Clínico Universitario 'Lozano Blesa', Avda. San Juan Bosco no 15, 50009 Zaragoza, Spain
- Instituto Investigación Sanitaria Aragón, Zaragoza, Spain
| | | | - Ignacio Giménez-López
- Instituto Investigación Sanitaria Aragón, Zaragoza, Spain
- Facultad de Medicina, Universidad de Zaragoza, Zaragoza, Spain
- Instituto Aragonés de Ciencias de la Salud (IACS), Zaragoza, Spain
| | - Juan Ignacio Pérez-Calvo
- Internal Medicine Department, Hospital Clínico Universitario 'Lozano Blesa', Avda. San Juan Bosco no 15, 50009 Zaragoza, Spain
- Instituto Investigación Sanitaria Aragón, Zaragoza, Spain
- Facultad de Medicina, Universidad de Zaragoza, Zaragoza, Spain
| | - Julio Nuñez
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Departamento de Medicina, Universitat de València, Valencia, Spain
- CIBER in Cardiovascular Diseases (CIBERCV), Madrid, Spain
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Intra-abdominal hypertension and abdominal compartment syndrome. Curr Probl Surg 2021; 58:100971. [PMID: 34836571 DOI: 10.1016/j.cpsurg.2021.100971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 02/10/2021] [Indexed: 11/21/2022]
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Kühn A, Fuchs C, Hahnenkamp K. [Intra-abdominal pressure measurement]. Dtsch Med Wochenschr 2021; 146:1211-1217. [PMID: 34521127 DOI: 10.1055/a-1287-5112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
An elevated intra-abdominal pressure (IAP) above 12 mmHg is a pathological finding in critically ill patients. IAP are classified into different degrees of intra-abdominal hypertension and, in the presence of associated organ failure, as abdominal compartment syndrome. Both disease entities represent an underestimated factor in intensive care patients and are associated with increased mortality and prolonged intensive care and hospital stay. The measurement of intra-abdominal pressure in critically ill patients in intensive care units is not widely established and there is often considerable uncertainty regarding measurement conditions and methods. If risk factors are present, intra-abdominal pressure should be monitored every 4 hours. Bladder pressure measurement is the gold standard for determining intra-abdominal pressure. The measurement is a non-invasive, cost-effective, easy to perform bedside and safe method for the patient.
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Jiang H, Woodhouse I, Selvamani V, Ma JL, Tang R, Goergen CJ, Soleimani T, Rahimi R. A Wireless Implantable Passive Intra-Abdominal Pressure Sensing Scheme via Ultrasonic Imaging of a Microfluidic Device. IEEE Trans Biomed Eng 2021; 68:747-758. [PMID: 32780694 DOI: 10.1109/tbme.2020.3015485] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In this article, we demonstrate a wireless and passive physiological pressure sensing scheme that utilizes ultrasound imaging of an implantable microfluidic based pressure sensitive transducer. The transducer consists of a sub-mm scale pressure sensitive membrane that covers a reservoir filled with water and is connected to a hydrophobic micro-channel. Applied pressure onto the transducer deflects the membrane and pushes the water from the reservoir into the channel; the water's travelling distance in the channel is a function of the applied pressure, which is quantitatively measured by using a 40 MHz ultrasound imaging system. The sensor presents a linear sensitivity of 42 kPa/mm and a spatial resolution of 1.2 kPa/30 μm in the physiological range of abdominal compartment syndrome. Reliability assessments of the transducer confirm its ability to remain functional after more than 600 cycles of pressure up to 55 kPa over the course of 2 days. Ex vivo experimental results verify the practical capability of the technology to effectively measure pressures under a 15 mm thick porcine skin. It is anticipated that this technology can be applied to a broad range of implantable pressure measurement, by simply tuning the thickness of the thin polydimethylsiloxane membrane and the geometry of the reservoir.
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Abstract
OBJECTIVE Acute pancreatitis can usually recover after conservative treatment. Five to 10 percent of acute pancreatitis may proceed into peripancreatic fluid collection and necrosis development, called necrotizing pancreatitis (NP), which has a high mortality rate. If it is accompanied by the occurrence of abdominal compartment syndrome (ACS) and does not respond to medical therapy, surgical intervention is indicated. METHODS We analyzed our experience of surgical intervention strategies for NP patients with medically irreversible ACS from January 1, 2004, to December 31, 2018. RESULTS Of the 47 NP patients with ACS, mean Ranson score was 6.5, mean Acute Physiology and Chronic Health Evaluation II score was 22.2, and Modified computed tomography severity index score was all 8 or greater. The mean total postoperative hospital length of stay was 80.2 days, of which the mean intensive care unit length of stay was 16.6 days. The overall complication rate was 31.9%. The mortality rate was 8.5%. Among the 47 patients, only fungemia was significantly associated with mortality incidence. CONCLUSIONS The combination of multiple drainage tube placement, feeding jejunostomy, and ileostomy at the same time were effective surgical intervention strategies for NP patients with ACS, which brought a lower mortality rate.
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Gorad K, Prabhu V. A Study of Intra-abdominal Pressure Measurement Using a New Innovative Technique with Foley's Catheter. MEDICAL JOURNAL OF DR. D.Y. PATIL VIDYAPEETH 2021. [DOI: 10.4103/mjdrdypu.mjdrdypu_544_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Lee RK, Gallagher JJ, Ejike JC, Hunt L. Intra-abdominal Hypertension and the Open Abdomen: Nursing Guidelines From the Abdominal Compartment Society. Crit Care Nurse 2020; 40:13-26. [PMID: 32006038 DOI: 10.4037/ccn2020772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Intra-abdominal hypertension has been identified as an independent risk factor for death in critically ill patients. Known risk factors for intra-abdominal hypertension indicate that intra-abdominal pressures should be measured and monitored. The Abdominal Compartment Society has identified medical and surgical interventions to relieve intra-abdominal hypertension or to manage the open abdomen if abdominal compartment syndrome occurs. The purpose of this article is to describe assessments and interventions for managing intra-abdominal hypertension and open abdomen that are within the scope of practice for direct-care nurses. These guidelines provide direction to critical care nurses caring for these patients.
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Affiliation(s)
- Rosemary K Lee
- Rosemary K. Lee is an acute care nurse practitioner and clinical nurse specialist at Baptist Health South Florida, Coral Gables, Florida
| | - John J Gallagher
- John J. Gallagher is a clinical nurse specialist and trauma program coordinator, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania
| | - Janeth Chiaka Ejike
- Janeth Chiaka Ejike is an associate professor of pediatrics, pediatric critical care medicine practitioner, and Program Director of the Pediatric Critical Care Medicine Fellowship at Loma Linda University Children's Hospital, Loma Linda, California
| | - Leanne Hunt
- Leanne Hunt is a senior lecturer at Western Sydney University and a registered nurse at Liverpool Hospital, Sydney, Australia
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de Paula VB, Canola PA, Rivera GG, Z. Filho D, Amaral GPD, Ferraz GC, Ferraudo AS, Canola JC. Intrabladder pressure as predictor of intra-abdominal pressure in horses. PLoS One 2019; 14:e0223705. [PMID: 31600317 PMCID: PMC6786750 DOI: 10.1371/journal.pone.0223705] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 09/27/2019] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES To investigate effects of postural changes and bladder distention on intrabladder pressure whilst estimating intra-abdominal pressure in horses. DESIGN Two-year cohort study. Patients admitted for elective surgical procedures unrelated to gastrointestinal or genitourinary tract. SETTING School of Agricultural and Veterinarian Sciences, Jaboticabal, SP, Brazil. ANIMALS 20 adult horses, 11 males (stallions and geldings) and 9 females; between 3.5 and 12 years, weighing 350 to 500 kg. INTERVENTIONS Intra-abdominal pressure was directly-recorded through abdominocentesis at the ventral midline with a fluid-filled system. Intrabladder pressure was obtained from a bladder catheter with the fluid-filled system zeroed at the level of the tuber ischia with patients in dorsal recumbency or pubic symphysis if in lateral recumbency. MEASUREMENTS AND MAIN RESULTS Body position directly influenced intra-abdominal pressure. In dorsal recumbency, intra-abdominal pressure differed (p < 0.05) from intrabladder pressure at end-inspiration and end-expiration regardless of whether the bladder was empty or distended. There was no correlation nor association between the two pressures in this body position. In lateral recumbency a difference (p <0.05) between intra-abdominal pressure and intrabladder pressure was recorded at end-inspiration with the bladder distended with 25 ml, and at end-expiration for distension volumes of 25 ml and 50 ml. There was a strong correlation between both pressures for left and right lateral recumbency, regardless of the distension volume. Ordinary least product (OLP) regression analysis showed no fixed or proportional bias between both pressures for distension volume of 50 ml, at both end-inspiration and end-expiration. CONCLUSIONS Indirect assessment of equine intra-abdominal pressure cannot be made in dorsal recumbency. For that purpose, patients should be in left lateral recumbency with the bladder distended with 50 ml. Values can be recorded at end-inspiration or end-expiration. RESTRICTION Occlusion of the catheter tip by the bladder wall when minimally distended.
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Affiliation(s)
- Vanessa B. de Paula
- Graduate Program in Veterinary Surgery, São Paulo State University (Unesp), School of Agricultural and Veterinarian Sciences, Jaboticabal, SP, Brazil
| | - Paulo A. Canola
- Department of Veterinary Medicine and Surgery, São Paulo State University (Unesp), School of Agricultural and Veterinarian Sciences, Jaboticabal, SP, Brazil
- * E-mail:
| | - Gabriela G. Rivera
- Graduate Program in Veterinary Surgery, São Paulo State University (Unesp), School of Agricultural and Veterinarian Sciences, Jaboticabal, SP, Brazil
| | - Dárcio Z. Filho
- Graduate Program in Veterinary Surgery, São Paulo State University (Unesp), School of Agricultural and Veterinarian Sciences, Jaboticabal, SP, Brazil
| | - Gabriel P. D. Amaral
- Residency Program in Large Animal Surgery, São Paulo State University (Unesp), School of Agricultural and Veterinarian Sciences, Jaboticabal, SP, Brazil
| | - Guilherme C. Ferraz
- Department of Animal Morphology and Physiology, São Paulo State University (Unesp), School of Agricultural and Veterinarian Sciences, Jaboticabal, SP, Brazil
| | - Antônio S. Ferraudo
- Department of Exact Sciences, São Paulo State University (Unesp), School of Agricultural and Veterinarian Sciences, Jaboticabal, SP, Brazil
| | - Júlio C. Canola
- Department of Veterinary Medicine and Surgery, São Paulo State University (Unesp), School of Agricultural and Veterinarian Sciences, Jaboticabal, SP, Brazil
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Bouveresse S, Piton G, Badet N, Besch G, Pili-Floury S, Delabrousse E. Abdominal compartment syndrome and intra-abdominal hypertension in critically ill patients: diagnostic value of computed tomography. Eur Radiol 2019; 29:3839-3846. [PMID: 30737569 DOI: 10.1007/s00330-018-5994-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 12/05/2018] [Accepted: 12/28/2018] [Indexed: 12/11/2022]
Abstract
AIMS The aims of the present work were to reevaluate, prospectively, the diagnostic value of already-described computed tomography (CT) landmarks of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) and to study the diagnostic value of some undescribed CT signs for the diagnosis of IAH and ACS. MATERIALS AND METHODS Consecutive patients admitted to the intensive care unit (ICU) in shock for whom an abdominal CT was clinically indicated were included. CT examinations were reviewed and scored by two reviewers for the 12 proposed CT features of IAH and ACS. Intravesical pressure (IVP) was measured for each patient. Imaging features and clinical data of patients with IAH (IVP ≥ 12 mmHg) were compared to those of patients with normal intra-abdominal pressure (IVP < 12 mmHg). RESULTS Forty-one patients were included. Twenty-one patients (51%) presented IAH with an IVP value ≥ 12 mmHg. Four patients (10%) were considered to have ACS (10%). Only an increased peritoneal-to-abdominal height ratio (PAR) was associated with the presence of IAH (PAR = 0.45 [0.40-0.49] in patients with IVP < 12 mmHg and PAR = 0.52 [0.48-0.53] in patients with IVP ≥ 12 mmHg; p < 0.001). Increased PAR ≥ 0.52 had a specificity of 85% for IAH diagnosis. CONCLUSION The present study suggests that a PAR ≥ 0.52 could help radiologists to identify IAH on abdominal CT scan and could lead to adequate identification and/or treatment, even at early stages of IAH. KEY POINTS • CT is an efficient first-intention procedure to evaluate and follow up underlying conditions in critically ill patients at risk of IAH and ACS overcome. • Raising the possibility of an IAH on a CT examination is relevant information for the clinician. • The only factors associated with intra-abdominal hypertension were the peritoneal-to-abdominal height ratio (PAR) and the ratio of maximal anteroposterior to transverse abdominal diameter (which define the round belly sign when > 0.8).
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Affiliation(s)
- S Bouveresse
- Department of Radiology, University Hospital, 3 Boulevard Fleming, 25030, Besançon, France
| | - G Piton
- Department of Medical Intensive Care, University Hospital, 3 Boulevard Fleming, 25030, Besançon, France
| | - N Badet
- Department of Radiology, University Hospital, 3 Boulevard Fleming, 25030, Besançon, France
| | - G Besch
- Department of Surgical Intensive Care, University Hospital, 3 Boulevard Fleming, 25030, Besançon, France
| | - S Pili-Floury
- Department of Surgical Intensive Care, University Hospital, 3 Boulevard Fleming, 25030, Besançon, France
| | - E Delabrousse
- Department of Radiology, University Hospital, 3 Boulevard Fleming, 25030, Besançon, France.
- EA 4662 Nanomedicine Lab, Imagery and Therapeutics, University of Franche-Comté, Besançon, France.
- Service de Radiologie Viscérale, CHRU Besançon, Hôpital Jean Minjoz, 3 Boulevard Fleming, 25030, Besançon, France.
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Seternes A, Rekstad LC, Mo S, Klepstad P, Halvorsen DL, Dahl T, Björck M, Wibe A. Open Abdomen Treated with Negative Pressure Wound Therapy: Indications, Management and Survival. World J Surg 2017; 41:152-161. [PMID: 27541031 DOI: 10.1007/s00268-016-3694-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Open abdomen treatment (OAT) is a significant burden for patients and is associated with considerable mortality. The primary aim of this study was to report survival and cause of mortality after OAT. Secondary aims were to evaluate length of stay (LOS) in intensive care unit (ICU) and in hospital, time to abdominal closure and major complications. METHODS Retrospective review of prospectively registered patients undergoing OAT between October 2006 and June 2014 at Trondheim University Hospital, Norway. RESULTS The 118 patients with OAT had a median age of 63 (20-88) years. OAT indications were abdominal compartment syndrome (ACS) (n = 53), prophylactic (n = 29), abdominal contamination/second look laparotomy (n = 22), necrotizing fasciitis (n = 7), hemorrhage packing (n = 4) and full-thickness wound dehiscence (n = 3). Eight percent were trauma patients. Vacuum-assisted wound closure (VAWC) with mesh-mediated traction (VAWCM) was used in 92 (78 %) patients, the remaining 26 (22 %) had VAWC only. Per-protocol primary fascial closure rate was 84 %. Median time to abdominal closure was 12 days (1-143). LOS in the ICU was 15 (1-89), and in hospital 29 (1-246) days. Eighty-one (68 %) patients survived the hospital stay. Renal failure requiring renal replacement therapy (RRT) (OR 3.9, 95 % CI 1.37-11.11), ACS (OR 3.1, 95 % CI 1.19-8.29) and advanced age (OR 1.045, 95 % CI 1.004-1.088) were independent predictors of mortality in multivariate analysis. The nine patients with an entero-atmospheric fistula (EAF) survived. CONCLUSION Two-thirds of the patients treated with OAT survived. Renal failure with RRT, ACS and advanced age were predictors of mortality, whereas EAF was not associated with increased mortality.
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Affiliation(s)
- A Seternes
- Departments of Vascular Surgery, St. Olavs Hospital, Trondheim University Hospital, Prinsesse Kristinas gate 3, 7006, Trondheim, Norway. .,Departments of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Høgskoleringen 1, 7491, Trondheim, Norway. .,Departments of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), 7006, Trondheim, Norway.
| | - L C Rekstad
- Departments of Gastrointestinal Surgery, St. Olavs Hospital, Trondheim University Hospital, Prinsesse Kristinas gate 3, 7006, Trondheim, Norway
| | - S Mo
- Departments of Anesthesiology and Intensive Care Medicine, St. Olavs Hospital, Trondheim University Hospital, Prinsesse Kristinas gate 3, 7006, Trondheim, Norway
| | - P Klepstad
- Departments of Anesthesiology and Intensive Care Medicine, St. Olavs Hospital, Trondheim University Hospital, Prinsesse Kristinas gate 3, 7006, Trondheim, Norway.,Departments of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), 7006, Trondheim, Norway
| | - D L Halvorsen
- Departments of Urologic Surgery, St. Olavs Hospital, Trondheim University Hospital, Prinsesse Kristinas gate 3, 7006, Trondheim, Norway
| | - T Dahl
- Departments of Vascular Surgery, St. Olavs Hospital, Trondheim University Hospital, Prinsesse Kristinas gate 3, 7006, Trondheim, Norway.,Departments of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), 7006, Trondheim, Norway
| | - M Björck
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, 751 85, Uppsala, Sweden
| | - A Wibe
- Departments of Gastrointestinal Surgery, St. Olavs Hospital, Trondheim University Hospital, Prinsesse Kristinas gate 3, 7006, Trondheim, Norway.,Departments of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Høgskoleringen 1, 7491, Trondheim, Norway
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Intraabdominal Hypertension, Abdominal Compartment Syndrome, and the Open Abdomen. Chest 2017; 153:238-250. [PMID: 28780148 DOI: 10.1016/j.chest.2017.07.023] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 06/27/2017] [Accepted: 07/18/2017] [Indexed: 12/11/2022] Open
Abstract
Abdominal compartment syndrome (ACS) is the end point of a process whereby massive interstitial swelling in the abdomen or rapid development of a space-filling lesion in the abdomen (such as ascites or a hematoma) leads to pathologically increased pressure. This results in so-called intraabdominal hypertension (IAH), causing decreased perfusion of the kidneys and abdominal viscera and possible difficulties with ventilation and maintenance of cardiac output. These effects contribute to a cascade of ischemia and multiple organ dysfunction with high mortality. A few primary disease processes traditionally requiring large-volume crystalloid resuscitation account for most cases of IAH and ACS. Once IAH is recognized, nonsurgical steps to decrease intraabdominal pressure (IAP) can be undertaken (diuresis/dialysis, evacuation of intraluminal bowel contents, and sedation), although the clinical benefit of such therapies remains largely conjectural. Surgical decompression with midline laparotomy is the standard ultimate treatment once ACS with organ dysfunction is established. There is minimal primary literature on the pathophysiological underpinnings of IAH and ACS and few prospective randomized trials evaluating their treatment or prevention; this concise review therefore provides only brief summaries of these topics. Many modern studies nominally dealing with IAH or ACS are simply epidemiologic surveys on their incidence, so this paper summarizes the incidence of IAH and ACS in a variety of disease states. Especially emphasized is the fact that modern critical care paradigms emphasize rational limitations to fluid resuscitation, which may have contributed to an apparent decrease in ACS among critically ill patients.
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Muresan M, Muresan S, Brinzaniuc K, Voidazan S, Sala D, Jimborean O, Hussam AH, Bara T, Popescu G, Borz C, Neagoe R. How much does decompressive laparotomy reduce the mortality rate in primary abdominal compartment syndrome?: A single-center prospective study on 66 patients. Medicine (Baltimore) 2017; 96:e6006. [PMID: 28151898 PMCID: PMC5293461 DOI: 10.1097/md.0000000000006006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Revised: 01/03/2017] [Accepted: 01/03/2017] [Indexed: 11/26/2022] Open
Abstract
Contribution of decompressive laparotomy within the framework of the complex therapeutic algorithm of abdominal compartment syndrome (ACS) is cited with an extremely heterogeneous percentage in terms of survival. The purpose of this study was to present new data regarding contribution of each therapeutic step toward decreasing the mortality of this syndrome.This is a longitudinal prospective study including 134 patients with risk factors for ACS. The intra-abdominal pressure was measured every hour indirectly based on transvesical approach and the appearance of organ dysfunction. Specific therapy for ACS was based on the 2013 World Society of Abdominal Compartment Syndrome guidelines, which include laparotomy decompression. Management of the temporarily open abdomen included an assisted vacuum wound therapy.Of 134 patients, 66 developed ACS. The average intra-abdominal pressure significantly decreased after therapy and decompression surgery. The overall rate of mortality was 27.3% with statistical significance in necrotizing infected pancreatitis. Surgical decompression performed within the first 24 hours after the onset of ACS had a protective role against mortality (odds ratio <1). The average time after which laparotomy decompression was performed was 16.23 hours. The complications occurred during TAC were 2 wound suppurations and 1 intestinal obstruction. Wound suppurations evolved favorably by using vacuum wound-assisted therapy associated with the general treatment, whereas for occlusion, resurgery was performed after which adhesions dissolved. The final closure of the abdomen was performed at a mean of 11.7 days (min. = 9, max. = 14). The closure type was primary suture of the musculoaponeurotic edges in 4 cases, and the use of dual mesh in the other 11 cases.The highest mortality rate in the study group was registered in patients with necrotizing pancreatitis and the lowest in trauma group. Surgical decompression within the framework of the complex algorithm treatment of ACS contributed to the reduction of mortality by 8.7%. It is extremely important that the elapsed time since the initiation of the ACS until the surgical decompression is minimal (under 24 hours).
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Affiliation(s)
| | | | | | | | | | | | - Al Husseim Hussam
- Cardiovascular Surgery Clinic, University of Medicine and Pharmacy of Tirgu Mures, Tirgu Mures, Romania
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Holodinsky JK, Roberts DJ, Ball CG, Blaser AR, Starkopf J, Zygun DA, Stelfox HT, Malbrain ML, Jaeschke RC, Kirkpatrick AW. Risk factors for intra-abdominal hypertension and abdominal compartment syndrome among adult intensive care unit patients: a systematic review and meta-analysis. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2013; 17:R249. [PMID: 24144138 PMCID: PMC4057241 DOI: 10.1186/cc13075] [Citation(s) in RCA: 126] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 09/25/2013] [Indexed: 02/08/2023]
Abstract
Introduction Although intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are associated with substantial morbidity and mortality among critically ill adults, it remains unknown if prevention or treatment of these conditions improves patient outcomes. We sought to identify evidence-based risk factors for IAH and ACS in order to guide identification of the source population for future IAH/ACS treatment trials and to stratify patients into risk groups based on prognosis. Methods We searched electronic bibliographic databases (MEDLINE, EMBASE, PubMed, and the Cochrane Database from 1950 until January 21, 2013) and reference lists of included articles for observational studies reporting risk factors for IAH or ACS among adult ICU patients. Identified risk factors were summarized using formal narrative synthesis techniques alongside a random effects meta-analysis. Results Among 1,224 citations identified, 14 studies enrolling 2,500 patients were included. The 38 identified risk factors for IAH and 24 for ACS could be clustered into three themes and eight subthemes. Large volume crystalloid resuscitation, the respiratory status of the patient, and shock/hypotension were common risk factors for IAH and ACS that transcended across presenting patient populations. Risk factors with pooled evidence supporting an increased risk for IAH among mixed ICU patients included obesity (four studies; odds ratio (OR) 5.10; 95% confidence interval (CI), 1.92 to 13.58), sepsis (two studies; OR 2.38; 95% CI, 1.34 to 4.23), abdominal surgery (four studies; OR 1.93; 95% CI, 1.30 to 2.85), ileus (two studies; OR 2.05; 95% CI, 1.40 to 2.98), and large volume fluid resuscitation (two studies; OR 2.17; 95% CI, 1.30 to 3.63). Among trauma and surgical patients, large volume crystalloid resuscitation and markers of shock/hypotension and metabolic derangement/organ failure were risk factors for IAH and ACS while increased disease severity scores and elevated creatinine were risk factors for ACS in severe acute pancreatitis patients. Conclusions Although several IAH/ACS risk factors transcend across presenting patient diagnoses, some appear specific to the population under study. As our findings were somewhat limited by included study methodology, the risk factors reported in this study should be considered candidate risk factors until confirmed by a large prospective multi-centre observational study.
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Petejova N, Martinek A. Acute kidney injury following acute pancreatitis: A review. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2013; 157:105-13. [PMID: 23774848 DOI: 10.5507/bp.2013.048] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 06/07/2013] [Indexed: 02/07/2023] Open
Abstract
UNLABELLED BACKROUND. Acute kidney injury (AKI) is a common serious complication of severe acute pancreatitis (SAP) and an important marker of morbidity and mortality in critically ill septic patients. AKI due to severe acute pancreatitis can be the result of hypoxemia, release of pancreatic amylase from the injured pancreas with impairment of renal microcirculation, decrease in renal perfusion pressure due to abdominal compartment syndrome, intraabdominal hypertension or hypovolemia. Endotoxins and reactive oxygen species (ROS) also play an important role in the pathophysiology of SAP and AKI. Knowledge of the pathophysiology and diagnosis of AKI following SAP might improve the therapeutic outcome of critically ill patients. METHODS AND RESULTS An overview of the pathophysiology, diagnosis and potential treatment options based on a literature search of clinical human and experimental studies from 1987 to 2013. CONCLUSIONS Early recognition of AKI and SAP in order to prevent severe complication like septic shock, intraabdominal hypertension or abdominal compartment syndrome leading to multiple organ dysfunction syndrome is a crucial tool of therapeutic measures in intensive care.
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Affiliation(s)
- Nadezda Petejova
- Department of Internal Medicine, University Hospital Ostrava and Faculty of Medicine, University of Ostrava, Czech Republic.
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Malbrain ML, De laet IE, De Waele JJ, Kirkpatrick AW. Intra-abdominal hypertension: Definitions, monitoring, interpretation and management. Best Pract Res Clin Anaesthesiol 2013; 27:249-70. [DOI: 10.1016/j.bpa.2013.06.009] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 06/28/2013] [Indexed: 02/01/2023]
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