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Arruda Correia ML, Peixoto Filho FM, Gomes Júnior SC, Peixoto MVM. Effects of intra-abdominal hypertension on maternal-fetal outcomes in term pregnant women: A systematic review. PLoS One 2023; 18:e0280869. [PMID: 37368887 DOI: 10.1371/journal.pone.0280869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 01/10/2023] [Indexed: 06/29/2023] Open
Abstract
OBJECTIVE To carry out a systematic review to assess the effects of intra-abdominal hypertension on maternal-fetal outcomes. METHODS The search was carried out between 28th June to 4th July 2022 on the Biblioteca Virtual em Saúde, Pubmed, Embase, Web of Science, and Cochrane databases. The study was registered in PROSPERO (CRD42020206526). The systematic review was performed according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. To assess the methodological quality and control the risk of bias, New Castle was used. RESULTS A total of 6203 articles were found. Of these, 5 met the selection criteria for a full reading. The selected studies included a total of 271 pregnant women, of which 242 underwent elective cesarean section and measurement of intra-abdominal pressure via a bladder catheter. In both pregnant women groups, the lowest intra-abdominal pressure values were found in the supine position with left lateral tilt. Prepartum values in normotensive women with singleton pregnancy (7.3±1.3 to 14.1 ± 1 mmHg) were lower than in gestational hypertensive disorders (12.0±3.3 to 18.3±2.6 mmHg). In postpartum, the values decreased in both groups but were even lower in normotensive women (3.7±0.8 to 9.9 ± 2.6 mmHg vs 8.5 ± 3.6 to 13.6 ± 3.3 mmHg). The same was true for twin pregnancies. The Sequential Organ Failure Assessment index ranged from 0.6 (0.5) to 0.9 (0.7) in both groups of pregnant women. The placental malondialdehyde levels were statistically (p < 0.05) higher in pregnant women with pre-eclampsia (2.52±1.05) than normotensive (1.42±0.54). CONCLUSIONS Prepartum intra-abdominal pressure values in normotensive women were close or equal to intra-abdominal hypertension and compatible with gestational hypertensive disorders even in the postpartum period. IAP values were consistently lower in supine position with lateral tilt in both groups. Significant correlations were found between prematurity, low birth weight, pregnant women with hypertensive disorders, and increased intra-abdominal pressure. However, there was no significant association of dysfunction in any system in the relationship between intra-abdominal pressure and Sequential Organ Failure Assessment. Despite the higher malondialdehyde values in pregnant women with pre-eclampsia, the findings were inconclusive. Given the observed data on maternal and fetal outcomes, it would be recommended that intra-abdominal pressure measurements be standardized and used as a diagnostic tool during pregnancy. TRIAL REGISTRATION PROSPERO registration: October 9th, 2020, CRD42020206526.
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Kamo M, Kajimoto Y, Ohmura T, Kameda M, Tucker A, Miyake H, Wanibuchi M. Weight and Abdominal Pressure-Induced Shunt Trouble in Patients With Shunted Normal Pressure Hydrocephalus: A Comprehensive Study on Pressure Environment of Shunt System. Front Neurol 2022; 13:882757. [PMID: 35677338 PMCID: PMC9167924 DOI: 10.3389/fneur.2022.882757] [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: 02/24/2022] [Accepted: 03/30/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives We identified a new type of shunt malfunction (SM) in patients with normal pressure hydrocephalus (NPH). It is induced by weight change and can be treated with valve readjustment. There were two types of SM as follows: Underdrainage induced by the weight gain and overdrainage induced by the weight loss. This study aims to elucidate this mechanism by assessing the shunt pressure environment. Methods The total pressure environment of the shunt system was prospectively studied in patients with shunted NPH at Osaka Medical College Hospital from 1999 to 2005. We measured the pressure environment during the initial pressure setting of the valve by the intracranial pressure (ICP) guide, after setting the valve, and when SM was suspected. We evaluated ICP, intra-abdominal pressure (IAP), and hydrostatic and perfusion pressures of the shunt system in the sitting and supine positions. The target ICP for valve setting was empirically set at the range from −8 to −13 mm Hg in the sitting position, referring to the external auditory meatus. During the study period, we identified five cases of SM induced by weight change and assessed the changes in the pressure environment across pre-SM, SM, and post-SM. Results In four cases of underdrainage, gait disturbance worsened with an average weight gain of 6.8 ± 1.2 kg. With weight gain, IAP and ICP increased by 8.8 ± 1.6 and 4.8 ± 1.0 mm Hg, respectively. Consequently, ICP increased to −6.5 ± 1.9 mm Hg. One overdrainage patient developed an asymptomatic chronic subdural hematoma (CSDH) with a weight loss of 10 kg. With the weight loss, both IAP and ICP decreased by 5 mm Hg, and concomitantly, ICP decreased to −18 mm Hg. In all patients, the valve readjustment restored their ICP to the target pressure. After the valve readjustment, the gait disturbance improved immediately, and the CSDH disappeared after 1 month. Conclusion In patients with shunts, the weight change was linked to ICP via IAP. Due to the weight change, the underdrainage occurred when ICP was above the target pressure, and the overdrainage occurred when ICP was below it. We named this SM as the weight and abdominal pressure-induced shunt trouble. The patients with SM along with weight changes should be the first to be tried for the valve readjustment.
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Affiliation(s)
- Masatsugu Kamo
- Department Neurosurgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Yoshinaga Kajimoto
- Department Neurosurgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
- *Correspondence: Yoshinaga Kajimoto
| | - Tomohisa Ohmura
- Department Neurosurgery, Nishinomiya Kyoritsu Neurosurgical Hospital, Nishinomiya, Japan
| | - Masahiro Kameda
- Department Neurosurgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Adam Tucker
- Department Neurosurgery, Kitami Red Cross Hospital, Kitami, Japan
| | - Hiroji Miyake
- Department Neurosurgery, Nishinomiya Kyoritsu Rehabilitation Hospital, Nishinomiya, Japan
| | - Masahiko Wanibuchi
- Department Neurosurgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
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Higami S, Kondo E, Shibata E, Fujimoto S, Hagimoto M, Urakawa R, Matsumiya T, Uchimura T, Sakuragi T, Amimoto S, Kuwazuru T, Mori H, Aramaki S, Yoshino K. A case of preeclampsia developing massive ascites after delivery. Clin Case Rep 2022; 10:e05830. [PMID: 35600020 PMCID: PMC9107923 DOI: 10.1002/ccr3.5830] [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: 12/16/2020] [Revised: 03/26/2022] [Accepted: 04/05/2022] [Indexed: 11/11/2022] Open
Abstract
We experienced a case of preeclampsia in which massive ascites became apparent in the postpartum period. The patient had isolated proteinuria without hypertension before delivery. The infant had fatal growth restriction and neonatal distress. Massive ascites and isolated proteinuria are important symptoms for predicting the aggravation of PE.
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Affiliation(s)
- Shota Higami
- Department of Obstetrics and Gynecology University of Occupational and Environmental Health Kitakyushu Japan
| | - Emi Kondo
- Department of Obstetrics and Gynecology University of Occupational and Environmental Health Kitakyushu Japan
| | - Eiji Shibata
- Department of Obstetrics and Gynecology University of Occupational and Environmental Health Kitakyushu Japan
| | - Shigeki Fujimoto
- Department of Obstetrics and Gynecology University of Occupational and Environmental Health Kitakyushu Japan
| | - Marina Hagimoto
- Department of Obstetrics and Gynecology University of Occupational and Environmental Health Kitakyushu Japan
| | - Ruka Urakawa
- Department of Obstetrics and Gynecology University of Occupational and Environmental Health Kitakyushu Japan
| | - Tamaki Matsumiya
- Department of Obstetrics and Gynecology University of Occupational and Environmental Health Kitakyushu Japan
| | - Takayuki Uchimura
- Department of Obstetrics and Gynecology University of Occupational and Environmental Health Kitakyushu Japan
| | - Toshihide Sakuragi
- Department of Obstetrics and Gynecology University of Occupational and Environmental Health Kitakyushu Japan
| | - Shoko Amimoto
- Department of Obstetrics and Gynecology University of Occupational and Environmental Health Kitakyushu Japan
| | - Tomoichiro Kuwazuru
- Department of Obstetrics and Gynecology University of Occupational and Environmental Health Kitakyushu Japan
| | - Hiroshi Mori
- Department of Obstetrics and Gynecology University of Occupational and Environmental Health Kitakyushu Japan
| | - Satoshi Aramaki
- Department of Obstetrics and Gynecology University of Occupational and Environmental Health Kitakyushu Japan
| | - Kiyoshi Yoshino
- Department of Obstetrics and Gynecology University of Occupational and Environmental Health Kitakyushu Japan
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Petrenko AP, Castelo-Branco C, Marshalov DV, Kuligin AV, Mysovskaya YS, Shifman EM, Abdulaev AMR. Physiology of intra-abdominal volume during pregnancy. J OBSTET GYNAECOL 2020; 41:1016-1022. [PMID: 33251897 DOI: 10.1080/01443615.2020.1820470] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
A total of 580 pregnant and 50 puerperal women were included in this cross-sectional study to assess the physiological changes that allow women to adapt to a chronic increase in intra-abdominal pressure during pregnancy. The volume of the uterus, intra-abdominal volume (IAV), visceral and subcutaneous fat was calculated. During pregnancy, the IAV increases up to 1.5 times. Changes in IAV until 24 weeks present a linear relationship (5.2%); thereafter, changes become exponential and, at 40 weeks, IAV increases by 61%. This fact is exclusively related to the progressive growth of the foetus and to the increase in uterine size. At term, the IAV reserve is exhausted, becoming equal the anteroposterior and transverse diameters of the abdomen.In conclusion, the adaptive capabilities of IAV related to the foetal growth are limited by the IAV reserve. The reserve capacity of the IAV and tensile properties of the abdominal wall can be estimated by the dynamics of the anteroposterior and transverse abdominal diameters.IMPACT STATEMENTWhat is already known on this subject? A causal relationship between intra-abdominal hypertension and the development of adverse obstetric and perinatal outcomes has been suggested. Nevertheless, the role of this condition as a leading cause of systemic dysfunction during pregnancy remains unrecognised and underestimated.What do the results of this study add? This study assesses the dynamics of IAV in uncomplicated singleton pregnancies.What are the implications of these findings for clinical practice and/or further research? The study of abdominal pressure indicators such as intra-abdominal volume and compliance will help to a better understand the aetiology, pathophysiology, prognosis and treatment strategies for pregnant women with intra-abdominal hypertension.
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Affiliation(s)
- Aleksei Petrovich Petrenko
- Institut Clinic of Gynecology, Obstetrics and Neonatology, Faculty of Medicine-University of Barcelona, Hospital Clinic-Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Department of Emergency Anesthesiology-Resuscitation Care and Simulation Technologies in Medicine, Saratov State Medical University named after V. I. Razumovsky, Saratov, Russian Federation.,City Clinical Hospital No. 1 named after Y.Ya. Gordeev, Saratov, Russian Federation
| | - Camil Castelo-Branco
- Institut Clinic of Gynecology, Obstetrics and Neonatology, Faculty of Medicine-University of Barcelona, Hospital Clinic-Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Dimitry Vasilevich Marshalov
- Department of Emergency Anesthesiology-Resuscitation Care and Simulation Technologies in Medicine, Saratov State Medical University named after V. I. Razumovsky, Saratov, Russian Federation.,City Clinical Hospital No. 1 named after Y.Ya. Gordeev, Saratov, Russian Federation
| | - Alexander Valerievich Kuligin
- Department of Emergency Anesthesiology-Resuscitation Care and Simulation Technologies in Medicine, Saratov State Medical University named after V. I. Razumovsky, Saratov, Russian Federation
| | | | - Efim Munevich Shifman
- Department of Anesthesiology and Critical Care, State Budgetary Healthcare Institution of Moscow Region, M. F. Vladimirskiy Moscow's Regional Research Clinical Institute, Moscow, Russian Federation
| | - Adam Muhamed Rasulovich Abdulaev
- Department of Emergency Anesthesiology-Resuscitation Care and Simulation Technologies in Medicine, Saratov State Medical University named after V. I. Razumovsky, Saratov, Russian Federation.,City Clinical Hospital No. 1 named after Y.Ya. Gordeev, Saratov, Russian Federation
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Dreesen P, Schoutteten MK, Vande Velde N, Kaminski I, Heylen L, De Moor B, Malbrain ML, Gyselaers W. Increased Intra-Abdominal Pressure During Laparoscopic Pneumoperitoneum Enhances Albuminuria via Renal Venous Congestion, Illustrating Pathophysiological Aspects of High Output Preeclampsia. J Clin Med 2020; 9:jcm9020487. [PMID: 32054051 PMCID: PMC7074134 DOI: 10.3390/jcm9020487] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 01/13/2020] [Accepted: 02/09/2020] [Indexed: 01/31/2023] Open
Abstract
Intra-abdominal hypertension (IAH) causes severe organ dysfunction. Our aim is to evaluate the effect of increased intra-abdominal pressure (IAP) on renal function, hypothesizing that venous congestion may increase proteinuria and fluid retention without endothelial dysfunction. Three urine samples were collected from 32 non-pregnant women undergoing laparoscopic-assisted vaginal hysterectomy (LAVH) and from 10 controls placed in Trendelenburg position for 60 min. Urine sampling was done before (PRE), during or immediately after (PER), and two hours after (POST) the procedure. Urinary albumin, protein and creatinine concentrations were measured in each sample, and ratios were calculated and compared within and between groups. During LAVH, the albumin/creatinine ratio (ACR) increased and persisted POST-procedure, which was not observed in controls. A positive correlation existed between the LAVH duration and the relative change in both ACR and protein/creatinine ratio (PCR) PER- and POST-procedure. Iatrogenic IAH increases urinary ACR and PCR in non-pregnant women via a process of venous congestion. This mechanism might explain the presentation of one specific subtype of late-onset preeclampsia, where no drop of maternal cardiac output is observed.
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Affiliation(s)
- Pauline Dreesen
- UHasselt—Hasselt University, Faculty of Medicine and Life Sciences, Department of Physiology, Limburg Clinical Research Center, 3590 Diepenbeek, Belgium
- Future Health, Ziekenhuis Oost-Limburg, 3600 Genk, Belgium
| | - Melanie K. Schoutteten
- UHasselt—Hasselt University, Faculty of Medicine and Life Sciences, Department of Physiology, Limburg Clinical Research Center, 3590 Diepenbeek, Belgium
- Future Health, Ziekenhuis Oost-Limburg, 3600 Genk, Belgium
- Department of Nephrology, Catharina Ziekenhuis, 5623 EJ Eindhoven, The Netherlands
| | - Nele Vande Velde
- UHasselt—Hasselt University, Faculty of Medicine and Life Sciences, Department of Physiology, Limburg Clinical Research Center, 3590 Diepenbeek, Belgium
| | - Iris Kaminski
- UHasselt—Hasselt University, Faculty of Medicine and Life Sciences, Department of Physiology, Limburg Clinical Research Center, 3590 Diepenbeek, Belgium
| | - Line Heylen
- UHasselt—Hasselt University, Faculty of Medicine and Life Sciences, Department of Physiology, Limburg Clinical Research Center, 3590 Diepenbeek, Belgium
- Department of Nephrology, Ziekenhuis Oost-Limburg, 3600 Genk, Belgium
| | - Bart De Moor
- UHasselt—Hasselt University, Faculty of Medicine and Life Sciences, Department of Physiology, Limburg Clinical Research Center, 3590 Diepenbeek, Belgium
- Department of Nephrology, Jessa Ziekenhuis, 3500 Hasselt, Belgium
| | - Manu L.N.G. Malbrain
- Department of Intensive Care, Universitair Ziekenhuis Brussel, 1090 Jette, Belgium
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, 1050 Brussels, Belgium
| | - Wilfried Gyselaers
- UHasselt—Hasselt University, Faculty of Medicine and Life Sciences, Department of Physiology, Limburg Clinical Research Center, 3590 Diepenbeek, Belgium
- Department of Obstetrics & Gynecology, Ziekenhuis Oost-Limburg, 3600 Genk, Belgium
- Correspondence: ; Tel.: +32-89327524
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Arora V, Tyagi A, Ramanujam M, Luthra A. Intraabdominal pressure in non-laboring preeclamptic vs normotensive patients undergoing cesarean section: A prospective observational study. Acta Obstet Gynecol Scand 2019; 99:1031-1038. [PMID: 31643082 DOI: 10.1111/aogs.13757] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 10/03/2019] [Accepted: 10/08/2019] [Indexed: 12/15/2022]
Abstract
INTRODUCTION It is hypothesized that increased intraabdominal pressure (IAP) may be a cause of preeclampsia. There is, however, a paucity of clinical data regarding IAP in preeclamptics. We evaluated and compared the IAP and its effects on organ functions, in normotensive and preeclamptic patients. MATERIAL AND METHODS Previously healthy non-laboring patients with a singleton pregnancy scheduled for elective cesarean section under subarachnoid block were enrolled (preeclamptic and normotensive; n = 29 each). IAP was measured using an indwelling Foley catheter, and compared in both cohorts at four predefined time points: just before subarachnoid block, immediately after the onset of sensory block to T6 dermatomal level, just after surgery, and 2 hours later. In addition, the presence of organ dysfunction for respiratory, cardiovascular, renal, hepatic, hematopoietic and central nervous systems were evaluated for association with IAP. RESULTS Although age, body mass index, gravidity, parity, serum bilirubin, serum creatinine, PaO2 /FiO2 ratio and Glasgow coma score of the preeclamptic and normotensive patients were similar, the mean blood pressure was significantly higher (P < 0.001), the period of gestation less (P = 0.003) and the platelet count lower (P = 0.020) in the former. The IAP was significantly higher in the preeclamptic group at all four time points: respectively, 15.1 (1.0) vs 14.2 (0.9) mm Hg (P = 0.002); 14.9 (0.9) vs 14.1 (1.0) mm Hg (P = 0.002), 10.4 (1.0) vs 9.5 (1.3) mm Hg (P = 0.008) and 10.2 (0.8) vs 9.2 (1.2) mm Hg (P = 0.001). There was no correlation between the IAP and various organ dysfunctions. CONCLUSIONS Preeclampsia is associated with a significantly higher IAP in patients undergoing a cesarean section. The clinical relevance of this finding needs further investigation.
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Affiliation(s)
- Vandna Arora
- Department of Anesthesiology and Critical Care, University College of Medical Sciences & Guru Teg Bahadur Hospital, New Delhi, India
| | - Asha Tyagi
- Department of Anesthesiology and Critical Care, University College of Medical Sciences & Guru Teg Bahadur Hospital, New Delhi, India
| | - Mukundan Ramanujam
- Department of Anesthesiology and Critical Care, University College of Medical Sciences & Guru Teg Bahadur Hospital, New Delhi, India
| | - Ankit Luthra
- Department of Anesthesiology and Critical Care, University College of Medical Sciences & Guru Teg Bahadur Hospital, New Delhi, India
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Lozada MJ, Goyal V, Levin D, Walden RL, Osmundson SS, Pacheco LD, Malbrain MLNG. Management of peripartum intra-abdominal hypertension and abdominal compartment syndrome. Acta Obstet Gynecol Scand 2019; 98:1386-1397. [PMID: 31070780 PMCID: PMC7313226 DOI: 10.1111/aogs.13638] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 04/09/2019] [Accepted: 05/02/2019] [Indexed: 12/24/2022]
Abstract
Normal pregnancy leads to a state of chronically increased intra-abdominal pressure. Obstetric and non-obstetric conditions may increase intra-abdominal pressure further, causing intra-abdominal hypertension and abdominal compartment syndrome, which leads to maternal organ dysfunction and a compromised fetal state. Limited medical literature exists to guide treatment of pregnant women with these conditions. In this state-of-the-art review, we propose a diagnostic and treatment algorithm for the management of peripartum intra-abdominal hypertension and abdominal compartment syndrome, informed by newly available studies.
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Affiliation(s)
- M. James Lozada
- Division of Obstetric Anesthesiology, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Varun Goyal
- Department of Anesthesiology, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Danielle Levin
- Department of Anesthesiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | | | - Sarah S. Osmundson
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Luis D. Pacheco
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - Manu L. N. G. Malbrain
- Intensive Care Unit, University Hospital Brussels, Jette, Belgium
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
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Lappen JR, Myers SA, Bolden N, Shaman Z, Angirekula V, Chien EK. Pulse Pressure and Carotid Artery Doppler Velocimetry as Indicators of Maternal Volume Status: A Prospective Cohort Study. Anesth Analg 2019; 127:457-464. [PMID: 29505444 DOI: 10.1213/ane.0000000000003304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Narrow pulse pressure has been demonstrated to indicate low central volume status. In critically ill patients, volume status can be qualitatively evaluated using Doppler velocimetry to assess hemodynamic changes in the carotid artery in response to autotransfusion with passive leg raise (PLR). Neither parameter has been prospectively evaluated in an obstetric population. The objective of this study was to determine if pulse pressure could predict the response to autotransfusion using carotid artery Doppler in healthy intrapartum women. We hypothesized that the carotid artery Doppler response to PLR would be greater in women with a narrow pulse pressure, indicating relative hypovolemia. METHODS Intrapartum women with singleton gestations ≥35 weeks without acute or chronic medical conditions were recruited to this prospective cohort study. Participants were grouped by admission pulse pressure as <45 mm Hg (narrow) or ≥50 mm Hg (normal). Maternal carotid artery Doppler assessment was then performed in all patients before and after PLR using a standard technique where carotid blood flow (mL/min) = π × (carotid artery diameter/2) × (velocity time integral) × (60 seconds). The velocity time integral was calculated from the Doppler waveform. The primary outcome was the change in the carotid Doppler parameters (carotid artery diameter, velocity time integral, and carotid blood flow) after PLR. Outcomes were compared between study groups with univariable and multivariable analyses with adjustment for potential confounding factors. RESULTS Thirty-three women consented to participation, including 18 in the narrow and 15 in the normal pulse pressure groups (mean and standard deviation initial pulse pressure, 38.3 ± 4.4 vs 57.3 ± 4.1 mm Hg). The 2 groups demonstrated similar characteristics except for initial pulse pressure, systolic and diastolic blood pressure, and race. In response to PLR, the narrow pulse pressure group had a significantly greater increase in carotid artery diameter (0.08 vs 0.02 cm; standardized difference, 2.0; 95% confidence interval [CI], 1.16-2.84), carotid blood flow (79.4 vs 16.0 mL/min; standardized difference, 2.23; 95% CI, 1.36-3.10), and percent change in carotid blood flow (47.5% vs 8.7%; standardized difference, 2.52; 95% CI, 1.60-3.43) compared with the normal pulse pressure group. In multivariable analysis with adjustment for potential confounding factors, women with narrow admission pulse pressure had a significantly larger carotid diameter (0.66 vs 0.62 cm; P < .0001) and greater carotid flow (246.7 vs 219.3 cm/s; P = .001) after PLR compared to women with a normal pulse pressure. Initial pulse pressure was strongly correlated with the change in carotid flow after PLR (r = 0.60; P < .0001). CONCLUSIONS The hemodynamic response of the carotid artery to autotransfusion after PLR is significantly greater in women with narrow pulse pressure. Pulse pressure correlates with the physiological response to autotransfusion and provides a qualitative indication of intravascular volume in term and near-term pregnant women.
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Affiliation(s)
- Justin R Lappen
- From the Division of Maternal Fetal Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Stephen A Myers
- Division of Maternal Fetal Medicine, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | | | - Ziad Shaman
- Pulmonary and Critical Care Medicine, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Venkata Angirekula
- Pulmonary and Critical Care Medicine, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Edward K Chien
- Division of Maternal Fetal Medicine, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
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Gyselaers W, Thilaganathan B. Preeclampsia: a gestational cardiorenal syndrome. J Physiol 2019; 597:4695-4714. [PMID: 31343740 DOI: 10.1113/jp274893] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 06/13/2019] [Indexed: 12/12/2022] Open
Abstract
It is generally accepted today that there are two different types of preeclampsia: an early-onset or placental type and a late-onset or maternal type. In the latent phase, the first one presents with a low output/high resistance circulation eventually leading in the late second or early third trimester to an intense and acutely aggravating systemic disorder with an important impact on maternal and neonatal mortality and morbidity; the other type presents initially as a high volume/low resistance circulation, gradually evolving to a state of circulatory decompensation usually in the later stages of pregnancy, with a less severe impact on maternal and neonatal outcome. For both processes, numerous dysfunctions of the heart, kidneys, arteries, veins and interconnecting systems are reported, most of them presenting earlier and more severely in early- than in late-onset preeclampsia; however, some very specific dysfunctions exist for either type. Experimental, clinical and epidemiological observations before, during and after pregnancy are consistent with gestation-induced worsening of subclinical pre-existing chronic cardiovascular dysfunction in early-onset preeclampsia, and thus sharing the pathophysiology of cardiorenal syndrome type II, and with acute volume overload decompensation of the maternal circulation in late-onset preeclampsia, thus sharing the pathophysiology of cardiorenal syndrome type 1. Cardiorenal syndrome type V is consistent with the process of preeclampsia superimposed upon clinical cardiovascular and/or renal disease, alone or as part of a systemic disorder. This review focuses on the specific differences in haemodynamic dysfunctions between the two types of preeclampsia, with special emphasis on the interorgan interactions between heart and kidneys, introducing the theoretical concept that the pathophysiological processes of preeclampsia can be regarded as the gestational manifestations of cardiorenal syndromes.
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Affiliation(s)
- Wilfried Gyselaers
- Department of Obstetrics & Gynaecology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium.,Department Physiology, Hasselt University, Agoralaan, 3590, Diepenbeek, Belgium
| | - Basky Thilaganathan
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, UK.,Molecular and Clinical Sciences Research Institute, St George's University of London, UK
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Michalska M, Wen K, Pauly RP. Acute Kidney Injury in Pregnant Patient With Pancreas-Kidney Transplant Caused by Abdominal Compartment Syndrome: A Case Presentation, Review of Literature, and Proposal of Diagnostic Approach. Can J Kidney Health Dis 2019; 6:2054358119861942. [PMID: 31384476 PMCID: PMC6651678 DOI: 10.1177/2054358119861942] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 03/12/2019] [Indexed: 12/13/2022] Open
Abstract
Rationale: With increasing number of complex medical patients with renal transplant who get pregnant, clinicians need to be aware of abdominal compartment syndrome which may masquerade as acute renal allograft injury in pregnancy. Presenting concerns of the patient: A 34-year-old nulliparous Caucasian female with end-stage renal disease (ESRD) due to type 1 diabetes mellitus who received a simultaneous pancreas-kidney transplant (SPK) in 2006 and then after rejection of renal allograft another, kidney-only allograft from a donation after circulatory death became pregnant in May 2013 with dichorionic, diamniotic twins without reproductive technology, and during pregnancy, she developed two episodes of acute injury to the renal allograft. Diagnoses: End-stage renal disease secondary to type I diabetes, acute renal allograft injury, tacrolimus toxicity, abdominal pain. Interventions (including prevention and lifestyle): She received intravenous hydration, medications contributing to renal failure were held, and pain and nauseas were controlled appropriately. Abdominal compartment syndrome was managed by maintaining intravascular pressure and optimizing regional and systemic vascular perfusion by appropriate fluid balance, evacuating intraluminal contents by decompressing gastrointestinal system, and improving abdominal wall compliance by using appropriate analgesics, sedation, and patient positioning. Outcomes: With advancing pregnancy, the patient developed progressive abdominal pain, nausea, leg edema, and rising creatinine that were not responsive to ongoing therapies and required delivery via Cesarean section at 31 weeks of gestational age. Lessons learned: In the era of increasing number of pregnant renal transplant patients with multiple medical issues, we need organized approach to diagnosis of acute renal allograft injury in pregnancy and we need to consider abdominal compartment syndrome as one of the causes.
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Affiliation(s)
| | - Kevin Wen
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
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Collins PD, McFerran SJ, Goldrick I, Cevallos-Morales J, Martin-Lazaro J. Postpartum Bilateral Tension Pneumothoraces. Cureus 2019; 11:e4856. [PMID: 31410339 PMCID: PMC6684301 DOI: 10.7759/cureus.4856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 06/06/2019] [Indexed: 11/16/2022] Open
Abstract
We report the first case report of postpartum bilateral tension pneumothoraces. A 31-year-old primigravida presented with obstructive shock and respiratory failure five days following a normal spontaneous vaginal delivery. Bilateral surgical chest drains were inserted and following computed tomography suggestive of an underlying interstitial lung disease she was transferred to a tertiary cardiothoracic centre. Video-assisted thoracic surgery was carried out with left apicectomy and parietal pleurectomy. Histopathology supported a diagnosis of pulmonary lymphangioleiomyomatosis. We discuss the pathophysiology of labour-induced barotrauma and examine pertinent elements of the acute management of this case.
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Tyagi A, Lahan S, Verma G, Das S, Kumar M. Role of Intra-abdominal Pressure in Early Acute Kidney Injury: A Prospective Cohort Study in Critically Ill Obstetric Patients. Indian J Crit Care Med 2018; 22:602-607. [PMID: 30186012 PMCID: PMC6108294 DOI: 10.4103/ijccm.ijccm_170_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Aims: This prospective cohort study evaluated intra-abdominal pressure (IAP) and its role in causing acute kidney injury (AKI) in critically ill obstetric patients and utility of urinary neutrophil gelatinase-associated lipocalin (NGAL) to predict AKI. Methods: A total of 50 eligible obstetric patients admitted to our Intensive Care Unit were enrolled and daily IAP measured using indwelling Foley catheter. Early AKI was diagnosed as per the KDIGO criteria and urine assessed for NGAL using ELISA. Results: AKI was seen in 54% and intra-abdominal hypertension (IAH) in 21% patients. In patients with and without AKI, there was statistically similar IAP on day 1 (P = 0.542) and day 2 (P = 0.907) as well as incidence of IAH (19% vs. 23%) (P = 0.766). Area under receiver operating characteristic curve (AUC) for IAP to predict early AKI was 0.499 (95% confidence interval [CI]: 0.325–0.673) (P = 0.992). Urinary NGAL concentration was significantly greater in patients with early AKI compared to those without (P = 0.006); AUC for urinary NGAL to detect early AKI was 0.734 (95% CI: 0.583–0.884) (P = 0.006) and optimal cutoff was 53.7 ng/ml. Conclusions: IAH and AKI are common in critically ill obstetric patients. While IAP does not correlate with early AKI, NGAL is useful to predict AKI.
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Affiliation(s)
- Asha Tyagi
- Department of Anaesthesiology and Critical Care, University College of Medical Sciences and GTB Hospital, New Delhi, India
| | - Shubham Lahan
- Department of Anaesthesiology and Critical Care, University College of Medical Sciences and GTB Hospital, New Delhi, India
| | - Gaurav Verma
- Department of Anaesthesiology and Critical Care, University College of Medical Sciences and GTB Hospital, New Delhi, India
| | - Shukla Das
- Department of Anaesthesiology and Critical Care, University College of Medical Sciences and GTB Hospital, New Delhi, India
| | - Mahendra Kumar
- Department of Anaesthesiology and Critical Care, University College of Medical Sciences and GTB Hospital, New Delhi, India
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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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Tyagi A, Singh S, Kumar M, Sethi AK. Intra-abdominal pressure and intra-abdominal hypertension in critically ill obstetric patients: a prospective cohort study. Int J Obstet Anesth 2017; 32:33-40. [PMID: 28619279 DOI: 10.1016/j.ijoa.2017.05.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 04/15/2017] [Accepted: 05/04/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Critically ill obstetric patients may have risk factors for intra-abdominal hypertension. This study evaluated the intra-abdominal pressure and its effect on organ function and the epidemiology of intra-abdominal hypertension. METHODS Obstetric patients admitted to an Intensive Care Unit, with an anticipated stay greater than 24hours, were included. Intra-abdominal pressure was measured daily via a Foley catheter, based on intravesical pressure. RESULTS One-hundred-and-one patients were enrolled. The intra-abdominal pressure was 5-7mmHg in 34%; 7-12mmHg in 60%; and ≥12mmHg (intra-abdominal hypertension) in 6%. All six patients with intra-abdominal hypertension were pregnant at the time of admission. The intra-abdominal pressure in four patients normalized to <12mmHg following delivery, but in the remaining two it persisted ≥12mmHg and both these patients died. Correlation between intra-abdominal pressure and organ dysfunction was weak (r=0.211). Statistical comparison between patients with and without intra-abdominal hypertension for risk factors, daily intra-abdominal pressures, and Sequential Organ Failure Assessment score could not be done due to the disproportionately small number of patients with intra-abdominal hypertension as opposed to those without (6 versus 95). Intra-abdominal pressure did not significantly differ between survivors and non-survivors (8.5±1.1 vs 7.9±1.7mmHg, P=0.079). CONCLUSIONS The incidence of intra-abdominal hypertension in critically ill obstetric patients was lower than previously defined for mixed Intensive Care Unit populations, with an association with the pregnant state. Normalization of intra-abdominal pressure after delivery was associated with better survival. There was no correlation between intra-abdominal pressure and organ function or mortality.
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Affiliation(s)
- A Tyagi
- Department of Anaesthesiology & Critical Care, University College of Medical Sciences & GTB Hospital, Delhi 110095, India.
| | - S Singh
- Department of Anaesthesiology & Critical Care, University College of Medical Sciences & GTB Hospital, Delhi 110095, India
| | - M Kumar
- Department of Anaesthesiology & Critical Care, University College of Medical Sciences & GTB Hospital, Delhi 110095, India
| | - A K Sethi
- Department of Anaesthesiology & Critical Care, University College of Medical Sciences & GTB Hospital, Delhi 110095, India
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Jones BP, Hunjan T, Terry J. Surgical management of a large peritoneal pseudocyst causing acute kidney injury secondary to abdominal compartment syndrome in a rare case of congenital absence of omentum during pregnancy. Obstet Med 2016; 9:142-4. [PMID: 27630753 DOI: 10.1177/1753495x16648496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Accepted: 04/13/2016] [Indexed: 11/16/2022] Open
Abstract
Complete congenital absence of the omentum is very rare with only one previously reported case. We present a unique case of the management of a pregnant woman with a large pelvic pseudocyst caused by complications related to congenital absence of omentum, resulting in acute kidney injury, likely secondary to acute compartment syndrome. This case highlights the importance of considering acute compartment syndrome in critically unwell pregnant women and reiterates the need to measure intra-abdominal pressure when clinically indicated. Given that pregnancy is in itself a state of intra-abdominal hypertension, obstetricians should maintain a high index of suspicion in the context of additional risk factors.
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Affiliation(s)
- Benjamin P Jones
- Department of Obstetrics & Gynaecology, St Mary's Hospital, Imperial NHS Trust, London, UK
| | - Tia Hunjan
- Department of Obstetrics & Gynaecology, St Mary's Hospital, Imperial NHS Trust, London, UK
| | - Jayne Terry
- Department of Obstetrics & Gynaecology, St Mary's Hospital, Imperial NHS Trust, London, UK
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Merz WM, Rüland AM, Hippe V, Poetzsch B, Meyer C, Pollok JM, Gembruch U, Trebicka J. Pregnancy in Budd-Chiari Syndrome: Case Report and Proposed Risk Score. Medicine (Baltimore) 2016; 95:e3817. [PMID: 27258526 PMCID: PMC4900734 DOI: 10.1097/md.0000000000003817] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Due to its rarity, experience with pregnancy in Budd-Chiari syndrome (BCS) is limited. With the advent of new treatment modalities, transjugular intrahepatic portosystemic shunt in particular, numbers of affected women seeking pregnancy with BCS are expected to rise. Here, we use a case that ended lethal within 2 years after delivery to discuss the effect of pregnancy on BCS and vice versa, and to highlight the necessity of a multidisciplinary teamwork. Additionally, a risk classification is proposed which may serve as a framework for preconception counseling and assist in the establishment and evaluation of treatment algorithms; its criteria need to be defined and assessed for their applicability in further studies.
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Affiliation(s)
- Waltraut M Merz
- From the Department of Obstetrics and Prenatal Medicine (WMM, AMR, UG), University Bonn Medical School; Department of Internal Medicine I (VH, JT); Institute of Experimental Hematology and Transfusion Medicine (BP); Department of Radiology (CM); and Department of General (JMP), Visceral, Thoracic, and Vascular Surgery, University Bonn Medical School, Bonn, Germany
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Staelens ASE, Van Cauwelaert S, Tomsin K, Mesens T, Malbrain MLN, Gyselaers W. Intra-abdominal pressure measurements in term pregnancy and postpartum: an observational study. PLoS One 2014; 9:e104782. [PMID: 25117778 PMCID: PMC4130571 DOI: 10.1371/journal.pone.0104782] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 07/16/2014] [Indexed: 11/18/2022] Open
Abstract
Objective To determine intra-abdominal pressure (IAP) and to evaluate the reproducibility of IAP-measurements using the Foley Manometer Low Volume (FMLV) in term uncomplicated pregnancies before and after caesarean section (CS), relative to two different reference points and to non-pregnant values. Design Observational cohort study. Setting Secondary level referral center for feto-maternal medicine. Population Term uncomplicated pregnant women as the case-group and non-pregnant patients undergoing a laparoscopic assisted vaginal hysterectomy (LAVH) as control group. Methods IAP was measured in 23 term pregnant patients, before and after CS and in 27 women immediately after and 1 day after LAVH. The midaxillary line was used as zero-reference (IAPMAL) in all patients and in 13 CS and 13 LAVH patients, the symphysis pubis (IAPSP) was evaluated as additional zero-reference. Intraobserver correlation (ICC) was calculated for each zero-reference. Paired student's t-tests were performed to compare IAP values and Pearson's correlation was used to assess correlations between IAP and gestational variables. Main outcome measures ICC before and after surgery, IAP before and after CS, IAP after CS and LAVH. Results The ICC for IAPMAL before CS was lower than after (0.71 versus 0.87). Both mean IAPMAL and IAPSP were significantly higher before CS than after: 14.0±2.6 mmHg versus 9.8±3.0 mmHg (p<0.0001) and 8.2±2.5 mmHg versus 3.5±1.9 mmHg (p = 0.010), respectively. After CS, IAP was not different from values measured in the LAVH-group. Conclusion IAP-measurements using FMLV is reproducible in pregnant women. Before CS, IAP is increased in the range of intra-abdominal hypertension for non-pregnant individuals. IAP significantly decreases to normal values after delivery.
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Affiliation(s)
- Anneleen S. E. Staelens
- Dept. Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
- Dept. Obstetrics & Gynaecology, Ziekenhuis Oost Limburg, Genk, Belgium
- * E-mail:
| | | | - Kathleen Tomsin
- Dept. Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
- Dept. Obstetrics & Gynaecology, Ziekenhuis Oost Limburg, Genk, Belgium
| | - Tinne Mesens
- Dept. Obstetrics & Gynaecology, Ziekenhuis Oost Limburg, Genk, Belgium
| | - Manu L. N. Malbrain
- Dept. of Intensive Care, Ziekenhuis Netwerk Antwerpen, ZNA Stuivenberg, Antwerp, Belgium
| | - Wilfried Gyselaers
- Dept. Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
- Dept. Obstetrics & Gynaecology, Ziekenhuis Oost Limburg, Genk, Belgium
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Lee AJ, Wells BJ, Chun R, Ball CG, Kirkpatrick AW. The abdomen in "thoracoabdominal" cannot be ignored: abdominal compartment syndrome complicating extracorporeal life support. Case Rep Crit Care 2014; 2014:351340. [PMID: 24900925 PMCID: PMC4034444 DOI: 10.1155/2014/351340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 03/31/2014] [Indexed: 12/12/2022] Open
Abstract
Extracorporeal life support (ECLS) is an incredible life-saving measure that is being used ever more frequently in the care of the critically ill. Management of these patients requires extreme vigilance on the part of the care providers in recognizing and addressing the complications and challenges that may arise. We present a case of overt abdominal compartment syndrome (ACS) in a previously well young male on ECLS with a history of trauma, submersion, hypothermia, and no intra-abdominal injuries. The patient developed ACS soon after ECLS was initiated which resulted in drastically compromised flow rates. Taking into account the patient's critical status, an emergent laparotomy was performed in the intensive care unit which successfully resolved the ACS and restored ECLS flow. The patient had an unremarkable course following and was weaned off ECLS but unfortunately died from his original anoxic injury. This case highlights several salient points: first, care of patients on ECLS is challenging and multiple etiologies can affect our ability to manage these patients; second, intra-abdominal pressures should be monitored liberally in the critically ill, especially in patients on ECLS; third, protocols for emergent operative treatment outside of traditional operating rooms should be established and care providers should be prepared for these situations.
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Affiliation(s)
| | - Bryan J. Wells
- University of Calgary, Calgary, AB, Canada
- Departments of Surgery, Foothills Medical Centre, 1403 29 Street NW, Calgary, AB, Canada T2N 2T9
- Critical Care Medicine, Foothills Medical Centre, 1403 29 Street NW, Calgary, AB, Canada T2N 2T9
- The Regional Trauma Program, Foothills Medical Centre, 1403 29 Street NW, Calgary, AB, Canada T2N 2T9
| | - Rosaleen Chun
- University of Calgary, Calgary, AB, Canada
- Anesthesia, Foothills Medical Centre, 1403 29 St NW, Calgary, Alberta, Canada T2N 2T9
| | - Chad G. Ball
- University of Calgary, Calgary, AB, Canada
- Departments of Surgery, Foothills Medical Centre, 1403 29 Street NW, Calgary, AB, Canada T2N 2T9
- The Regional Trauma Program, Foothills Medical Centre, 1403 29 Street NW, Calgary, AB, Canada T2N 2T9
| | - Andrew. W. Kirkpatrick
- University of Calgary, Calgary, AB, Canada
- Departments of Surgery, Foothills Medical Centre, 1403 29 Street NW, Calgary, AB, Canada T2N 2T9
- The Regional Trauma Program, Foothills Medical Centre, 1403 29 Street NW, Calgary, AB, Canada T2N 2T9
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Verburgh P, Reintam-Blaser A, Kirkpatrick AW, De Waele JJ, Malbrain MLNG. Overview of the recent definitions and terminology for acute gastrointestinal injury, intra-abdominal hypertension and the abdominal compartment syndrome. ACTA ACUST UNITED AC 2013. [DOI: 10.1007/s13546-013-0819-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Fuchs F, Bruyere M, Senat MV, Purenne E, Benhamou D, Fernandez H. Are standard intra-abdominal pressure values different during pregnancy? PLoS One 2013; 8:e77324. [PMID: 24204808 PMCID: PMC3808400 DOI: 10.1371/journal.pone.0077324] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 09/09/2013] [Indexed: 01/09/2023] Open
Abstract
Background Measurement of intra-abdominal pressure (IAP) is an important parameter in the surveillance of intensive care unit patients. Standard values of IAP during pregnancy have not been well defined. The aim of this study was to assess IAP values in pregnant women before and after cesarean delivery. Methods This prospective study, carried out from January to December 2011 in a French tertiary care centre, included women with an uneventful pregnancy undergoing elective cesarean delivery at term. IAP was measured through a Foley catheter inserted in the bladder under spinal anaesthesia before cesarean delivery, and every 30 minutes during the first two hours in the immediate postoperative period. Results The study included 70 women. Mean IAP before cesarean delivery was 14.2 mmHg (95%CI: 6.3–23). This value was significantly higher than in the postoperative period: 11.5 mmHg (95%CI: 5–19.7) for the first measurement (p = 0.002). IAP did not significantly change during the following two postoperative hours (p = 0.2). Obese patients (n = 25) had a preoperative IAP value significantly higher than non-obese patients: 15.7 vs. 12.4; p = 0.02. Conclusion In term pregnancies, IAP values are significantly higher before delivery than in the post-partum period, where IAP values remain elevated for at least two hours at the level of postoperative classical abdominal surgery. The knowledge of these physiological changes in IAP values may help prevent organ dysfunction/failure when abdominal compartment syndrome occurs after cesarean delivery.
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Affiliation(s)
- Florent Fuchs
- Department of Obstetrics and Gynecology. Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, France
- Inserm, Centre for research in Epidemiology and Population Health, Unit 1018, Reproduction and child development, Villejuif, France
- Paris-Sud University, Unit 1018, Villejuif, France
- * E-mail:
| | - Marie Bruyere
- Département of Anesthesia, Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Marie-Victoire Senat
- Department of Obstetrics and Gynecology. Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, France
- Inserm, Centre for research in Epidemiology and Population Health, Unit 1018, Reproduction and child development, Villejuif, France
- Paris-Sud University, Unit 1018, Villejuif, France
| | - Emilien Purenne
- Département of Anesthesia, Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Dan Benhamou
- Département of Anesthesia, Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Hervé Fernandez
- Department of Obstetrics and Gynecology. Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, France
- Inserm, Centre for research in Epidemiology and Population Health, Unit 1018, Reproduction and child development, Villejuif, France
- Paris-Sud University, Unit 1018, Villejuif, France
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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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