Current recognition and management of intra-abdominal hypertension and abdominal compartment syndrome among tertiary Chinese intensive care physicians

Biomechanical and tissue reaction: the effects of varying sutures size on canine abdominal wall stitching

Objective

Larger diameter sutures can provide sufficient tensile strength to surgical incisions but may exacerbate the inflammatory response caused by the amount of implanted foreign material. This experiment aims to investigate the differences in biomechanical stability and tissue reactivity after suturing canine midline abdominal incisions with different suture sizes.

Method

Assessing the biomechanical differences between USP 2-0, 3-0, and 4-0 PGA sutures using uniaxial tensile testing on ex vivo canine midline skin and fascial muscle tissues using either a simple continuous or simple interrupted technique. mRNA and protein expression levels of inflammatory factors were measured through RT-PCR and ELISA. Tissue reactivity was evaluated using a semi-quantitative scoring system.

Result

For strains below 30% in skin and below 50% in muscle, there were no significant differences among groups. The results of skin biomechanical testing showed that the USP 4-0 PGA suture group demonstrated significantly lower maximum tensile strength compared to the USP 2-0 PGA or USP 3-0 PGA suture groups. However, it remained capable of providing at least 56.3 N (1.03 MPa) tensile strength for canine skin incisions, matching the tensile strength requirements of general canine abdominal wall surgical incisions. In addition, there were no statistically significant differences observed in the maximum tensile strength among different size of sutures according to the data of biomechanical testing in muscle. Larger diameter sutures led to increased levels of inflammatory factors (IL-1β, IL-6, TNF-ɑ) and tissue reactivity. Simple interrupted sutures caused higher levels of inflammatory factors in muscular tissue compared to simple continuous sutures.

Conclusion

USP 4-0 PGA sutures provide sufficient biomechanical stability for suturing canine abdominal skin and linea alba. Suture size significantly influences tissue reactivity after suturing, with smaller gauge sutures reducing early tissue inflammatory response. Thus, USP 4-0 PGA suture has more advantages to suturing canine abdominal surgical incisions.

Affecting factors for abdominal incisional tension in surgery of dogs and cats

OBJECTIVE

Proper assessment of intraoperative abdominal incisional tension helps to select the appropriate sutures and suture method. Wound tension is usually thought to be associated with wound size, but few relevant articles have been reported. The aim of this study was to investigate the core factors influencing abdominal incisional tension and construct regression equations to judge incisional tension in clinical surgery.

METHODS

Medical records were collected from clinical surgical cases at the Teaching Animal Hospital of Nanjing Agricultural University from March 2022 to June 2022. The data collected mainly included the body weight, and the incisional length, margin, and tension. The core factors affecting abdominal wall incisional tension were screened by correlation analysis, random forest analysis, and multiple linear regression analysis.

RESULTS

Although correlation analysis showed that multiple same and deep layer abdominal incision parameters and body weight were significantly correlated with abdominal incisional tension. However, the same layer of abdominal incisional margin had the largest correlation coefficient. In random forest models, the abdominal incisional margin had the main contribution to the prediction of the same layer's abdominal incisional tension. In the multiple linear regression model, all incisional tension could be predicted by the same layer of abdominal incisional margin as the only independent variable, except for canine muscle and subcutaneous. The canine muscle and subcutaneous incisional tension were binary regressions with the same layer's abdominal incision margin and body weight.

CONCLUSION

The same layer's abdominal incisional margin is the core factor positively related to the abdominal incisional tension intraoperatively.

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

Objective

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

Methods

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

Results

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

Conclusion

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

Identification and quantification of flavonoids in 207 cultivated lotus (Nelumbo nucifera) and their contribution to different colors

Sacred lotus (Nelumbo nucifera) is a large economic crop, which is also cultivated as a horticultural crop. This study performed a systematic qualitative and quantitative determination of five anthocyanins and 18 non-anthocyanin flavonoids from the petals of 207 lotus cultivars. Among the compounds identified in this study, quercetin 3-O-pentose-glucuronide, quercetin 7-O-glucoside, laricitrin 3-O-hexose, and laricitrin 3-O-glucuronide were discovered for the first time in sacred lotus. The relationships between these pigments and petals colors were also evaluated. A decrease in the total content of anthocyanins and increase in the content of myricetin 3-O-glucuronide resulted in a lighter flower color. Furthermore, petals were yellow when the content of quercetin 3-O-neohesperidoside and myricetin 3-O-glucuronide were increased, whereas petals were red when the total anthocyanin content was high and the quercetin 3-O-sambubioside content was low. These investigations contribute to the understanding of mechanisms that underlie the development of flower color and provide a solid theoretical basis for the further study of sacred lotus.

Dynamic response and failure characteristics of combined rocks under confining pressure

Gas explosions or coal and gas outbursts can cause transient destruction of combined coal–rock, and the dynamic mechanical response of combined coal–rock masses plays a key role in accident failure, but we now know little about the dynamic mechanical responses of combined coal–rock. In this article, we selected three rocks (limestone, shale, sandstone) and two coals (bituminous coal and anthracite coal) to form combined coal–rock, and analyze their dynamic mechanical properties by using the SHPB system. We find that the dynamic compressive strength and elastic modulus of combined rock–coal are lower than the average value of single rock and coal, while the ultimate strain and strain rate of combined coal–rock are higher than the average values of single rock and coal. Compressive strength and elastic modulus of the combined body increase gradually with increasing confining pressure, and the strain decreases accordingly. The dynamic stress–strain curve demonstrates an obvious double-peak at high strain rate (85.55 s⁻¹ and above in the present work), while there is no obvious double-peak of the curve at low strain rate. Dynamic compressive strength of combined coal–rock body increases significantly with increasing confining pressure at low strain rate, but it increases more smoothly at higher strain rate. The elastic modulus also increases with increasing confining pressure, and it seems to be stable as confining pressure increases at low strain rate. The ultimate strain decreases gradually with increasing confining pressure but more gently compared with that at low strain rate. Besides, longitudinal fractures of combined coal–rock bodies include penetrating fractures, partially penetrating fractures, and interrupted fractures stopped at the coal–rock interface. The dynamic mechanical response of combined coal–rock is of guiding significance for maintaining the stability of the roadway and formulating the support measures for the roadway.

Impact of Water Level Fluctuations on Landslide Deformation at Longyangxia Reservoir, Qinghai Province, China

The construction of Longyangxia Reservoir has altered the hydrogeological conditions of its banks. Infiltration and erosion caused by the periodic rise and fall of the water level leads to collapse of the reservoir banks and local deformation of the landslide. Due to heterogeneous topographic characteristics across the region, water level also varies between different location. Previous research on the influence of fluctuations in reservoir water level on landslide deformation has focused on single-point monitoring of specific slopes, and single-point water level monitoring data have often been used instead of water level data for the entire reservoir region. In addition, integrated remote sensing methods have seldom been used for regional analysis. In this study, the freely-available Landsat8 OLI and Sentinel-2 data were used to extract the water level of Longyangxia Reservoir using the NDWI method, and Sentinel-1A data were used to obtain landslide deformation time series using SBAS-InSAR technology. Taking the Chana, Chaxi, and Mangla River Estuary landslides (each having different reservoir water level depths) as typical examples, the influence of changes in reservoir water level on the deformation of three wading landslides was analyzed. Our main conclusions are as follows: First, the change in water level is the primary external factor controlling the deformation velocity and trend of landslides in the Longyangxia Reservoir, with falling water levels having the greatest influence. Second, the displacement of the Longyangxia Reservoir landslides lags water level changes by 0 to 62 days. Finally, this study provides a new method applicable other areas without water level monitoring data.

An equivalent method of jet impact loading from collapsing near-wall acoustic bubbles: A preliminary study

Cavitation damage is a micro, high-speed, multi-phase complex phenomenon caused by the near-wall bubble group collapse. The current numerical simulation method of cavitation mainly focuses on the collapse impact of a single cavitation bubble. The large-scale simulation of the cavitation bubble group collapse is difficult to perform and has not been studied, to the best of our knowledge. In this study, the equivalent model of impact loading of acoustic bubble collapse micro-jets is proposed to study the cavitation erosion damage of materials. Based on the theory of the micro-jet and the water hammer effect of the liquid-solid impact, an equivalent model of impact loading of a single acoustic bubble collapse micro-jet is established under the principle of deformation equivalence. Since the acoustic bubbles can be considered uniformly distributed in a small enough area, an equivalent model of impact loading of multiple acoustic bubble collapse micro-jets in a micro-segment can be derived based on the equivalent results of impact loading of a single acoustic bubble collapse micro-jet. In fact, the equivalent methods of cavitation damage loading for single and multiple near-wall acoustic bubble collapse micro-jets are formed. The verification results show the law of cavitation deformation of concrete using equivalent loading is consistent with that of a micro-jet simulation, and the average relative errors and the mean square errors are insignificant. The equivalent method of impact loading proposed in this paper has high accuracy and can greatly improve the calculation efficiency, which provides technical support for numerical simulation of concrete cavitation.

Regulating Effect of Cement Accelerator on High Content Solid-Wastes Autoclaved Aerated Concrete (HCS-AAC) Slurry Performance and Subsequent Influence

Adverse side-effects occurred in slurry foaming and thickening process when carbide slag was substituted for quicklime in HCS-AAC. Cement accelerators were introduced to modify the slurry foaming and coagulating process during pre-curing. Meanwhile, the affiliated effects on the physical-mechanical properties and hydration products were discussed to evaluate the applicability and influence of the cement accelerator. The hydration products were characterized by mineralogical (XRD) and thermal analysis (DSC-TG). The results indicated that substituting carbide slag for quicklime retarded slurry foaming and curing progress; meanwhile, the induced mechanical property declination had a negative effect on the generation of C–S–H (I) and tobermorite. Na₂SO₄ and Na₂O·2.0SiO₂ can effectively accelerate the slurry foaming rate, but the promoting effect on slurry thickening was inconspicuous. The compressive strength of HCS-AAC obviously declined with increasing cement coagulant content, which was mainly ascribed to the decrease in bulk density caused by the accelerating effect on the slurry foaming process. Dosing Na₂SO₄ under 0.4% has little effect on the generation of strength contributing to hydration products while the addition of Na₂O·2.0SiO₂ can accelerate the generation and crystallization of C–S–H, which contributed to the high activity gelatinous SiO₂ generated from the reaction between Na₂O·2.0SiO₂ and Ca(OH)₂.

Abdominal compartment syndrome: Often overlooked conditions in medical intensive care units

Intra-abdominal hypertension (IAH) and abdominal compartment syndrome are well recognized entities among surgical patients. Nevertheless, a number of prospective and retrospective observational studies have shown that IAH is prevalent in about half of the critically ill patients in the medical intensive care units (ICU) and has been widely recognized as an independent risk factor for mortality. It is alarming to note that many members of the critical care team in medical ICU are not aware of the consequences of untreated IAH and the delay in making the diagnosis leads to increased morbidity and mortality. Frequently it is underdiagnosed and undertreated in this patient population. Elevated intra-abdominal pressure decreases the blood flow to the kidneys and other abdominal viscera and also results in reduced cardiac output and difficulties in ventilating the patient because of increased intrathoracic pressure. When intraabdominal hypertension is not promptly recognized and treated, it leads to abdominal compartment syndrome, multiorgan dysfunction syndrome and death. Large volume fluid resuscitation is very common in medical ICU patients presenting with sepsis, shock and other inflammatory conditions like pancreatitis and it is one of the major risk factors for the development of intra-abdominal hypertension. This article presents an overview of the epidemiology, definitions, risk factors, pathophysiology and management of IAH and abdominal compartment syndrome in critically ill medical ICU patients.

Application progress of enhanced coagulation in water treatment

Water industries worldwide consider coagulation/flocculation to be one of the major treatment methods for improving the overall efficiency and cost effectiveness of water and wastewater treatment. Enhancing the coagulation process is currently a popular research topic. In this review article, the latest developments in enhanced coagulation are summarized. In addition, the mechanisms of enhanced coagulation and the effect of process parameters on processing efficiency are discussed from the perspective of ballast-enhanced coagulation, preoxidation, ultrasound, and composite coagulants. Finally, improvements and new directions for enhanced coagulation are proposed.

This review summarizes the current situation of enhanced coagulation and looks forward to future development.

Current Approach to the Evaluation and Management of Abdominal Compartment Syndrome in Pediatric Patients

Abdominal compartment syndrome is an emergent condition caused by increased pressure within the abdominal compartment. It can be caused by a number of etiologies, which are associated with decreased abdominal wall compliance, increased intraluminal or intraperitoneal contents, or edema from capillary leak or fluid resuscitation. The history and physical examination are of limited utility, and the criterion standard for diagnosis is intra-abdominal pressure measurement, which is typically performed via an intravesical catheter. Management includes increasing abdominal wall compliance, evacuating gastrointestinal or intraperitoneal contents, avoiding excessive fluid resuscitation, and decompressive laparotomy in select cases.

Influence of Elevated Intra-abdominal Pressure on Suture Tension Dynamics in a Porcine Model

BACKGROUND

Inadequate suture tension is a risk factor for the failure of laparotomy closure. Suture tension dynamics in the abdominal wall are still obscure due to the lack of measuring devices. To answer the questions if intra-abdominal hypertension (IAH) influences suture tension in midline laparotomies and if IAH leads to a permanent loss of suture tension, microsensors were applied in a porcine model of IAH.

MATERIAL AND METHODS

Microsensors measuring suture tension "on the thread" with a frequency of 1/s were developed and implanted in the suture lines of midline laparotomies in four pigs. During a 23-h experiment under general anesthesia, two intervals of IAH (30 mm Hg) were applied, interrupted by a 3-h interval without elevated intra-abdominal pressure.

RESULTS

All sensors showed an immediate and reproducible response to changes of intra-abdominal pressure. The two 9-h periods of IAH resulted in a significant elevation of suture tension (P = 0.003 and P = 0.0009, respectively). Reducing the IAH lead to a significant loss of suture tension (P = 0.0005 and P = 0.0001, respectively). After the second interval with IAH, a complete loss of mean suture tension was observed. A statistically significant "recovery" of suture tension in the interval between the two phases with IAH was not observed.

CONCLUSIONS

Intervals with elevated intra-abdominal pressure have a direct influence on suture tension in midline laparotomy wounds. Intervals with IAH lead to a significant loss of suture tension in the suture line and to a complete loss of mean suture tension at the end of this experiment. A subsequent gaping of the fascia might contribute to either acute or chronic failure of laparotomy closure.

Prevalence and diagnosis rate of intra-abdominal hypertension in critically ill adult patients: A single-center cross-sectional study

PURPOSE

To investigate the prevalence and diagnosis rate of intra-abdominal hypertension (IAH) in a mixed-population intensive care unit (ICU), and to investigate the knowledge of ICU staff regarding the guidelines published by the World Society of Abdominal Compartment Syndrome (WSACS) in 2013.

METHODS

A one-day cross-sectional study based on the WSACS 2013 guidelines was conducted in the general ICU of a tertiary teaching hospital in Chongqing, China. The included patients were divided into intravesical pressure (IVP) measured group and IVP unmeasured group. The epidemiologic data were recorded, and potential IAH risk factors (RFs) were collected based on the guidelines. IVP measurements were conducted by investigators every 4 h and the result was compared to that measured by the ICU staff to evaluate the diagnosis rate. Besides, a questionnaire was used to investigate the understanding of the guidelines among ICU staff.

RESULTS

Thirty-two patients were included, 14 in the IVP measured group and 18 in the IVP unmeasured group. The prevalence of IAH during the survey was 15.63% (5/32), 35.71% (5/14) in IVP measured group. Only one case of IAH had been diagnosed by the ICU physician and the diagnosis rate was as low as 20.00%. Logistic regression analysis showed that sequential organ failure assessment (SOFA) score was an independent RF for IAH (OR: 1.532, 95% CI: 1.029-2.282, p=0.036. Fourteen doctors and 5 nurses were investigated and the response rate was 67.86%. The average scores of the doctors and nurses were 27.14±20.16 and 16.00±8.94 respectively. None of them had studied the WSACS 2013 guidelines thoroughly.

CONCLUSION

Patients with a higher SOFA score has a higher incidence of IAH. The IAH prevalence in 14 ICU patients with indwelling catheter was 35.71%. Strengthening the wide and rational use of WSACS guideline is important to improve the diagnosis of IAH.

Intra-abdominal pressure: an integrative review

There is a growing request for measuring intra-abdominal pressure in critically ill patients with acute abdominal pain to be clarified. Summarizing the research results on measurement of vesical intra-abdominal pressure and analyzing the level of evidence were the purposes of this integrative literature review, carried out based on the databases LILACS, MEDLINE and PubMed, from 2005 to July 2012. Twenty articles were identified, in that, 12 literature reviews, 4 descriptive and exploratory studies, 2 expert opinions, one prospective cohort study and one was an experience report. The vesical intra-abdominal pressure measurement was considered gold standard. There are variations in the technique however, but some common points were identified: complete supine position, in absence of abdominal contracture, in the end of expiration and expressed in mmHg. Most research results indicate keeping the transducer zeroed at the level of the mid-axillary line at the iliac crest level, and instill 25mL of sterile saline. Strong evidence must be developed.

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

Purpose

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

Methods

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

Results

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

Conclusion

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

Study of intra-abdominal hypertension prevalence and awareness level among experienced ICU medical staff

BACKGROUND

Intra-abdominal hypertension (IAH) is a disease with high morbidity and mortality among critically ill patients. The study's objectives were to explore the prevalence of IAH and physicians' awareness of the 2013 World Society of Abdominal Compartment Syndrome (WSACS) guidelines in Chinese intensive care units (ICUs).

METHODS

A cross-sectional study of four ICUs in Southwestern China was conducted from June 17 to August 2, 2014. Adult patients admitted to the ICU for more than 24 h, with bladder catheter but without obvious intravesical pressure (IVP) measurement contraindications, were recruited. Intensivists with more than 5 years of ICU working experience were also recruited. Epidemiological information, potential IAH risk factors, IVP measurements and questionnaire results were recorded.

RESULTS

Forty-one patients were selected. Fifteen (36.59 %) had IVP ≥ 12 mmHg. SOFA (Sequential Organ Failure Assessment) hepatic and neurological sub-scores were utilized as independent predictors for IAH via logistic backward analysis. Thirty-seven intensivists participated in the survey (response rate: 80.43 %). The average score of each center was less than 35 points. All physicians believed the IAH prevalence in their departments was no more than 20.00 %. A significant negative correlation was observed between the intensivists' awareness of the 2013 WSACS guidelines and the IAH prevalence in each center (r = -0.975, P = 0.025).

CONCLUSIONS

The prevalence and independent predictors of IAH among the surveyed population are similar to the reports in the literature. Intensivists generally have a low awareness of the 2013 WSACS guidelines. A systematic guideline training program is vital for improving the efficiency of the diagnosis and treatment of IAH.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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

INTRODUCTION

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Pediatric critical care nurses' experience with abdominal compartment syndrome

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Abdominal decompression in children

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

Percutaneous catheter decompression in the treatment of elevated intraabdominal pressure

BACKGROUND

Intraabdominal hypertension (IAH) and abdominal compartment syndrome (ACS) traditionally have been treated surgically through emergent laparotomy. Intensivist-performed bedside drainage of free intraperitoneal fluid or blood (percutaneous catheter decompression [PCD]) has been advocated as a less-invasive alternative to open abdominal decompression (OAD).

METHODS

A single-center disease and severity of illness-matched case-control comparison of 62 patients with IAH/ACS treated with PCD vs traditional OAD was performed. The relative efficacy of each treatment in reducing elevated intraabdominal pressure (IAP) and improving organ dysfunction was assessed. Physiologic and demographic predictors of successful PCD therapy were determined.

RESULTS

PCD and OAD both were effective in significantly decreasing IAP and peak inspiratory pressure as well as in increasing abdominal perfusion pressure. PCD potentially avoided the need for subsequent OAD in 25 of 31 patients (81%) treated. Successful PCD therapy was associated with fluid drainage of > 1,000 mL or a decrease in IAP of > 9 mm Hg in the first 4 h postdecompression.

CONCLUSIONS

Intensivist-performed PCD is an effective and less-invasive technique for treating patients with IAH/ACS where free intraperitoneal fluid or blood is present as determined by bedside ultrasonography. Failure to drain at least 1,000 mL of fluid and decrease IAP by at least 9 mm Hg in the first 4 h postdecompression is associated with PCD failure and should prompt urgent OAD.