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Łagosz P, Biegus J, Lewandowski Ł, Ponikowski P, Zymliński R. Prevalence of increased intra-abdominal pressure and its impact on renal function in acute decompensated heart failure: A prospective pilot study. Kardiol Pol 2024; 82:292-302. [PMID: 38493453 DOI: 10.33963/v.phj.99497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 02/22/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Intra-abdominal pressure (IAP) is a frequently overlooked aspect in clinical assessment that can have a significant impact on organ dysfunction in patients with acute decompensated heart failure (ADHF). AIMS We aimed to investigate dynamics of IAP in patients with ADHF and its impact on diuretic response. METHODS We conducted a prospective observational pilot study on a group consisting of 30 patients admitted for ADHF. In every individual IAP measurement, blood and urine samples were taken upon admission, on the second and third days of hospitalization. RESULTS The study showed a high (63.3%) prevalence of intra-abdominal hypertension (IAH) defined as IAP ≥12 mm Hg upon admission, while only roughly 13% had signs of ascites. We observed poorer diuresis on the first day of hospitalization in the IAH group (P = 0.03). IAP was negatively correlated with urine output (P = 0.01) and positively correlated with urine osmolality (P = 0.03) on the first day of hospitalization. During follow-up, there was a significant decrease in IAP in patients with IAH upon admission who received standard decongestive therapy. CONCLUSIONS The study shows a high prevalence of IAH in patients admitted for ADHF, even in individuals who do not present symptoms of abdominal congestion. Established correlation between IAP, reduced diuresis, and increased urine osmolality, despite achieving target natriuresis, contributes novel insights into the understanding of pathomechanisms underlying diuretic resistance in ADHF.
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Affiliation(s)
- Piotr Łagosz
- Institute of Heart Diseases, Wroclaw Medical University, Wrocław, Poland.
- Institute of Heart Diseases, University Clinical Hospital, Wrocław, Poland.
| | - Jan Biegus
- Institute of Heart Diseases, Wroclaw Medical University, Wrocław, Poland
- Institute of Heart Diseases, University Clinical Hospital, Wrocław, Poland
| | - Łukasz Lewandowski
- Department of Medical Biochemistry, Wroclaw Medical University, Wrocław, Poland
| | - Piotr Ponikowski
- Institute of Heart Diseases, Wroclaw Medical University, Wrocław, Poland
- Institute of Heart Diseases, University Clinical Hospital, Wrocław, Poland
| | - Robert Zymliński
- Institute of Heart Diseases, Wroclaw Medical University, Wrocław, Poland
- Institute of Heart Diseases, University Clinical Hospital, Wrocław, Poland
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Godo ZA, Peto K, Balog K, Deak A, Vanyolos E, Fazekas LA, Szentkereszty Z, Nemeth N. A Custom-Tailored Multichannel Pressure Monitoring System Designed for Experimental Surgical Model of Abdominal Compartment Syndrome. Sensors (Basel) 2024; 24:524. [PMID: 38257617 PMCID: PMC10819495 DOI: 10.3390/s24020524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/11/2024] [Accepted: 01/13/2024] [Indexed: 01/24/2024]
Abstract
In experimental medicine, a wide variety of sensory measurements are used. One of these is real-time precision pressure measurement. For comparative studies of the complex pathophysiology and surgical management of abdominal compartment syndrome, a multichannel pressure measurement system is essential. An important aspect is that this multichannel pressure measurement system should be able to monitor the pressure conditions in different tissue layers, and compartments, under different settings. We created a 12-channel positive-negative sensor system for simultaneous detection of pressure conditions in the abdominal cavity, the intestines, and the circulatory system. The same pressure sensor was used with different measurement ranges. In this paper, we describe the device and major experiences, advantages, and disadvantages. The sensory systems are capable of real-time, variable frequency sampling and data collection. It is also important to note that the pressure measurement system should be able to measure pressure with high sensitivity, independently of the filling medium (gas, liquid). The multichannel pressure measurement system we developed was well suited for abdominal compartment syndrome experiments and provided data for optimizing the method of negative pressure wound management. The system is also suitable for direct blood pressure measurement, making it appropriate for use in additional experimental surgical models.
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Affiliation(s)
- Zoltan Attila Godo
- Department of Information Technology, Faculty of Informatics, University of Debrecen, Kassai Str. 26, H-4028 Debrecen, Hungary;
| | - Katalin Peto
- Department of Operative Techniques and Surgical Research, Faculty of Medicine, University of Debrecen, Moricz Zsigmond Str. 22, H-4032 Debrecen, Hungary; (A.D.); (E.V.); (L.A.F.); (N.N.)
| | - Klaudia Balog
- Department of Surgery, Faculty of Medicine, University of Debrecen, Moricz Zsigmond Str. 22, H-4032 Debrecen, Hungary; (K.B.); (Z.S.)
| | - Adam Deak
- Department of Operative Techniques and Surgical Research, Faculty of Medicine, University of Debrecen, Moricz Zsigmond Str. 22, H-4032 Debrecen, Hungary; (A.D.); (E.V.); (L.A.F.); (N.N.)
| | - Erzsebet Vanyolos
- Department of Operative Techniques and Surgical Research, Faculty of Medicine, University of Debrecen, Moricz Zsigmond Str. 22, H-4032 Debrecen, Hungary; (A.D.); (E.V.); (L.A.F.); (N.N.)
| | - Laszlo Adam Fazekas
- Department of Operative Techniques and Surgical Research, Faculty of Medicine, University of Debrecen, Moricz Zsigmond Str. 22, H-4032 Debrecen, Hungary; (A.D.); (E.V.); (L.A.F.); (N.N.)
| | - Zsolt Szentkereszty
- Department of Surgery, Faculty of Medicine, University of Debrecen, Moricz Zsigmond Str. 22, H-4032 Debrecen, Hungary; (K.B.); (Z.S.)
| | - Norbert Nemeth
- Department of Operative Techniques and Surgical Research, Faculty of Medicine, University of Debrecen, Moricz Zsigmond Str. 22, H-4032 Debrecen, Hungary; (A.D.); (E.V.); (L.A.F.); (N.N.)
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Sato H, Okada F, Iwatsu S, Asayama Y. Abdominal Compartment Syndrome Due to Acute Gastric Dilation. Intern Med 2024; 63:345-346. [PMID: 37258164 PMCID: PMC10864068 DOI: 10.2169/internalmedicine.1763-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/10/2023] [Indexed: 06/02/2023] Open
Affiliation(s)
- Haruka Sato
- Department of Radiology, Oita University Faculty of Medicine, Japan
| | - Fumito Okada
- Department of Radiology, Oita Prefectural Hospital, Japan
| | - Shinichi Iwatsu
- Department of Gastroenterology, Oita Prefectural Hospital, Japan
| | - Yoshiki Asayama
- Department of Radiology, Oita University Faculty of Medicine, Japan
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Tayebi S, McKinney T, McKinney C, Delvadia D, Levine MA, Spofford ES, Malbrain L, Stiens J, Dabrowski W, Malbrain MLNG. Evaluation of the TraumaGuard Balloon-in-Balloon Catheter Design for Intra-Abdominal Pressure Monitoring: Insights from Pig and Human Cadaver Studies. Sensors (Basel) 2023; 23:8806. [PMID: 37960507 PMCID: PMC10650764 DOI: 10.3390/s23218806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023]
Abstract
Introduction: Intra-abdominal pressure (IAP) monitoring is crucial for the detection and prevention of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS). In the 1970s, air-filled catheters (AFCs) for urodynamic studies were introduced as a solution to overcome the limitations of water-perfused catheters. Recent studies have shown that for correct IAP measurement with traditional AFC, the bladder needs to be primed with 25 mL of saline solution to allow pressure wave transmission to the transducer outside of the body, which limits continuous IAP monitoring. Methods: In this study, a novel triple balloon, air-filled TraumaGuard (TG) catheter system from Sentinel Medical Technologies (Jacksonville, FL, USA) with a unique balloon-in-balloon design was evaluated in a porcine and cadaver model of IAH via laparoscopy (IAPgold). Results: In total, 27 and 86 paired IAP measurements were performed in two pigs and one human cadaver, respectively. The mean IAPTG was 20.7 ± 10.7 mmHg compared to IAPgold of 20.3 ± 10.3 mmHg in the porcine study. In the cadaver investigation, the mean IAPTG was 15.6 ± 10.8 mmHg compared to IAPgold of 14.4 ± 10.4 mmHg. The correlation, concordance, bias, precision, limits of agreement, and percentage error were all in accordance with the WSACS (Abdominal Compartment Society) recommendations and guidelines for research. Conclusions: These findings support the use of the TG catheter for continuous IAP monitoring, providing early detection of elevated IAP, thus enabling the potential for prevention of IAH and ACS. Confirmation studies with the TraumaGuard system in critically ill patients are warranted to further validate these findings.
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Affiliation(s)
- Salar Tayebi
- Department of Electronics and Informatics, Vrije Universiteit Brussel, 1050 Brussels, Belgium; (S.T.); (J.S.)
| | - Tim McKinney
- College of Medicine, Drexel University, Philadelphia, PA 19129, USA; (T.M.); (D.D.)
| | - Cynthia McKinney
- SGU School of Medicine, Danbury University Hospital, Danbury, CT 06810, USA;
| | - Dipak Delvadia
- College of Medicine, Drexel University, Philadelphia, PA 19129, USA; (T.M.); (D.D.)
| | - Marc-Alan Levine
- Cricket Innovations, Pottstown, PA 19465, USA; (M.-A.L.); (E.S.S.J.)
| | | | - Luca Malbrain
- Faculty of Medicine, Katholieke Universiteit Leuven, 3000 Leuven, Belgium;
| | - Johan Stiens
- Department of Electronics and Informatics, Vrije Universiteit Brussel, 1050 Brussels, Belgium; (S.T.); (J.S.)
| | - Wojciech Dabrowski
- First Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, 20-954 Lublin, Poland;
| | - Manu L. N. G. Malbrain
- First Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, 20-954 Lublin, Poland;
- Medical Data Management, Medaman, 2440 Geel, Belgium
- International Fluid Academy, 3360 Lovenjoel, Belgium
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Zhao Z, Zhang Z, Liu J, Xia Z, Xing Q, Zhang Y, Zheng Y, Shen L, Lin Q, Gu D, Wang P, Zhang S, Li F, Zhu B. Supine transfer test-induced changes in cardiac index predict fluid responsiveness in patients without intra-abdominal hypertension. BMC Anesthesiol 2023; 23:318. [PMID: 37723480 PMCID: PMC10506238 DOI: 10.1186/s12871-023-02280-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/14/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND The reversible maneuver that mimics the fluid challenge is a widely used test for evaluating volume responsiveness. However, passive leg raising (PLR) does have certain limitations. The aim of the study is to determine whether the supine transfer test could predict fluid responsiveness in adult patients with acute circulatory failure who do not have intra-abdominal hypertension, by measuring changes in cardiac index (CI). METHODS Single-center, prospective clinical study in a 25-bed surgery intensive care unit at the Fudan University Shanghai Cancer Center. Thirty-four patients who presented with acute circulatory failure and were scheduled for fluid therapy. Every patient underwent supine transfer test and fluid challenge with 500 mL saline for 15-30 min. There were four sequential steps in the protocol: (1) baseline-1: a semi-recumbent position with the head of the bed raised to 45°; (2) supine transfer test: patients were transferred from the 45° semi-recumbent position to the strict supine position; (3) baseline-2: return to baseline-1 position; and (4) fluid challenge: administration of 500 mL saline for 15-30 min. Hemodynamic parameters were recorded at each step with arterial pulse contour analysis (ProAQT/Pulsioflex). A fluid responder was defined as an increase in CI ≥ 15% after fluid challenge. The receiver operating characteristic curve and gray zone were defined for CI. RESULTS Seventeen patients were fluid challenge. The r value of the linear correlations was 0.73 between the supine transfer test- and fluid challenge-induced relative CI changes. The relative changes in CI induced by supine transfer in predicting fluid responsiveness had an area under the receiver operating characteristic curve of 0.88 (95% confidence interval 0.72-0.97) and predicted a fluid responder with 76.5% (95% confidence interval 50.1-93.2) sensitivity and 88.2% (95% confidence interval 63.6-98.5) specificity, at a best threshold of 5.5%. Nineteen (55%) patients were in the gray zone (CI ranging from -3 and 8 L/min/m2). CONCLUSION The supine transfer test can potentially assist in detecting fluid responsiveness in patients with acute circulatory failure without intra-abdominal hypertension. Nevertheless, the small threshold and the 55% gray zone were noteworthy limitation. TRIAL REGISTRATION Predicting fluid responsiveness with supine transition test (ChiCTR2200058264). Registered 2022-04-04 and last refreshed on 2023-03-26, https://www.chictr.org.cn/showproj.html?proj=166175 .
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Affiliation(s)
- Zhiyong Zhao
- Department of Critical Care, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Zhongwei Zhang
- Department of Critical Care, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Jing Liu
- Department of Critical Care, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Zhili Xia
- Department of Critical Care, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Qian Xing
- Department of Critical Care, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Yaodong Zhang
- Department of Critical Care, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Yijun Zheng
- Department of Critical Care, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Lihua Shen
- Department of Critical Care, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Qionghua Lin
- Department of Critical Care, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Danyan Gu
- Department of Critical Care, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Pengmei Wang
- Department of Critical Care, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Shan Zhang
- Department of Critical Care, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Fangfang Li
- Department of Critical Care, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Biao Zhu
- Department of Critical Care, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
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Pereira RA, Virella D, Perdigoto R, Marcelino P, Saliba F, Germano N. Continuous passive paracentesis versus large-volume paracentesis in the prevention and treatment of intra-abdominal hypertension in the critically ill cirrhotic patient with ascites (COPPTRIAHL): study protocol for a randomized controlled trial. Trials 2023; 24:534. [PMID: 37582719 PMCID: PMC10426145 DOI: 10.1186/s13063-023-07541-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 07/25/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Critically ill patients with cirrhosis and ascites are at high risk for intra-abdominal hypertension (IAH) which increases mortality. Clinical guidelines recommend maintaining intra-abdominal pressure (IAP) below 16 mmHg; nonetheless, more than three quarters of critically ill patients with cirrhosis develop IAH during their first week of ICU stay. Standard-of-care intermittent large-volume paracentesis (LVP) relieves abdominal wall tension, reduces IAP, optimizes abdominal perfusion pressure, and is associated with short-term improvement in renal and pulmonary dysfunction. However, there is no evidence of the superiority of different paracentesis strategies in the prevention and treatment of IAH in critically ill patients with cirrhosis. This trial aims to compare the outcomes of continuous passive paracentesis versus LVP in the prevention and treatment of IAH in patients with cirrhosis and ascites. METHODS An investigator-initiated, open label, randomized controlled trial, set in a general ICU specialized in liver disease, was initiated in August 2022, with an expected duration of 36 months. Seventy patients with cirrhosis and ascites will be randomly assigned, in a 1:1 ratio, to receive one of two methods of therapeutic paracentesis. A stratified randomization method, with maximum creatinine and IAP values as strata, will homogenize patient baseline characteristics before trial group allocation, within 24 h of admission. In the control group, LVP will be performed intermittently according to clinical practice, with a maximum duration of 8 h, while, in the intervention group, continuous passive paracentesis will drain ascitic fluid for up to 7 days. The primary endpoint is serum creatinine concentration, and secondary endpoints include IAP, measured creatinine clearance, daily urine output, stage 3 acute kidney injury and multiorgan dysfunction assessed at day 7 after enrollment, as well as 28-day mortality rate and renal replacement therapy-free days, and length-of-stay. Prespecified values will be used in case of renal replacement therapy or, beforehand ICU discharge, liver transplant and death. Safety analysis will include paracentesis-related complication rate and harm. Data will be analyzed with an intention-to-treat approach. DISCUSSION This is the first trial to compare the impact of different therapeutic paracentesis strategies on organ dysfunction and outcomes in the prevention and treatment of IAH in critically ill patients with cirrhosis and ascites. TRIAL REGISTRATION ClinicalTrials.gov NCT04322201 . Registered on 20 December 2019.
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Affiliation(s)
- Rui Antunes Pereira
- Unidade de Cuidados Intensivos Polivalente 7, Hospital de Curry Cabral, Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal
| | - Daniel Virella
- Unidade Funcional de Neonatologia, Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal
| | - Rui Perdigoto
- Unidade de Transplante, Hospital de Curry Cabral, Centro Hospitalar Universitário Lisboa Central; Nova Medical School, Lisboa, Portugal
| | - Paulo Marcelino
- Unidade de Cuidados Intensivos Polivalente 4, Hospital de Santa Marta, Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal
| | - Faouzi Saliba
- Hôpital Paul Brousse, Hepato-Biliary Center, Université Paris Saclay, INSERM Unit 1193, Villejuif, France
| | - Nuno Germano
- Unidade de Cuidados Intensivos Polivalente 7, Hospital de Curry Cabral, Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal
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Jena A, Singh AK, Kochhar R. Intra-abdominal hypertension and abdominal compartment syndrome in acute pancreatitis. Indian J Gastroenterol 2023; 42:455-466. [PMID: 37418050 DOI: 10.1007/s12664-023-01407-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 05/26/2023] [Indexed: 07/08/2023]
Abstract
Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are underrecognized entities in patients of acute pancreatitis (AP). IAH develops in 30% to 60% and ACS in 15% to 30% of all AP patients and they are markers of severe disease with high morbidity and mortality. The detrimental effect of increased IAP has been recognized in several organ systems, including the central nervous system, cardiovascular, respiratory, renal and gastrointestinal systems. The pathophysiology of IAH/ACS development in patients with AP is multifactorial. Pathogenetic mechanisms include over-zealous fluid management, visceral edema, ileus, peripancreatic fluid collections, ascites and retroperitoneal edema. Laboratory and imaging markers are neither sensitive nor specific enough to detect IAH/ACS and intra-abdominal pressure (IAP) monitoring is vital for early diagnosis and the management of patients of AP with IAH/ACS. The treatment of IAH/ACS requires a multi-modality approach with both medical and surgical attention. Medical management consists of nasogastric/rectal decompression, prokinetics, fluid management and diuretics or hemodialysis. If conservative management is not effective, percutaneous drainage of fluid collection or ascites is necessary. Despite medical management, if IAP worsens, surgical decompression is warranted. The review discusses the relevance of IAH/ACS in patients of AP and its management.
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Affiliation(s)
- Anuraag Jena
- Department of Gastroenterology, Topiwala National Medical College and B Y L Nair Hospital, Mumbai 400 008, India
| | - Anupam Kumar Singh
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160 012, India
| | - Rakesh Kochhar
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160 012, India.
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Rubio-Gracia J, Crespo-Aznarez S, De la Espriella R, Nuñez G, Sánchez-Marteles M, Garcés-Horna V, Yanguas-Barea N, Josa-Laorden C, Cobo-Marcos M, Giménez-López I, Pérez-Calvo JI, Nuñez J. Utility of plasma CA125 as a proxy of intra-abdominal pressure in patients with acute heart failure. Eur Heart J Acute Cardiovasc Care 2022; 11:453-460. [PMID: 35512321 DOI: 10.1093/ehjacc/zuac046] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 04/11/2022] [Accepted: 04/12/2022] [Indexed: 06/14/2023]
Abstract
AIMS Increased intra-abdominal pressure (IAP) is now considered a potential contributor to organ damage and disease progression in acute heart failure (AHF). In this work, we aimed to determine if antigen carbohydrate 125 (CA125) is associated with IAP and to identify a cutpoint of CA125 useful for ruling out intra-abdominal hypertension (defined as IAP ≥ 12 mmHg). METHODS AND RESULTS We prospectively evaluated a cohort of 53 patients admitted with AHF in which IAP was measured within the first 24-h of admission. The mean age was 80 ± 8 years, 31 (58.5%) were female, and 31 (58.5%) had left ventricular ejection fraction ≥50%. The median plasma levels of NT-proBNP and CA125 were 3830 pg/mL (2417-8929) and 45.8 U/mL (29.8-114.0), respectively. The median of IAP was 15 mmHg (11-17), and 39 (73%) patients had an IAP ≥ 12 mmHg. The diagnostic performance of CA125 for identifying an IAP ≥ 12 mmHg was tested using the receiving operating characteristic (ROC) curve. The cut-off for CA125 of 17.1 U/mL showed a sensitivity of 92%, a specificity of 50%, and an area under the ROC curve of 0.71. After multivariate adjustment, CA125 remained non-linearly and positively associated with higher IAP (P-value = 0.003), explaining almost 28% of the model's variability (R2: 27.6%). CONCLUSIONS Patients with AHF and intra-abdominal hypertension had higher CA125 plasma levels. A baseline concentration of CA125 below 17.1 U/mL will increase the odds of identifying a subset of patients with normal IAP.
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Affiliation(s)
- Jorge Rubio-Gracia
- Internal Medicine Department, Hospital Clínico Universitario 'Lozano Blesa', Avda. San Juan Bosco no 15, 50009 Zaragoza, Spain
- Instituto Investigación Sanitaria Aragón, Zaragoza, Spain
| | - Silvia Crespo-Aznarez
- Internal Medicine Department, Hospital Clínico Universitario 'Lozano Blesa', Avda. San Juan Bosco no 15, 50009 Zaragoza, Spain
- Instituto Investigación Sanitaria Aragón, Zaragoza, Spain
| | - Rafael De la Espriella
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Departamento de Medicina, Universitat de València, Valencia, Spain
| | - Gonzalo Nuñez
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Departamento de Medicina, Universitat de València, Valencia, Spain
| | - Marta Sánchez-Marteles
- Internal Medicine Department, Hospital Clínico Universitario 'Lozano Blesa', Avda. San Juan Bosco no 15, 50009 Zaragoza, Spain
- Instituto Investigación Sanitaria Aragón, Zaragoza, Spain
| | - Vanesa Garcés-Horna
- Internal Medicine Department, Hospital Clínico Universitario 'Lozano Blesa', Avda. San Juan Bosco no 15, 50009 Zaragoza, Spain
- Instituto Investigación Sanitaria Aragón, Zaragoza, Spain
| | - Nerea Yanguas-Barea
- Radiology Department, Hospital Clínico Universitario 'Lozano Blesa', Zaragoza, Spain
| | - Claudia Josa-Laorden
- Internal Medicine Department, Hospital Clínico Universitario 'Lozano Blesa', Avda. San Juan Bosco no 15, 50009 Zaragoza, Spain
- Instituto Investigación Sanitaria Aragón, Zaragoza, Spain
| | | | - Ignacio Giménez-López
- Instituto Investigación Sanitaria Aragón, Zaragoza, Spain
- Facultad de Medicina, Universidad de Zaragoza, Zaragoza, Spain
- Instituto Aragonés de Ciencias de la Salud (IACS), Zaragoza, Spain
| | - Juan Ignacio Pérez-Calvo
- Internal Medicine Department, Hospital Clínico Universitario 'Lozano Blesa', Avda. San Juan Bosco no 15, 50009 Zaragoza, Spain
- Instituto Investigación Sanitaria Aragón, Zaragoza, Spain
- Facultad de Medicina, Universidad de Zaragoza, Zaragoza, Spain
| | - Julio Nuñez
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Departamento de Medicina, Universitat de València, Valencia, Spain
- CIBER in Cardiovascular Diseases (CIBERCV), Madrid, Spain
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Crumley C. Intra-Abdominal Pressure Measurement Devices: A Technologic Analysis. J Wound Ostomy Continence Nurs 2022; 49:220-225. [PMID: 35523236 DOI: 10.1097/won.0000000000000871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this Technologic Analysis is to review devices designed to measure intra-abdominal pressure (IAP); these devices are used to detect intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS). APPROACH Published literature focusing on devices designed to measure IAP was reviewed, comparing the options available and outlining recommendations for appropriate use. Safety information regarding IAP measurement devices was derived from the Manufacturer and User Facility Device Experience (MAUDE) database. CONCLUSIONS Intra-abdominal hypertension is prevalent among critically ill patients of all ages and is linked to adverse consequences, such as abdominal compartment syndrome. The condition is often unrecognized due to the lack of overt clinical symptoms, supporting the need for devices to accurately measure IAP. Commercially available devices measure IAP indirectly, typically via the bladder or stomach. Additional research is needed to demonstrate the benefits of routine screening, further define risk factors for IAH/ACS development, and evaluate the impact of measures to reduce IAP in an effort to improve patient outcomes.
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Affiliation(s)
- Carolyn Crumley
- Carolyn Crumley, DNP, RN, ACNS-BC CWOCN, Saint Luke's East Hospital, Lee's Summit, Missouri; University of Missouri Sinclair School of Nursing, Columbia; and Section Editor JWOCN Evidence-Based Report Card
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Shiomura R, Tara S, Ito N, Watanabe M, Arai T, Kobayashi N, Wakita M, Fujimoto Y, Matsuda J, Nakata J, Yamamoto T, Shimizu W. Hemodynamic Collapse Caused by Cardiac Dysfunction and Abdominal Compartment Syndrome in a Patient with Mitochondrial Disease. Intern Med 2022; 61:489-493. [PMID: 34393167 PMCID: PMC8907761 DOI: 10.2169/internalmedicine.7729-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We herein report a case of mitochondrial disease with heart and intestinal tract involvement resulting in hemodynamic collapse. A 66-year-old woman was transferred to our hospital because of cardiogenic shock. Vasopressors were administered, and a circulatory support device was deployed. However, her hemodynamics did not improve sufficiently, and we detected abdominal compartment syndrome caused by the aggravation of chronic intestinal pseudo-obstruction as a complication. Insertion of a colorectal tube immediately decreased the intra-abdominal pressure, improving the hemodynamics. Finally, we diagnosed her with mitochondrial disease, concluding that the resulting combination of acute heart failure and abdominal compartment syndrome had aggravated the hemodynamics.
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Affiliation(s)
- Reiko Shiomura
- Division of Cardiovascular Intensive Care, Nippon Medical School, Japan
| | - Shuhei Tara
- Division of Cardiovascular Intensive Care, Nippon Medical School, Japan
| | - Nobuaki Ito
- Department of Cardiovascular Medicine, Nippon Medical School, Japan
| | - Makoto Watanabe
- Division of Cardiovascular Intensive Care, Nippon Medical School, Japan
| | - Toshiki Arai
- Division of Cardiovascular Intensive Care, Nippon Medical School, Japan
| | | | - Masaki Wakita
- Division of Cardiovascular Intensive Care, Nippon Medical School, Japan
| | - Yuhi Fujimoto
- Division of Cardiovascular Intensive Care, Nippon Medical School, Japan
| | - Junya Matsuda
- Division of Cardiovascular Intensive Care, Nippon Medical School, Japan
| | - Jun Nakata
- Division of Cardiovascular Intensive Care, Nippon Medical School, Japan
| | - Takeshi Yamamoto
- Division of Cardiovascular Intensive Care, Nippon Medical School, Japan
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Japan
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11
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Morozova NS, Mamedov AA, Kogan EA, Zakharova NV, Yurchenko PN, Morozova OL. Morphological changes in salivary glands of neonatal rats after intra-abdominal hypertension. Eur Rev Med Pharmacol Sci 2022; 26:518-525. [PMID: 35113428 DOI: 10.26355/eurrev_202201_27879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Given the overall prevalence of elevated Intra-abdominal pressure (IAP), along with earlier detection and appropriate therapy of Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS), a significant reduction in patient morbidity and mortality is currently achieved by modern medicine. This article assesses the long-term degree of salivary gland damage in rats depending on the severity of experimental IAH during the neonatal period. MATERIALS AND METHODS To simulate IAH, newborn rats, under the control of intravesical manometry, were injected into the abdominal cavity with bulking collagen filler in the amount necessary to create a given level of IAP. RESULTS As shown by the results obtained, rats exposed to intra-abdominal hypertension for ten days had pathological changes in their salivary glands within 120 days. The severity of sialadenitis revealed a correlation with the severity of IAH. Some rats had individual reactions expressed in relative resistance to their organs' abnormalities under hypoxia. CONCLUSIONS It was concluded that children with severe IAH history might need the disease prevention of the CNS, kidneys, digestive, and respiratory systems and oral diseases, particularly diseases involving the salivary glands. Future research is supposed to investigate further the IAH effect on various organs and tissues, including the dentofacial system.
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Affiliation(s)
- N S Morozova
- Department of Pediatric Dentistry and Orthodontics, Sechenov First Moscow State Medical University, Moscow, Russia.
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12
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Rezeni N, Thabet F. Awareness and management of intra-abdominal hypertension and abdominal compartment syndrome by paediatric intensive care physicians: a national survey. Anaesthesiol Intensive Ther 2022; 54:315-319. [PMID: 36278253 PMCID: PMC10156537 DOI: 10.5114/ait.2022.120366] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 12/20/2021] [Indexed: 08/27/2023] Open
Abstract
INTRODUCTION This study aimed to evaluate the current awareness and management of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) among paediatric intensivists. MATERIAL AND METHODS A web-based electronic survey was sent to all physicians working in paedia-tric intensive care units (PICUs) in Saudi Arabia. The survey questions obtained information regarding awareness of ACS and IAH, recognition criteria, monitoring of intra-abdominal pressure (IAP), and experience in managing ACS. RESULTS A total of 79 physicians responded to the survey (response rate: 53%). Among respondents 48% were consultants. 85% of respondents were familiar with IAP/IAH/ACS. Only 35% and 10% were aware of the Abdominal Compartment Society consensus definitions for IAH and ACS in the paediatric population, respectively. Most respondents considered the cut-off for IAH to be ≥ 15 mm Hg, and approximately two-thirds thought that the cut-off for ACS was higher than the currently suggested consensus definition (10 mm Hg). More than two-thirds of respondents monitored IAP in the PICU, and it was measured almost exclusively via the bladder (96%); the majority (70%) reported that they instilled volumes well above the current recommendations. Medical management was the most frequent therapeutic approach to treat IAH/ACS, while surgical decompression was the least attempted option. Decisions to decompress the abdomen were predominantly based on the presence of organ dysfunction (74.4%). CONCLUSIONS This survey showed that although most responding physicians claim to be familiar with IAH and ACS, their knowledge of published consensus definitions, measurement techniques, and clinical management must be updated.
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Affiliation(s)
| | - Farah Thabet
- Paediatric Intensive Care Unit, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
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Malbrain MLNG, De Keulenaer BL, Khanna AK. Continuous intra-abdominal pressure: is it ready for prime time? Intensive Care Med 2022; 48:1501-1504. [PMID: 35925322 PMCID: PMC9468118 DOI: 10.1007/s00134-022-06780-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/05/2022] [Indexed: 02/04/2023]
Affiliation(s)
- Manu L N G Malbrain
- First Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, Lublin, Poland.
- Medical Data Management, Medaman, Geel, Belgium.
- International Fluid Academy, Lovenjoel, Belgium.
| | - Bart L De Keulenaer
- Intensive Care, Fiona Stanley Hospital, Murdoch, WA, Australia
- School of Surgery, The University of Western Australia, Perth, WA, Australia
- Murdoch Hospital Intensive Care Unit, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Ashish K Khanna
- Wake Forest University School of Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
- Outcomes Research Consortium, Cleveland, OH, USA
- Perioperative Outcomes and Informatics Collaborative (POIC), Winston-Salem, NC, USA
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Ney JP, Moll V, Kimball EJ. Urinary catheter monitoring of intra-abdominal pressure after major abdominal surgery, a cost-benefit analysis. J Med Econ 2022; 25:412-420. [PMID: 35282753 DOI: 10.1080/13696998.2022.2053383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To estimate costs and benefits associated with measurement of intra-abdominal pressure (IAP). METHODS We built a cost-benefit analysis from the hospital facility perspective and time horizon limited to hospitalization for patients undergoing major abdominal surgery for the intervention of urinary catheter monitoring of IAP. We used real-world data estimating the likelihood of intra-abdominal hypertension (IAH), abdominal compartment syndrome (ACS), and acute kidney injury (AKI) requiring renal replacement therapy (RRT). Costs included catheter costs (estimated $200), costs of additional intensive care unit (ICU) days from IAH and ACS, and costs of CRRT. We took the preventability of IAH/ACS given early detection from a trial of non-surgical interventions in IAH. We evaluated uncertainty through probabilistic sensitivity analysis and the effect of individual model parameters on the primary outcome of cost savings through one-way sensitivity analysis. RESULTS In the base case, urinary catheter monitoring of IAP in the perioperative period of major abdominal surgery had 81% fewer cases of IAH of any grade, 64% fewer cases of AKI, and 96% fewer cases of ACS. Patients had 1.5 fewer ICU days attributable to IAH (intervention 1.6 days vs. control of 3.1 days) and a total average cost reduction of $10,468 (intervention $10,809, controls $21,277). In Monte Carlo simulation, 86% of 1,000 replications were cost-saving, for a mean cost savings of $10,349 (95% UCI $8,978, $11,720) attributable to real-time urinary catheter monitoring of intra-abdominal pressure. One-way factor analysis showed the pre-test probability of IAH had the largest effect on cost savings and the intervention was cost-neutral at a prevention rate as low as 2%. CONCLUSIONS In a cost-benefit model using real-world data, the potential average in-hospital cost savings for urinary catheter monitoring of IAP for early detection and prevention of IAH, ACS, and AKI far exceed the cost of the catheter.
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Affiliation(s)
- John P Ney
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Vanessa Moll
- Department of Anesthesiology, Division of Critical Care Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Edward J Kimball
- Depts of Surgery and Critical Care, University of Utah, Salt Lake City, UT, USA
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Xie Y, Yuan Y, Su W, Qing N, Xin H, Wang X, Tian J, Li Y, Zhu J. Effect of continuous hemofiltration on severe acute pancreatitis with different intra-abdominal pressure: A cohort study. Medicine (Baltimore) 2021; 100:e27641. [PMID: 34871235 PMCID: PMC8568405 DOI: 10.1097/md.0000000000027641] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 10/06/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The clinical efficacy and timing of continuous veno-venous hemofiltration (CVVH) in the treatment of severe acute pancreatitis (SAP) remain uncertain. In this prospective cohort study, patients with SAP were classified according to intra-abdominal pressure (IAP). METHODS Seventy-four patients with SAP admitted to the intensive care unit were randomly divided into group A (IAP ≥20 mm Hg) and group B (with IAP ≤20 mm Hg). Then, according to whether CVVH was administered or not, groups A and B were divided into 4 subgroups: group A1 and B1 (non-CVVH treatment), group A2 and B2 (CVVH treatment). Changes in clinical and laboratory indicators were recorded before and on the seventh day after treatment, and clinical outcomes were analyzed. RESULTS Before treatment, there was no significant difference in general conditions between subgroups A1 and A2, and between subgroups B1 and B2. After CVVH treatment, the indicators recorded in group A2 were significantly improved compared to those in group A1 (P < .05). In group A2, the 28 day operation rate was lower (P < .05), as mechanical ventilation, gastric decompression, and intensive care unit treatment time were shorter (P < .05). However, there was no statistically significant difference in any of the above indicators between subgroups B (P > .05). Groups A2 and B2 had more days of negative fluid balance within 1 week of admission than groups A1 and B1 (P < .05). CONCLUSIONS For SAP, patients with IAP ≥20 mm Hg can benefit from treatment with CVVH, but for patients with IAP ≤20 mm Hg, the efficacy is not clear, and monitoring IAP may be an indicator to decide whether or when to initiate CVVH. Negative fluid balance caused by CVVH treatment may be one of the reasons for the benefit of this group of patients.
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Affiliation(s)
- Yongle Xie
- Department of Intensive Care Unit, the First Hospital of Tianshui City, Gansu, China
| | - Yuan Yuan
- Department of Intensive Care Unit, Gansu Provincial People's Hospital, Gansu, China
| | - Wentao Su
- Department of Intensive Care Unit, the First Hospital of Tianshui City, Gansu, China
| | - Nan Qing
- Department of Intensive Care Unit, the First Hospital of Tianshui City, Gansu, China
| | - Hongwei Xin
- Department of Intensive Care Unit, the First Hospital of Tianshui City, Gansu, China
| | - Xiaoying Wang
- Department of Intensive Care Unit, the First Hospital of Tianshui City, Gansu, China
| | - Jing Tian
- Department of Intensive Care Unit, the First Hospital of Tianshui City, Gansu, China
| | - Yun Li
- Department of Intensive Care Unit, the First Hospital of Tianshui City, Gansu, China
| | - Junnian Zhu
- Department of Intensive Care Unit, the First Hospital of Tianshui City, Gansu, China
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Audil HY, Coston TW, Daniels CE. 37-Year-Old Man With an Altered Level of Consciousness. Mayo Clin Proc 2021; 96:2718-2723. [PMID: 34531061 DOI: 10.1016/j.mayocp.2021.02.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 02/03/2021] [Accepted: 02/09/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Hadiyah Y Audil
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Tucker W Coston
- Resident in Hematology and Medical Oncology, Mayo Clinic School of Graduate Medical Education, Jacksonville, FL
| | - Craig E Daniels
- Advisor to residents and Consultant in Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
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Tayebi S, Pourkazemi A, Malbrain ML, Stiens J. Non-Invasive Intra-Abdominal Pressure Measurement by Means of Transient Radar Method: In Vitro Validation of a Novel Radar-Based Sensor. Sensors (Basel) 2021; 21:s21185999. [PMID: 34577207 PMCID: PMC8472078 DOI: 10.3390/s21185999] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 08/30/2021] [Accepted: 09/03/2021] [Indexed: 11/16/2022]
Abstract
Intra-abdominal hypertension, defined as an intra-abdominal pressure (IAP) equal to or above 12 mmHg is one of the major risk-factors for increased morbidity (organ failure) and mortality in critically ill patients. Therefore, IAP monitoring is highly recommended in intensive care unit (ICU) patients to predict development of abdominal compartment syndrome and to provide a better care for patients hospitalized in the ICU. The IAP measurement through the bladder is the actual reference standard advocated by the abdominal compartment society; however, this measurement technique is cumbersome, non-continuous, and carries a potential risk for urinary tract infections and urethral injury. Using microwave reflectometry has been proposed as one of the most promising IAP measurement alternatives. In this study, a novel radar-based method known as transient radar method (TRM) has been used to monitor the IAP in an in vitro model with an advanced abdominal wall phantom. In the second part of the study, further regression analyses have been done to calibrate the TRM system and measure the absolute value of IAP. A correlation of –0.97 with a p-value of 0.0001 was found between the IAP and the reflection response of the abdominal wall phantom. Additionally, a quadratic relation with a bias of −0.06 mmHg was found between IAP obtained from the TRM technique and the IAP values recorded by a pressure gauge. This study showed a promising future for further developing the TRM technique to use it in clinical monitoring.
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Affiliation(s)
- Salar Tayebi
- Department of Electronics and Informatics, Vrije Universiteit Brussel, 1050 Brussels, Belgium; (A.P.); (J.S.)
- Correspondence:
| | - Ali Pourkazemi
- Department of Electronics and Informatics, Vrije Universiteit Brussel, 1050 Brussels, Belgium; (A.P.); (J.S.)
| | - Manu L.N.G. Malbrain
- First Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, 20-059 Lublin, Poland;
- Medical Department, Medical Direction, AZ Jan Palfijn, 9000 Ghent, Belgium
| | - Johan Stiens
- Department of Electronics and Informatics, Vrije Universiteit Brussel, 1050 Brussels, Belgium; (A.P.); (J.S.)
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Strong B, Spoors C, Richardson N, Martin N, Barnes D, El-Muttardi N, Shelley O. Abdominal compartment syndrome in burns patients: Introduction of an evidence-based management guideline and algorithm. J Trauma Acute Care Surg 2021; 90:e146-e154. [PMID: 34016932 DOI: 10.1097/ta.0000000000003131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT Abdominal compartment syndrome is a serious potential complication of burn injury, and carries high morbidity and mortality. Although there are generalised published guidelines on managing the condition, to date no management algorithm has yet been published tailored specifically to the burn injury patient. We set out to examine the literature on the subject in order to produce an evidence based management guideline, with the aim of improving outcomes for these patients. The guideline covers early detection and assessment of the condition as well as optimum medical, surgical and postoperative management. We believe that this guideline provides a much needed benchmark for managing burns patients with raised intra-abdominal pressure, as well as providing a template for further research and improvements in care.
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Affiliation(s)
- Ben Strong
- From the St Andrews Centre for Plastic Surgery and Burns (B.S., C.S., N.M., D.B., N.E.-M., O.S.), Broomfield Hospital; and Department of Surgery (N.R.), Broomfield Hospital, Chelmsford, United Kingdom
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Candan Y, Akinci M, Eraslan O, Yilmaz KB, Karabacak H, Dural HI, Tatar IG, Kaya IO. The Correlation of Intraabdominal Pressure With Renal Resistive Index. J Surg Res 2020; 252:240-246. [PMID: 32304930 DOI: 10.1016/j.jss.2020.03.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 03/01/2020] [Accepted: 03/09/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND To evaluate the correlation between intraabdominal pressure (IAP) measured via the bladder and renal resistive index (RRI) measured by Doppler ultrasonography (USG). METHODS Eighty consecutive surgical patients were included into this study. Before Doppler USG evaluation, IAP was measured by a Foley catheter via the bladder. The left and right RRI, the diameters of the inferior vena cava and portal vein were measured by colored Doppler USG. Spearman correlation analysis was used to evaluate the correlation between different measurements. Intraabdominal hypertension (IAH) was defined as of IAP ≥ 12 mmHg. Significantly different variables from the univariate analysis between patients with and without IAH were entered into backward stepwise binary logistic regression analysis of IAH as the dependent variable. P values < 0.05 were accepted as statistically significant. RESULTS In total, 80 patients were included into study. In 27 patients (34%) IAP was normal and in 53 patients (66%) IAH was diagnosed. The Spearman correlation analysis of IAP and the ultrasonographic measurements revealed a strong correlation between RRI and IAP (P < 0.001). Patients with IAH were more likely to be diabetic and had abdominal incisional hernia compared with patients with normal IAP (P < 0.05). The results of the multivariate logistic regression analysis revealed right RRI as the only independent predictor of IAH (B: 57.04, S. E.: 13.7, P < 0.001). CONCLUSIONS There is a strong correlation between IAP and RRI. RRI can be an alternative, noninvasive technique for the diagnosis and follow-up of IAH after further evaluations in different patient groups.
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Affiliation(s)
- Yeliz Candan
- Department of Surgery, University of Health Sciences, Ankara Diskapi Teaching and Research Hospital, Ankara, Turkey
| | - Melih Akinci
- Department of Surgery, University of Health Sciences, Gulhane Teaching and Research Hospital, Ankara, Turkey.
| | - Onder Eraslan
- Department of Radiology, Tokat Erbaa Ministry of Health State Hospital, Tokat, Turkey
| | - Kerim Bora Yilmaz
- Department of Surgery, University of Health Sciences, Gulhane Teaching and Research Hospital, Ankara, Turkey
| | - Harun Karabacak
- Department of Surgery, University of Health Sciences, Ankara Diskapi Teaching and Research Hospital, Ankara, Turkey
| | - Halil Ibrahim Dural
- Department of Surgery, University of Health Sciences, Ankara Diskapi Teaching and Research Hospital, Ankara, Turkey
| | - Idil Gunes Tatar
- Department of Radiology, University of Health Sciences, Ankara Diskapi Teaching and Research Hospital, Ankara, Turkey
| | - Ismail Oskay Kaya
- Department of Surgery, University of Health Sciences, Ankara Diskapi Teaching and Research Hospital, Ankara, Turkey
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García AF, Chica Yantén J, Sánchez ÁI, Aldana JL, Mejía JH, Burbano D, Salazar C. Bench Validation of a Handcrafted Prototype Catheter for Intra-gastric Pressure Monitoring. World J Surg 2020; 44:1706-1711. [PMID: 32016541 DOI: 10.1007/s00268-020-05392-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Abdominal compartment syndrome is a sustained intra-abdominal pressure (IAP) >20 mm Hg associated with new organ dysfunction. In order to prevent its development and related complications, IAP monitoring should be performed in patients with risk factors. Although techniques for its monitoring have been developed, they are of high cost and not always available in low- and lower-middle-income countries. Therefore, we aim to develop and validate in a bench model a handcrafted catheter to be used as an alternative method to measure the intra-gastric pressure (IGP) as a surrogate of the IAP. METHODS We used an acrylic water container as a model of the abdomen and four handcrafted catheters made of a 16 Fr Levin tube with a globe finger tied with silk in the distal end, inflated with 1 cm of air. They were placed on the bottom of the container where the water pressure was directly measured as a gold standard. The agreement between the two measures was assessed with the Bland-Altman method. RESULTS We performed 120 simultaneous measures. The mean pressure difference was 0.218 (95% CI 0.074 to 0.363). CONCLUSIONS The handcrafted prototype catheter and the direct measure were highly correlated. The new catheter is a reliable and reproducible tool for pressure monitoring. However, before it can be used in the clinical setting for IAP monitoring, validation in human models in a real clinical setting needs to be performed.
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Affiliation(s)
- Alberto Federico García
- Center for Clinical Research (CIC), Fundación Valle del Lili, Carrera 98 No. 18-49, Torre 7, Piso 3 (CIC), Cali, Colombia.
- Department of Surgery, Fundación Valle del Lili, Carrera 98 No. 18-49, Cali, Colombia.
- School of Medicine, Universidad ICESI, Calle 18 No. 122-135, Cali, Colombia.
| | - Julián Chica Yantén
- Center for Clinical Research (CIC), Fundación Valle del Lili, Carrera 98 No. 18-49, Torre 7, Piso 3 (CIC), Cali, Colombia
- School of Medicine, Universidad ICESI, Calle 18 No. 122-135, Cali, Colombia
| | - Álvaro Ignacio Sánchez
- Center for Clinical Research (CIC), Fundación Valle del Lili, Carrera 98 No. 18-49, Torre 7, Piso 3 (CIC), Cali, Colombia
- Department of Surgery, Fundación Valle del Lili, Carrera 98 No. 18-49, Cali, Colombia
| | - Jose Luis Aldana
- Center for Clinical Research (CIC), Fundación Valle del Lili, Carrera 98 No. 18-49, Torre 7, Piso 3 (CIC), Cali, Colombia
- Department of Anesthesia, Fundación Valle del Lili, Carrera 98 No. 18-49, Cali, Colombia
| | - Jorge Humberto Mejía
- Center for Clinical Research (CIC), Fundación Valle del Lili, Carrera 98 No. 18-49, Torre 7, Piso 3 (CIC), Cali, Colombia
- Department of Anesthesia, Fundación Valle del Lili, Carrera 98 No. 18-49, Cali, Colombia
| | - Daniela Burbano
- School of Medicine, Universidad ICESI, Calle 18 No. 122-135, Cali, Colombia
| | - Camilo Salazar
- School of Medicine, Universidad ICESI, Calle 18 No. 122-135, Cali, Colombia
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Rajasurya V, Surani S. Abdominal compartment syndrome: Often overlooked conditions in medical intensive care units. World J Gastroenterol 2020; 26:266-278. [PMID: 31988588 PMCID: PMC6969886 DOI: 10.3748/wjg.v26.i3.266] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 12/17/2019] [Accepted: 01/01/2020] [Indexed: 02/06/2023] Open
Abstract
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.
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Affiliation(s)
- Venkat Rajasurya
- Department of Pulmonary and Critical Care, Novant Health System, Winston-Salem, NC 27103, United States
| | - Salim Surani
- Department of Pulmonary Critical Care and Sleep Medicine, Texas A&M Health Science Center, Bryan, TX 77807, United States
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Kumar S, Mukherjee S, Bhalla A, Sharma N. Prevalence and prognostic signifi cance of intra-abdominal hypertension in critically ill medical patients with septic shock: A prospective observational study. J Assoc Physicians India 2020; 68:87. [PMID: 31979829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Susheel Kumar
- Postgraduate Institute of Medical Education and Research, Chandigarh
| | | | - Ashish Bhalla
- Postgraduate Institute of Medical Education and Research, Chandigarh
| | - Navneet Sharma
- Postgraduate Institute of Medical Education and Research, Chandigarh
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Nguyen J, Noory M, Capano-Wehrle L, Gaughan J, Hazelton JP. Expeditious Diagnosis and Laparotomy for Patients with Acute Abdominal Compartment Syndrome May Improve Survival. Am Surg 2018; 84:1836-1840. [PMID: 30747643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Causes of abdominal compartment syndrome (ACS) are varied and can result from both medical and surgical diseases. Early recognition of ACS and prompt surgical treatment has been shown to improve mortality. We hypothesize that earlier recognition of ACS and earlier involvement by surgical specialists may improve mortality. A retrospective review between July 2010 and July 2015 was performed of adult patients who underwent decompressive laparotomy for ACS. Patients were divided into surgical and medical intensive care units (SICU and MICU) arms. Twenty patients were included (MICU = 12; SICU = 8) without significant difference between the groups. Median time from admission to suspicion for MICU patients was 60 hours versus 13 hours for SICU patients (P = 0.013). Time from suspicion to surgical consult was 60 minutes versus 0 minutes, respectively (P = 0.003), however, time from surgical consult to intervention was not different. Mortality rate in the MICU was 83 per cent versus 12.5 per cent in the SICU (P = 0.005). Patients in the SICU who developed ACS were more quickly diagnosed than those in the MICU. These patients had a shorter time from suspicion of ACS to surgical consultation and eventual surgical intervention, and was associated with improved survival. A multidisciplinary approach, including early surgical consultation, for patients in whom there is a suspicion of ACS may contribute to improved mortality.
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Kovac N, Peric M. Liver function assessment by indocyanine green plasma disappearance rate in patients with intra-abdominal hypertension after "non-hepatic" abdominal surgery. Curr Med Res Opin 2018; 34:1741-1746. [PMID: 29388442 DOI: 10.1080/03007995.2018.1435522] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND OBJECTIVE Liver function assessment in patients with intra-abdominal hypertension (IAH) after major abdominal surgery is complex and often confounding. Elevated intra-abdominal pressure (IAP) often occurs after major abdominal surgery, and is associated with decreased abdominal blood flow and organ dysfunction, and it could cause abdominal compartment syndrome (ACS), which is a life-threatening condition. Plasma disappearance rate (PDR) of indocyanine green (ICG) and ICG retention rate after 15 min (R15) were used to evaluate liver function and as a prognostic parameter after major abdominal surgery. METHODS In this prospective/observational study, 51 patients were followed in the surgical intensive care unit after major abdominal surgery (operation of the small and large intestine, stomach, pancreas, spleen, or resection of the abdominal aorta), 29 had IAH. The PDR-ICG and R15 were analyzed 24 h after surgery concurrently with IAP, APP, bilirubin, AST, ALT, prothrombin time, albumin, cardiac index, arterial lactate, oxygen delivery, MAP (mean arterial pressure), APACHE II (acute physiology and chronic health evaluation), SOFA (sequential organ failure assessment), and SAPS II (simplified acute physiology score). IAH has been defined as a peak intra-abdominal pressure (IAP) value of ≥12 mmHg, at a minimum, as two standardized measurements obtained 1-6 h apart. RESULTS The PDR-ICG measured 24 h after surgery was not different among groups (20.95% [SD = 10.34] vs 25.40% [SD = 7.42]), p = .094. ICG R15 was significantly higher in patients with IAH, 11.10% [SD = 13.82] vs 8.30 [SD = 11.46], p < .05, respectively. The PDR/ICG value was significantly lower in non-survivors than survivors (16.82 [SD = 10.87] vs 24.35 [SD = 8.48], p < .05). CONCLUSIONS The results suggest that PDR/ICG and ICG R15 are useful dynamic tests for evaluation of complex liver function and survival prediction after major abdominal surgery in patients with IAH.
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Affiliation(s)
- Natasa Kovac
- a Departmen of Anaesthesiology , Reanimatology and Intensive Care, Clinical Hospital Centre Zagreb, School of Medicine of University of Zagreb , Zagreb , Croatia
| | - Mladen Peric
- a Departmen of Anaesthesiology , Reanimatology and Intensive Care, Clinical Hospital Centre Zagreb, School of Medicine of University of Zagreb , Zagreb , Croatia
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Abstract
BACKGROUND The abdominal compartment syndrome (ACS) has been clearly identified as being one of the main causes of mortality after ruptured abdominal aortic aneurysm (rAAA). The ACS is defined as a sustained intra-abdominal pressure > 20 mm Hg associated with a new organ dysfunction or failure. A pilot study was conducted and found that the threshold of 3 among 8 selected criteria, we would predict an ACS occurrence with a 54% positive predictive value and a 92% negative predictive value. But a multicentric prospective study was clearly needed to confirm these results. The outcome of this new study is to assess the qualities of a predictive test on occurrence of the ACS after rAAA surgery. METHODS This is a 30 months prospective cohort study conducted in 12 centers and 165 patients will be included. All patients with a rAAA will be consecutively included, whatever the surgical treatment. At the end of surgery, all patients have an abdominal closure and a monitoring of intrabladder pressure will be established every 3 to 4 hours. Decompressive laparotomy will be indicated when ACS occurs. Follow-up period is 1 month. Eight pre- and per-operative criteria will be studied: anemia, hypotension, cardiac arrest, obesity, massive fluid resuscitation, transfusion, hypothermia, and acidosis. DISCUSSION In the literature, there is no recommendation about prophylactic decompression, but early decompressive laparotomy appears to improve survival. This study should make it possible to establish a predictive test, detect the ACS early, and consider a prophylactic decompression in the operating room. TRIAL REGISTRATION ClinicalTrials.gov, NCT02859662, Registered on 4 August 2016.
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Affiliation(s)
- Betty Leclerc
- Vascular Surgery Unit, University Hospital of Besançon
- EA, University of Franche-Comté, Besançon
| | - Lucie Salomon Du Mont
- Vascular Surgery Unit, University Hospital of Besançon
- EA, University of Franche-Comté, Besançon
| | - Anne-Laure Parmentier
- UMR Chrono-Environnement, University of Franche-Comté, La Bouloie-UFR Sciences et Techniques, Besançon Cedex
- Clinical Methodology Center, University Hospital of Besançon, 2 place Saint Jacques, 25030 Besançon, France
| | - Guillaume Besch
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Besançon
- EA, University of Franche-Comté, Besançon
| | - Simon Rinckenbach
- Vascular Surgery Unit, University Hospital of Besançon
- EA, University of Franche-Comté, Besançon
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Izmaylov SG, Ryabkov MG, Baleyev MS, Mokeyev OA. [Comparative diagnostic value of various methods of intracavitary pressure measurement in abdominal compartment syndrome]. Khirurgiia (Mosk) 2018:31-35. [PMID: 30113590 DOI: 10.17116/hirurgia2018831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
AIM To investigate diagnostic value of various methods of biophysical somatic parameters (BSP) monitoring in peritonitis complicated by abdominal compartment syndrome. MATERIAL AND METHODS 220 patients with advanced peritonitis complicated by compartment syndrome were enrolled. Sensitivity, specificity, diagnostic value of the measurement of intraabdominal, intraintestinal, intrathoracic pressure, paravulnar tissues tension depending on abdominal hypertension severity were determined. RESULTS BSP control including intraabdominal, intraintestinal, intrathoracic pressure and paravulnar tissues tension is effective for BPS disturbances diagnosis and abele to detect them significantly more often (p=0.037) compared with M. Cheatham's method alone.
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Affiliation(s)
- S G Izmaylov
- Municipal Clinical Hospital #30 of the Moscow District of Nizhny Novgorod, Nizhny Novgorod, Russia
| | - M G Ryabkov
- Municipal Clinical Hospital #30 of the Moscow District of Nizhny Novgorod, Nizhny Novgorod, Russia
| | - M S Baleyev
- Municipal Clinical Hospital #30 of the Moscow District of Nizhny Novgorod, Nizhny Novgorod, Russia
| | - O A Mokeyev
- Municipal Clinical Hospital #30 of the Moscow District of Nizhny Novgorod, Nizhny Novgorod, Russia
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Jalalzadeh M, Ghadiani MH. Kidney Failure Due to Abdominal Compartment Syndrome Following Snakebite. Iran J Kidney Dis 2017; 11:66-69. [PMID: 28174355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 08/17/2016] [Accepted: 09/04/2016] [Indexed: 06/06/2023]
Abstract
Treatment of snakebite complications is challenging, as it is difficult to distinguish what kind of antivenins should be used. Kidney failure as a result of rhabdomyolysis or hemolysis may happen due to accumulated fluids that increase the pressure in the abdomen. This case report describes acute kidney failure probably due to intra-abdominal hypertension following an unknown bite.
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Affiliation(s)
- Mojgan Jalalzadeh
- Department of Nephrology, Loghman-Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Affiliation(s)
- Di Wu
- Department of Endocrinology and Metabolism, the Endocrine Institute and the Liaoning Provincial Key Laboratory of Endocrine Diseases, the First Hospital of China Medical University, 155 Nanjing Bei Street, Shenyang, Liaoning 110001, People's Republic of China
| | - Haixia Guan
- Department of Endocrinology and Metabolism, the Endocrine Institute and the Liaoning Provincial Key Laboratory of Endocrine Diseases, the First Hospital of China Medical University, 155 Nanjing Bei Street, Shenyang, Liaoning 110001, People's Republic of China.
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Abstract
PURPOSE To enhance the awareness of rare complications of pelvic fracture and describe the correct diagnosis and effective treatment. METHODS A total of 188 cases of pelvic fractures were retrospectively reviewed, and four patients who suffered from four types of rare pelvic fracture complications were described, namely ureteral obstruction caused by retroperitoneal hematoma-induced abdominal compartment syndrome (ACS), bowel entrapment, external iliac artery injury, and open scrotal sac injury. RESULTS We demonstrated that combined measures should be employed to prevent the occurrence of ACS following major pelvic fractures. Ureteral catheter support may be a good option at an early stage when ACS occurred. Contrasted computed tomography examination and sufficient awareness are keys to a correct diagnosis of bowel entrapment following pelvic fractures. Recognition of risk factors, early diagnosis, and prompt treatment of suspected injury of the external iliac artery are keys to patient survival and to avoid limb loss. Scrotal and/or testicular injury complicated by pelvic fractures should be carefully treated to maintain normal gonad function. Additionally, establishment of a sophisticated trauma care system and multi-disciplinary coordination are important for correct diagnosis and treat- ment of rare complications in pelvic fractures. CONCLUSIONS Rare complications of pelvic fractures are difficult to diagnose and negatively impact outcome. Recognition of risk factors and sufficient awareness are essential for correct diagnosis and prompt treatment.
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Affiliation(s)
- Zhao-Wen Zong
- Corresponding author. Tel.: +86 23 68757996; fax: +86 23 68757995.
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Campos-Muñoz MA, Villarreal-Ríos E, Chimal-Torres M, Pozas-Medina JA. [Intra-abdominal pressure as a surgery predictor in patients with acute abdominal pain]. Rev Med Inst Mex Seguro Soc 2016; 54:280-285. [PMID: 27100971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Intra-abdominal pressure is the pressure's state of balance within the abdominal cavity when a patient is at rest. This pressure may vary during mechanical ventilation or spontaneous breathing. The objective was to establish the intra-abdominal pressure as a surgery predictor in patients with acute abdominal pain. METHODS From April to December, 2013, it was carried out a nested case-control study on patients with acute abdominal pain in the emergency room of a second level hospital. Thirty-seven patients fit the inclusion criteria; they all underwent surgery with a previous measurement of the intra-abdominal pressure. Based on the results of the anatomopathological study, we divided the patients into two groups: those with evidence of acute abdominal inflammatory process (n=28) (case group), and patients without evidence of acute abdominal inflammatory process (n=9) (control group). RESULTS In the case group, 100 % of patients shown high intra-abdominal pressure with a p=0.01 (OR=5 [95 % CI=2.578-9.699]. In the case group, the mean intra-abdominal pressure was 11.46, and in the control group 9.2 (p=0.183). CONCLUSIONS Abdominal pain requiring surgical intervention is directly related to intra-abdominal pressure>5 mmHg.
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Moreno Serrano A, García Díaz JJ, Ferrer Márquez M, Moreno Marín P, Fabiano P. A propos of a case: Abdominal compartment syndrome caused by massive hydatid disease. Rev Esp Enferm Dig 2016; 108:110-111. [PMID: 26838500 DOI: 10.17235/reed.2015.3940/2015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Yang SS, Kardash K, Sirois C. Intraoperative Pneumothorax Presenting as Abdominal Distention. Ann Thorac Surg 2015; 101:336-8. [PMID: 26694270 DOI: 10.1016/j.athoracsur.2015.01.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 12/08/2014] [Accepted: 01/16/2015] [Indexed: 11/20/2022]
Abstract
A 74-year-old man with a history of lung cancer presented for right upper lobectomy. After induction of anesthesia, it was noted that the abdomen became progressively more distended. Soon afterward, there was a significant decrease in tidal volume. Ultrasonography of the lung showed no sign of pneumothorax at the anterior second intercostal space. However, the roentgenograms showed a massive right-sided pneumothorax and extensive pneumoperitoneum. Both the pneumothorax and the pneumoperitoneum were decompressed in the operating room, and the elective lobectomy proceeded as previously planned. The patient was extubated at the end of the operation, and there were no sequelae postoperatively.
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Affiliation(s)
- Stephen Su Yang
- Department of Anesthesia, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Kenneth Kardash
- Department of Anesthesia, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
| | - Christian Sirois
- Department of Thoracic Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
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Wu YF, Zheng YP, Zhang N, Liu H, Zheng QX, Yang FT, Wu YF. Study on the correlation between the changes in intra-abdominal pressure and renal functional in the patients with abdominal compartment syndrome. Eur Rev Med Pharmacol Sci 2015; 19:3682-3687. [PMID: 26502858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To observe the effect on renal function from increased intra-abdominal pressure. PATIENTS AND METHODS Sixty patients with abdominal compartment syndrome (ACS) were included in this study. Intra-abdominal pressure, mean arterial pressure (MAP) and central venous pressure (CVP) were recorded three times per day at a fixed time. Meanwhile, blood samples were collected for serum creatinine measurement and urine volume per hour was recorded. RESULTS The urine volume gradually decreased with the increasing intra-abdominal pressure, from 92. 6 ± 20 ml/h to 27.9 ± 20 ml/h (p < 0. 05), and the serum creatinine increased from 68.4 ± 39.9 mol/L to 249.4 ± 111.5 mol/L (p < 0. 05). The CVP increased from 0.98 ± 0.19 kPa to 1.56 ± 0.31 kPa with the increase or decrease of the MAP. The increase in intra-abdominal pressure was negatively related to the urine volume (r = -0.193, p < 0.05), and positively related to the serum creatinine (r = 0.162, p < 0.05), but not related to the MAP. CONCLUSIONS The increase of intra-abdominal pressure, was closely related to oliguria and increasing serum creatinine. The use of fluid resuscitation and diuretics had few effects on the recovery of the renal function. When the intra-abdominal pressure had decreased, the urine volume increased, and the serum creatinine decreased.
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Affiliation(s)
- Y-F Wu
- Department of Hepatobiliary and Pancreatic Surgery, Zhejiang Jinhua Guangfu Hospital, Jinhua, Zhejiang, China.
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Liu Y, Wang L, Cai Z, Zhao P, Peng C, Zhao L, Wan C. The Decrease of Peripheral Blood CD4+ T Cells Indicates Abdominal Compartment Syndrome in Severe Acute Pancreatitis. PLoS One 2015; 10:e0135768. [PMID: 26287969 PMCID: PMC4545887 DOI: 10.1371/journal.pone.0135768] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 07/24/2015] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE Few data are available on the role of T lymphocytes and inflammatory cytokines in abdominal compartment syndrome (ACS) in severe acute pancreatitis (SAP). We conducted a retrospective study to assess the risk factors associated with ACS in SAP. METHODS A total of 76 SAP patients who were admitted within 24 hours after symptom onset in our study. There were 36 patients suffering from ACS and 40 from intra-abdominal hypertension (IAH). On the 1st, 3rd and 7th days after hospital admission, the following variables were assessed: serum value of C-reactive protein (CRP), and the proportions of peripheral CD4+ and CD8+ T lymphocytes. Acute Physiology and Chronic Health Evaluation II (APACHE II) score, and computed tomography severity index (CTSI) score were assessed on days 1 and 7 after hospitalization. RESULTS Compared with the patients with IAH, ACS patients showed statistically higher CRP value on 7th day after hospital admission, proportions of CD4+ T cells on days 1, 3, 7 and CD4+/CD8+ ratio on day 1 were significantly lower (P < 0.05, respectively). A CD4+ T cell proportion of 30.3% on the 1st day indicated ACS with an area under the curve (AUC) of 0.774, a sensitivity with 82.5% and specificity with 72.0%, respectively. Sensitivity/specificity for predicting ACS in SAP patients on day 1 was 70.0%/68.0% for CD4+/CD8+ ratio, 72.2%/65.0% for APACHE II score. CONCLUSIONS The reduction of peripheral blood CD4+ T lymphocytes is associated with ACS in SAP, and may act as a potential predictor of ACS in SAP.
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Affiliation(s)
- Yao Liu
- Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People’s Republic of China
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou Province, People’s Republic of China
| | - Ling Wang
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou Province, People’s Republic of China
| | - Zhifang Cai
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou Province, People’s Republic of China
| | - Peng Zhao
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou Province, People’s Republic of China
| | - Cijun Peng
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou Province, People’s Republic of China
- * E-mail: (CW); (CP)
| | - Lijin Zhao
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou Province, People’s Republic of China
| | - Chidan Wan
- Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People’s Republic of China
- * E-mail: (CW); (CP)
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Strang SG, Van Imhoff DL, Van Lieshout EMM, D'Amours SK, Van Waes OJF. Identifying patients at risk for high-grade intra-abdominal hypertension following trauma laparotomy. Injury 2015; 46:843-8. [PMID: 25805553 DOI: 10.1016/j.injury.2014.12.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 12/04/2014] [Accepted: 12/19/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND Abdominal Compartment Syndrome (ACS) is an uncommon but deleterious complication after trauma laparotomy. Early recognition of patients at risk of developing ACS is crucial for their outcome. The aim of this study was to compare the characteristics of patients who developed high-grade intra-abdominal hypertension (IAH) (i.e., grade III or IV; intra-abdominal pressure, IAP >20 mm Hg) following an injury-related laparotomy versus those who did not (i.e., IAP ≤20 mm Hg). METHODS A retrospective analysis of consecutive trauma patients admitted to a level 1 trauma centre in Australia between January 1, 1995 and January 31, 2010 was performed. A comparison was made between characteristics of patients who developed high-grade IAH following trauma laparotomy versus those who did not. RESULTS A total of 567 patients (median age 31 years) were included in this study. Of these patients 10.2% (58/567) developed high-grade IAH of which 51.7% (30/58) developed ACS. Patients with high-grade IAH were older (p<0.001), had a higher Injury Severity Score (p<0.001), larger base deficit (p<0.001) and lower temperature at admission (p=0.011). In the first 24h of admission, patients with high-grade IAH received larger volumes of crystalloids (p<0.001), larger volumes of colloids (p<0.001) and more units of packed red blood cells (p<0.001). Following surgery prolonged prothrombin (p<0.001) and partial thromboplastin times (p<0.001) were seen. The patients with high-grade IAH suffered higher mortality rates (25.9% (15/58) vs. 12.2% (62/509); p=0.012). CONCLUSION Of all patients who underwent a trauma laparotomy, 10.2% developed high-grade IAH, which increases the risk of mortality. Patients with acidosis, coagulopathy, and hypothermia were especially at risk. In these patients, the abdomen should be left open until adequate resuscitation has been achieved, allowing for definitive surgery. LEVEL OF EVIDENCE This is a level III retrospective study.
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Affiliation(s)
- Steven G Strang
- Erasmus MC, University Medical Center Rotterdam, Trauma Research Unit Department of Surgery, Room H-822k, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Diederik L Van Imhoff
- Erasmus MC, University Medical Center Rotterdam, Trauma Research Unit Department of Surgery, Room H-822k, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Esther M M Van Lieshout
- Erasmus MC, University Medical Center Rotterdam, Trauma Research Unit Department of Surgery, Room H-822k, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Scott K D'Amours
- Department of Trauma, Liverpool Hospital and the University of New South Wales, Sydney, NSW, Australia
| | - Oscar J F Van Waes
- Erasmus MC, University Medical Center Rotterdam, Trauma Research Unit Department of Surgery, Room H-822k, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
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Dąbrowski W, Kotlinska-Hasiec E, Jaroszynski A, Zadora P, Pilat J, Rzecki Z, Zaluska W, Schneditz D. Intra-abdominal pressure correlates with extracellular water content. PLoS One 2015; 10:e0122193. [PMID: 25849102 PMCID: PMC4388733 DOI: 10.1371/journal.pone.0122193] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 02/12/2015] [Indexed: 12/24/2022] Open
Abstract
Background Secondary increase in intra-abdominal pressure (IAP) may result from extra-abdominal pathology, such as massive fluid resuscitation, capillary leak or sepsis. All these conditions increase the extravascular water content. The aim of this study was to analyze the relationship between IAP and body water volume. Material and Methods Adult patients treated for sepsis or septic shock with acute kidney injury (AKI) and patients undergoing elective pharyngolaryngeal or orthopedic surgery were enrolled. IAP was measured in the urinary bladder. Total body water (TBW), extracellular water content (ECW) and volume excess (VE) were measured by whole body bioimpedance. Among critically ill patients, all parameters were analyzed over three consecutive days, and parameters were evaluated perioperatively in surgical patients. Results One hundred twenty patients were studied. Taken together, the correlations between IAP and VE, TBW, and ECW were measured at 408 time points. In all participants, IAP strongly correlated with ECW and VE. In critically ill patients, IAP correlated with ECW and VE. In surgical patients, IAP correlated with ECW and TBW. IAP strongly correlated with ECW and VE in the mixed population. IAP also correlated with VE in critically ill patients. ROC curve analysis showed that ECW and VE might be discriminative parameters of risk for increased IAP. Conclusion IAP strongly correlates with ECW.
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Affiliation(s)
- Wojciech Dąbrowski
- Department of Anesthesiology and Intensive Therapy Medical University of Lublin, Lublin, Poland
- * E-mail:
| | - Edyta Kotlinska-Hasiec
- Department of Anesthesiology and Intensive Therapy Medical University of Lublin, Lublin, Poland
| | | | - Przemyslaw Zadora
- Department of Anesthesiology and Intensive Therapy Medical University of Lublin, Lublin, Poland
| | - Jacek Pilat
- Department of General Surgery, Transplantology and Clinical Nutrition Medical University of Lublin, Lublin, Poland
| | - Ziemowit Rzecki
- Department of Anesthesiology and Intensive Therapy Medical University of Lublin, Lublin, Poland
| | - Wojciech Zaluska
- Department of Nephrology Medical University of Lublin, Lublin, Poland
| | - Daniel Schneditz
- Department of Physiology, Medical University of Graz, Graz, Austria
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Hunt L, Frost SA, Alexandrou E, Hillman K, Newton PJ, Davidson PM. Reliability of intra-abdominal pressure measurements using the modified Kron technique. Acta Clin Belg 2015; 70:116-20. [PMID: 25287555 DOI: 10.1179/2295333714y.0000000083] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Assessment of intra-abdominal pressure (IAP) and the likelihood of abdominal compartment syndrome using valid and reliable measures is an important tool in the assessment of critically ill patients. The current method of relying on a single IAP per measurement period to determine patient clinical status raises the question: is a single intermittent IAP measurement an accurate indicator of clinical status or should more than one measurement be taken per measurement period? METHODS This study sought to assess the reliability of IAP measurements. Measurements were taken using the modified Kron technique. A total of two transvesical intra-abdominal pressure measurements were undertaken per patient using a standardized protocol. Recordings were taken at intervals of 5 minutes. RESULTS The majority of participants (58%) were surgical patients. Thirty-two were males and the mean age was 58 years (SD: 16·7 years). The concordance correlation coefficient between the two measurements was 0·95. Both the scatter and Bland-Altman plots demonstrate that the comparisons of two measurements are highly reproducible. CONCLUSION The findings of this study suggest that conducting two IAP measurements on single patient produce comparable results; therefore, there appears to be no advantage in doing two IAP measurements on a single patient. The measurement of an IAP requires the implementation of a standardized protocol and competent and credentialed assessors trained in the procedure.
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Bunnell A, Cheatham ML. Airway pressures as surrogate estimates of intra-abdominal pressure. Am Surg 2015; 81:81-85. [PMID: 25569070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Intra-abdominal pressure (IAP) measurements are essential to the diagnosis and management of patients with intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS). Peak inspiratory pressure (PIP), plateau pressure (Pplat), and mean airway pressure (Paw) are used by some surgeons as surrogate estimates of IAP during abdominal closure. Thirty mechanically ventilated surgical/trauma patients with risk factors for IAH/ACS underwent simultaneous triplicate measurements of PIP, Pplat, Paw, and IAP. PIP, Pplat, and Paw were compared with IAP using both coefficient of determination and Bland and Altman analysis. The coefficient of determination for each airway pressure in predicting change in IAP was: PIP 5 per cent (P = 0.24), Pplat 17 per cent (P = 0.02), and Paw 15 per cent (P = 0.03). Bland and Altman analysis identified that marked variability exists between airway pressure and IAP measurements: PIP 19.3 ± 18.7 mmHg, Pplat 11.1 ± 13.7 mmHg, and Paw 2.0 ± 9.8 mmHg. Airway pressures do not accurately reflect IAP and cannot be substituted for IAP measurements in patients at risk for IAH/ACS.
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Affiliation(s)
- Avianne Bunnell
- University of Central Florida College of Medicine, Orlando, Florida, USA
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Abstract
Critical acute pancreatitis (CAP) has recently emerged as the most ominous severity category of acute pancreatitis (AP). As such there have been no studies specifically designed to evaluate predictors of CAP. In this study, we aimed to evaluate the accuracy of 4 parameters (Acute Physiology and Chronic Health Evaluation [APACHE] II score, C-reactive protein [CRP], D-dimer, and intra-abdominal pressure [IAP]) for predicting CAP early after hospital admission. During the study period, data on patients with AP were prospectively collected and D-dimer, CRP, and IAP levels were measured using standard methods at admission whereas the APACHE II score was calculated within 24 hours of hospital admission. The receiver-operating characteristic (ROC) curve analysis was applied and the likelihood ratios were calculated to evaluate the predictive accuracy. A total of 173 consecutive patients were included in the analysis and 47 (27%) of them developed CAP. The overall hospital mortality was 11% (19 of 173). APACHE II score ≥11 and IAP ≥13 mm Hg showed significantly better overall predictive accuracy than D-dimer and CRP (area under the ROC curve-0.94 and 0.92 vs. 0.815 and 0.667, correspondingly). The positive likelihood ratio of APACHE II score is excellent (9.9) but of IAP is moderate (4.2). The latter can be improved by adding CRP (5.8). In conclusion, of the parameters studied, APACHE II score and IAP are the best available predictors of CAP within 24 hours of hospital admission. Given that APACHE II score is rather cumbersome, the combination of IAP and CRP appears to be the most practical way to predict critical course of AP early after hospital admission.
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Affiliation(s)
- Lu Ke
- Department of General Surgery (LK, ZT, WL, CW, NL, JL), Jinling Hospital, Nanjing University School of Medicine, Nanjing, China; and Department of Surgery (JAW, MSP), University of Auckland, Auckland, New Zealand
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40
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Iyer D, Rastogi P, Åneman A, D'Amours S. Early screening to identify patients at risk of developing intra-abdominal hypertension and abdominal compartment syndrome. Acta Anaesthesiol Scand 2014; 58:1267-75. [PMID: 25307712 DOI: 10.1111/aas.12409] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND To develop a screening tool to identify patients at risk of developing intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) within 24 h of a patient's admission to intensive care unit (ICU). METHODS Prospective, observational study of 403 consecutively enrolled patients with an indwelling catheter, admitted to a mixed medical-surgical ICU in a tertiary referral, university hospital. Intra-abdominal pressure was measured at least twice daily and IAH and ACS defined as per consensus definitions. RESULTS Thirty-nine per cent of patients developed IAH and 2% developed ACS. Abdominal distension, hemoperitoneum/pneumoperitoneum/intra-peritoneal fluid collection, obesity, intravenous fluid received > 2.3 l, abbreviated Sequential Organ Failure Assessment score > 4 points and lactate > 1.4 mmol/l were identified as independent predictors of IAH upon admission to ICU. The presence of three or more of these risk factors at admission identified patients that would develop IAH with a sensitivity of 75% and a specificity of 76%, the development of grades II, III and IV IAH with a sensitivity of 91% and a specificity of 62%. Patients that developed IAH required a significantly longer duration of mechanical ventilation and ICU care. Patients that developed grades II-IV IAH had a significantly higher rate of ICU mortality. CONCLUSION IAH is a common clinical entity in the intensive care setting that is associated with morbidity and mortality. A screening tool, based on data readily available within a patient's first 24 h in ICU, was developed and effectively identified patients that required intra-abdominal pressure monitoring.
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Affiliation(s)
- D Iyer
- Intensive Care Unit, Liverpool Hospital, Sydney, NSW, Australia; Trauma Department, Liverpool Hospital, Sydney, NSW, Australia; South Western Sydney Clinical School, The University of New South Wales, Sydney, NSW, Australia
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Abstract
Postinjury abdominal compartment syndrome (ACS) is an example of a deadly clinical occurrence that was eliminated by strategic research and focused preventions. In the 1990s, the syndrome emerged with the widespread use of damage control surgery and aggressive crystalloid-based resuscitation. Patients who previously exsanguinated on the operating table made it to intensive care units, but then developed highly lethal hyperacute respiratory, renal, and cardiac failure due to increased abdominal pressure. Among many factors, delayed haemorrhage control and preload driven excessive use of crystalloid resuscitation were identified as modifiable predictors. The surrogate effect of preventive strategies, including the challenge of the 40-year-old standard of large volume crystalloid resuscitation for traumatic shock, greatly reduced cases of ACS. The discoveries were rapidly translated to civilian and military trauma surgical practices and fundamentally changed the way trauma patients are resuscitated today with substantially improved outcomes.
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Affiliation(s)
- Zsolt J Balogh
- Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW, Australia.
| | - William Lumsdaine
- Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW, Australia
| | - Ernest E Moore
- Department of Surgery, University of Colorado, Denver, CO, USA
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Zhu H, Liao X, Guo S, Xuong G, Jiang D, Liu Y. Embryonal natural orifice transluminal endoscopic surgery treating severe acute pancreatitis complicated by abdominal compartment syndrome. Hepatogastroenterology 2014; 61:2096-2101. [PMID: 25713916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND/AIMS This study aims to estimate the value of embryonal natural orifice transluminal endoscopic surgery (ENOTES) as a treatment for severe acute pancreatitis (SAP) complicated by abdominal compartment syndrome (ACS). METHODOLOGY The patients who were randomized into ENOTES group and surgery group underwent ENOTES and laparotomy, respectively. The Efficacy and complications of these two treatments were compared. RESULTS Enterocinesia was observed earlier in patients of ENOTES group than that of surgery group. Acute Physiology and Chronic Health Evaluation II (APACHE II) score of patients in ENOTES group was superior to that of surgery group on the 1st, 3rd and 5th day after treatment (P < 0.05). The cure rate was 96.87% in ENOTES group, which was statistically different from 78.12% in surgery group (P < 0.05). Significant differences in complications and mortality were observed between two groups (P < 0.01). CONCLUSION Compared with surgical abdominal decompression, ENOTES and flexible endoscope therapy is a more effective and minimal invasive surgery with less complications.
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Iyer D, D'Amours S, Aneman A. Intra-abdominal hypertension in postoperative cardiac surgery patients. CRIT CARE RESUSC 2014; 16:214-219. [PMID: 25161025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To investigate screening variables identifying patients at risk of developing intra-abdominal hypertension (IAH) after cardiac surgery. DESIGN AND SETTING Prospective observational study in a tertiary general intensive care unit. PARTICIPANTS One hundred and eight patients admitted to the ICU after cardiac surgery, with measurements of intraabdominal pressure (IAP). MAIN OUTCOME MEASURES Routinely collected clinical, physiological and biochemical variables were analysed with at least twice-daily measurements of IAP during the postoperative stay in the ICU. Variables available within 24 hours of admission to the ICU were evaluated against the incidence of IAH using logistic regression analysis to develop a set of screening criteria to identify patients at risk. RESULTS Fifty patients (46%) developed IAH during their stay in the ICU and were ventilated for longer, needed more vasopressors and stayed one more day in the ICU. Plasma albumin concentration, central venous pressure, minimal abdominal perfusion pressure, cardiopulmonary and aortic cross-clamp times and the presence of abdominal distension within the first 24 hours were associated with the occurrence of IAH. A logistic regression model using these variables correctly identified 85% of patients who developed IAH. CONCLUSIONS A set of screening criteria routinely available within the first 24 hours of admission to the ICU after cardiac surgery could correctly identify most patients at risk of IAH.
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Affiliation(s)
- Dushyant Iyer
- The University of New South Wales, Sydney, NSW, Australia.
| | - Scott D'Amours
- Liverpool Hospital, South Western Sydney Local Health District, Sydney, NSW, Australia
| | - Anders Aneman
- Liverpool Hospital, South Western Sydney Local Health District, Sydney, NSW, Australia
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Mayer D, Rancic Z, Veith FJ, Pecoraro F, Pfammatter T, Lachat M. How to diagnose and treat abdominal compartment syndrome after endovascular and open repair of ruptured abdominal aortic aneurysms. J Cardiovasc Surg (Torino) 2014; 55:179-192. [PMID: 24670826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are frequently encountered in patients treated for ruptured abdominal aortic aneurysms (rAAA) and carry a high morbidity and mortality risk. Despite these facts, IAH/ACS are still overlooked by many physicians, timely diagnosis is missed and treatment often inadequate. All staff involved in the treatment of rAAA should be aware of the risk factors predicting IAH/ACS, the profound implications and derangements on all organ systems, the clinical presentation, the appropriate measurement of intra-abdominal pressure to detect IAH/ACS and the current treatment options for these detrimental syndromes. This comprehensive review provides contemporary knowledge that should help to improve patient survival and long-term outcome.
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Affiliation(s)
- D Mayer
- Clinic for Cardiovascular Surgery University Hospital of Zurich, Zurich, Switzerland -
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Marín Vivó G, Revuelta Escuté M, Rodríguez Martínez X. [Measurement of intra-abdominal pressure with intravesical system Unometer Abdo-Pressure]. Rev Enferm 2014; 37:42-48. [PMID: 24864414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The measurement of intra-abdominal pressure (IAP) has been incorporated routinely in Critical Units in order to monitor and control those clinical situations that make us suspicious of intraabdominal hypertension (IAH). There are several methods to measure IAP [1-3]: direct measurement, a catheter inserted through suprapubic aspiration, although it is a discouraged procedure by being very invasive; and indirect measurement. In this method there are mainly three different techniques: Through femoral vein puncture: a catheter into the inferior vena cava is channeled. It is a technique being deprecated invasive, associated with venous thrombosis, retroperitoneal hematoma and infection. Through a gastric tube: impractical, requires managing large amounts of water associated with leakage through the pylorus risk. Through intravesical measurement: is the most commonly used method. The bladder catheter allows monitoring the PIA and diuresis and electrolyte control. This method has potential for infection associated with catheterization risk. Although this risk, it is considered the gold standard for the measurement of IAP. Have now been introduced to the market each measuring intravesical kits guaranteeing sterility circuit without disconnections. It is necessary to know the material and the correct procedure for measuring the PIA and how to interpret the results.
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Malbrain MLNG, Chiumello D, Cesana BM, Reintam Blaser A, Starkopf J, Sugrue M, Pelosi P, Severgnini P, Hernandez G, Brienza N, Kirkpatrick AW, Schachtrupp A, Kempchen J, Estenssoro E, Vidal MG, De Laet I, De Keulenaer BL. A systematic review and individual patient data meta-analysis on intra-abdominal hypertension in critically ill patients: the wake-up project. World initiative on Abdominal Hypertension Epidemiology, a Unifying Project (WAKE-Up!). Minerva Anestesiol 2014; 80:293-306. [PMID: 24603146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Intra-abdominal hypertension (IAH), defined as a pathologically increase in intraabdominal pressure, is commonly found in critically ill patients. While IAH has been associated with several abdominal as well as extra-abdominal conditions, few studies have examined the occurrence of IAH in relation to mortality. The aim of this paper was to evaluate the prognostic role of IAH and its risk factors at admission in critically ill patients across a wide range of settings and countries. An individual patient meta-analysis of all available data and a systematic review of published (in full or as abstract) medical databases and studies between 1996 and June 2012 were performed. The search was limited to "clinical trials" and "randomized controlled trials", "adults", using the terms "intra-abdominal pressure", "intraabdominal hypertension" combined with any of the terms "outcome" and "mortality". All together data on 2707 patients, representing 21 centers from 11 countries was obtained. Data on 1038 patients were not analysed because of the following exclusion criteria: no IAP value on admission (N.=712), absence of information on ICU outcome (N.=195), age <18 or >95 years (N.=131). Data from 1669 individual patients (19 centers from 9 countries) were analyzed in the meta-analysis. Presence of IAH was defined as a sustained increase in IAP equal to or above 12 mmHg. At admission the mean overall IAP was 9.9±5.0 mmHg, with 463 patients (27.7%) presenting IAH with a mean IAP of 16.3±3.4 mmHg. The only independent predictors for IAH were SOFA score and fluid balance on the day of admission. Five hundred thirteen patients (30.8%) died in intensive care. The independent predictors for intensive care mortality were IAH, SAPS II score, SOFA score and admission category. This systematic review and individual patient data meta-analysis shows that IAH is frequently present in critically ill patients and it is an independent predictor for mortality.
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Affiliation(s)
- M L N G Malbrain
- Intensive Care Unit, ZiekenhuisNetwerk Antwerpen, ZNA Stuivenberg, Antwerpen, Belgium -
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Frank MR, Fromm DS. A case of abdominal compartment syndrome. S D Med 2014; 67:57-59. [PMID: 24624600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Diuzheva TG, Shefer AV. [Intra-abdominal hypertension in patients with severe acute pancreatitis]. Khirurgiia (Mosk) 2014:21-29. [PMID: 24429710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The role of parapancreatitis in the intra-abdominal hypertension (IAH) progression in patients with severe acute pancreatitis with various forms of organs failure was studied. It was analyzed the treatment results of 63 patients with severe acute pancreatitis. The patients were divided into 4 groups: the first group (n=24) had not the signs of organs failure, the second group (n=15) - with symptoms of acute respiratory failure (ARF), the third group (n=11) - with a combination of ARF and acute cardiovascular failure (CVF) and the fourth group (n=13) - with a combination of ARF, CVF and acute renal failure. Intra-abdominal pressure (IAP) was measured at 1, 3, 5, 7- days from the beginning of the disease with calculation of the abdominal perfusion pressure and filtration gradient values. The prevalence evaluation of parapancreatitis was carried out on the basis of CT-data with bolus-dosing of the contrast agent, ultrasound, video laparoscopy as well as data obtained during operation and autopsy. It was defined that the intra-abdominal pressure (IAP) values was not significantly different and complied with intra-abdominal hypertension of the first grade in patients of the groups 1-3 at the first day. IAP was significantly higher and complied with intra-abdominal hypertension of the second grade in patients of the fourth group. IAP normalized to 5-7th days in patients of the first and the second groups. The patients of the third and the fourth groups had IAH of the second grade in the 7th day. There was reliable (p<0.01) average positive correlation (r=0.57) between the indications of IAH and the scale APACHE II. The patients with common parapancreatitis (n=39) had indications of IAP and APACHE II significantly higher than in patients with local forms of parapancreatitis (n=24; p<0.01). Common defeat of retroperitoneal fat determined persistent increase of IAP more than the presence of effusion in the abdominal cavity. In case of the first grade of IAH the mortality was 6.6%, the second grade - 37.5%, the third grade - 58.3% and the fourth grade - 80%. All died patients had a common parapancreatitis. The authors consider that the indications of IAP and APACHE II let to suppose an adverse outcome by the development of multiple organ failure in the early stages of the disease. Common parapancreatitis is the main feature of the persistent IAH (IAP increase during 5-7 days), which is an indication for early decompression operations on the abdominal wall.
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Farrell MS, Marien B, Schiowitz MF. Nonresectional surgical approach to toxic megacolon with abdominal compartment syndrome. Am Surg 2013; 79:E349-E350. [PMID: 24351341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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50
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Marshalov DV, Salov IA, Shifman EM, Petrenko AP, Saliukov RR, Batsunova MO. [Role of intra-abdominal hypertension in the development and outcome of ovarian hyperstimulation syndrome]. Anesteziol Reanimatol 2013:41-46. [PMID: 24749264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To evaluate the role of intraabdominal hypertension in the development and outcome of ovarian hyperstimulation syndrome. MATERIAL AND METHODS 60 patients with varying degrees of ovarian hyperstimulation syndrome (OHSS) due to ongoing pregnancy were involved in the study. Intraabdominal pressure (IAP) was measured in the bladder. Performance of abdominal perfusion pressure, filtration gradient, extensibility and compliance of the anterior abdominal wall were evaluated. A size of the ovaries, chorionic condition and ascites were determined by ultrasonic method. Relation of pregnancy outcome and IAP was analyzed. RESULTS The mean value of IAP in patients with light form of ovarian hyperstimulation syndrome was 7.05 +/- 1.76 mm Hg, 13.65 +/- 1.92 mm Hg in patients with moderate form, and 20.60 +/- 2.52 mm Hg in patients with severe form of OHSS. The leading factors in the development and progression of intraabdominal hypertension (IAH) are the volume of the ovaries, ascites, and extensibility of the abdominal wall. The comparison of pregnancy outcome and severity of IAP revealed a strong positive correlation--r = 0.726, p < 0.001. CONCLUSION Evaluation of the severity of intra-abdominal hypertension in patients with ovarian hyperstimulation syndrome with considering the clinical data and results of laboratory and instrumental studies allow clarifying the severity of condition and predict the potential complications and pregnancy outcomes.
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