Association between intra-abdominal pressure and jugular bulb saturation in critically ill patients

BACKGROUND

Disorders in cerebral circulation following elevated intra-abdominal pressure (IAP) may lead to silent brain ischemia, which can be serious problem in sedated critically ill patients. The aim of the present study was to analyse the possible association between jugular venous bulb pressure (JVBP) and jugular venous bulb saturation (SjO2) to IAP in critically ill patients.

METHODS

Adult septic shock patients with acute kidney injury were studied just after the admission to Intensive Care Unit and after 24 and 48 hours of treatment. Patients were divided into: CVVH group (patients treated with continuous veno-venous haemofiltration) and furosemide group (patients treated with furosemide infusion). The IAP was measured via the bladder. The right jugular vein was retrogradely cannulated for JVBP and SjO2 measurement. Intra-abdominal hypertension was defined as a sustained increase of IAP equal to or above 12 mmHg.

RESULTS

Forty patients (25 male and 15 female patients) were studied. In all participants, IAP strongly correlated with JVBP (P<0.001, r=0.73). This correlation was stronger in the furosemide group than the CVVH group. Moreover, an increase in IAP was related to an increase in JVBP and a decrease in SjO2. There was an inverse correlation between IAP and SjO2 (P<0.001, r=-0.55). This correlation was stronger in furosemide group than CVVH group.

CONCLUSION

IAP is correlated to JVBP and inversely correlated to SjO2. Increase in IAP leads to elevation in JVBP and decrease in SjO2. Renal replacement therapy disturbs the correlation between IAP, JVBP and SjO2.

Recommendations for research from the International Conference of Experts on Intra-abdominal Hypertension and Abdominal Compartment Syndrome

OBJECTIVE

Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) have been increasingly recognized in the critically ill over the past decade, and the number of published studies has exploded in recent years. Interpretation of the results and comparison of these studies is difficult, because of incomplete and inconsistent reporting of data and statistics.

DESIGN

An international consensus group of multidisciplinary specialists convened at the third World Congress on Abdominal Compartment Syndrome to develop recommendations for research related to the diagnosis and management of IAH and ACS.

METHODS

Prior to the conference the authors developed a blueprint for consensus definitions and treatment guidelines which were refined both during and after the conference.

RESULTS

Three major types of studies were identified (measurement techniques, epidemiology, and interventions), each with different needs regarding methodology, reporting of data and statistical analysis.

CONCLUSIONS

These recommendations are proposed to guide clinical research in the field of IAH and ACS.

Strongyloides hyper-infection: a case for awareness

In patients receiving immunosuppressive therapies, Strongyloides stercoralis can cause a life-threatening septic shock, with multi-organ failure and infestation. Strongyloides hyper-infection should be considered in any immunosuppressed patient who has been exposed to the parasite, even if it is many years since that exposure occurred. Delayed eosinophilia may be a feature and treatment with high doses of anthelmintics may be required. An interesting case of S. stercoralis hyper-infection was recently observed at the Royal Darwin Hospital in tropical, northern Australia. The patient was an 18-year-old female with lupus glomerulonephritis, who was receiving immunosuppression in the form of corticosteroids and pulse cyclophosphamide. The characteristics and intensive-care management of this case, including the use of granulocyte-colony stimulating factor and high-dose ivermectin, are described. The patient, who survived, appears to represent the first reported case of S. stercoralis hyper-infection with suspected myocarditis.

Chronic pancreatitis: diagnostic role of computed tomography and magnetic resonance imaging

The value of computed tomography (CT) and magnetic resonance imaging (MRI) in the diagnosis and detection of complications in patients with chronic pancreatitis are reviewed. CT and MRI diagnoses are based on changes in the pancreatic duct and parenchyma and on the detection of ductal calculi. Despite technical refinements of these imaging methods, the diagnosis of chronic pancreatitis remains often difficult because of the complexity of the morphologic changes and the false-negative results in the early stages of the disease. This article describes and illustrates the imaging features of chronic pancreatitis classified according to the underlying etiology.

Enteral nutrition in the critically ill: a prospective survey in an Australian intensive care unit

Nutritional support is routine practice in critically ill patients and enteral feeding is preferred to the parenteral route. However this direct delivery of nutrients to the gut is potentially ineffective for a variety of reasons. We performed a prospective audit of 40 consecutive intensive care patients to determine whether enteral feeding met the nutritional requirements of our patients. The ideal requirements for each patient were calculated using the Harris-Benedict equation with an adjustment determined by the patient's diagnosis. We compared the amount of feed delivered with the daily requirements over a seven-day period Successful feeding was defined as the achievement of 90% of the ideal calorie requirement for two consecutive days. The mean calculated (+/- SD) energy requirement was 9,566 kJ (+/- 2,586). Patients received only 51% (SD 38) of their energy requirements throughout the study period. Only 10 patients (25%) were successfully fed for at least any two-day period in the seven days. Feeding was limited mainly by gastrointestinal dysfunction or by the need to fast the patient for medical, surgical and airway procedures. Success of feeding was not related to the use of sedative orparalysing agents and had no correlation with plasma albumin concentration. There was no difference in the volume of feed delivered to patients who survived or died. Prokinetic agents were used in 25 patients and in these patients there was a trend towards improved delivery of feed.

Pseudomyxoma peritonei in association with primary malignant tumor of the ovary and colon

Pseudomyxoma peritonei (PMP) is a rare entity that is characterised by abundant intraperitoneal mucinous and gelatinous material associated with an intraperitoneal adenocarcinoma. We report the case of a patient who presented with PMP associated with a ruptured well-differentiated mucinous adenocarcinoma of the ovary and an infiltrating moderately-differentiated mucinous adenocarcinoma of the sigmoid. Diagnosis was made by ultrasonography and CT. Due to the presence of 2 mucinous tumors with different histological grade the most likely pathogenesis was that of multifocal metaplasia. The ovarian and colonic mucinous tumors were independent primary neoplasms and PMP probably was the result of rupture of one of these tumors with peritoneal seeding of viable mucus secreting tumor cells. Aggressive surgical debulking in addition to left hemicolectomy and radical hysterectomy were performed.