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Hui M, Sibai B, Montealegre A, Leon MG. Uterine Leiomyomata as a Cause of Abdominal Compartment Syndrome in the Postpartum Period. AJP Rep 2024; 14:e74-e79. [PMID: 38370330 PMCID: PMC10874694 DOI: 10.1055/a-2164-8100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 08/17/2023] [Indexed: 02/20/2024] Open
Abstract
Uterine leiomyomas are common benign smooth muscle tumors that often occur during the reproductive years. Although many cases may not result in significant complications, negative pregnancy outcomes have been associated with the size and location of the fibroids. Degeneration of fibroids can occur as early as the late first trimester when they undergo significant volumetric growth, contributing to pain during pregnancy. While myomectomy is typically avoided during pregnancy, conservative management with anti-inflammatory medications may be effective. Surgical removal or preterm delivery may be necessary if symptoms persist. Abdominal compartment syndrome (ACS) is a rare condition characterized by sustained elevated intra-abdominal pressure leading to organ failure. Although ACS resulting from large-volume leiomyomas in the postpartum period has not been previously described, we present a case of a 25-year-old patient with massive uterine fibroids who required indicated preterm delivery via primary cesarean section at 25 weeks gestation. Her postpartum course was complicated by ACS, requiring emergent surgical decompression. When a large fibroid burden is present during pregnancy or in the postpartum period, ACS should be considered in the differential diagnosis. Early diagnosis and timely surgical decompression are necessary to prevent organ dysfunction and worsening maternal outcomes.
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Affiliation(s)
- Mason Hui
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas
| | - Baha Sibai
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas
| | - Alvaro Montealegre
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas
| | - Mateo G. Leon
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas
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2
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Ting JZL, Dharshini MP, Chew MF. Abdominal Compartment Syndrome Secondary to Constipation in an Adult Patient With Cerebral Palsy. Cureus 2023; 15:e46312. [PMID: 37916246 PMCID: PMC10616903 DOI: 10.7759/cureus.46312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2023] [Indexed: 11/03/2023] Open
Abstract
The majority of patients with constipation can often be treated conservatively with laxatives, suppositories, or enemas in mild cases. However, endoscopic decompression or surgical intervention may be required in some instances. Abdominal compartment syndrome as a result of constipation is rarely seen in the literature. We report a case of faecal impaction, which led to abdominal compartment syndrome in an adult patient with cerebral palsy. With increasing life expectancy, such cases may be increasingly encountered in the adult population. Severe complications of constipation should not be overlooked, especially in this at-risk population. Early recognition of abdominal compartment syndrome is key in its management.
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Affiliation(s)
| | | | - Mei Fang Chew
- Anaesthesiology, Tan Tock Seng Hospital, Singapore, SGP
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3
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Qutob R, Alkhannani AHA, Alassaf TY, Alhokail SO, Bagazi GA, Alsaleh AA, alqarni MK, Alammari Y, Al Harbi K, Elhazmi A, Bukhari AI, Alaryni A, Alghamdi A, Hakami OA. Physicians' Knowledge of Abdominal Compartment Syndrome and Intra-Abdominal Hypertension in Saudi Arabia: An Online Cross-Sectional Survey Study. Int J Gen Med 2022; 15:8509-8526. [PMID: 36514743 PMCID: PMC9741814 DOI: 10.2147/ijgm.s393300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 11/18/2022] [Indexed: 12/12/2022] Open
Abstract
Objective To determine physicians' knowledge of abdominal compartment syndrome and intra-abdominal hypertension in Saudi Arabia. Methods A cross-sectional online survey study was conducted on physicians in Saudi Arabia between March and August 2022. A previously developed questionnaire was adapted and used in this study. The survey instrument investigated the knowledge and management of intra-abdominal hypertension and abdominal compartment syndrome among physicians. Logistic regression was used to identify predictors of being knowledgeable about abdominal compartment syndrome and intra-abdominal hypertension. Results A total of 266 physicians participated in this study. Around one-fifth (21.8%) the study participants were ICU physicians and 25.0% reported that they practice internal medicine. Intra-abdominal hypertension (IAH) and the impact of increased intra-abdominal pressure (IAP) on organ function were terms that the majority of research participants (70.3%) reported they were familiar with. A similar percentage (73.7%) reported that they are familiar with abdominal compartment syndrome (ACS). Around 43.0% of the study participants reported that they do not know how to measure IAP. The most frequently reported (13.5%) intervention in the treatment of IAH and ACS was the use of inotropes or vasopressors. The study participants showed a weak level of knowledge of ACS and IAH with a median score of 3.00 (IQR: 5.00-2.00), which represents 27.3% of the maximum attainable score. Physicians working at hospitals with 20-50 ICU beds were 41.0% (odds ratio: 0.59 (CI: 0.37-0.96)) less likely to be knowledgeable about intra-abdominal hypertension and abdominal compartment syndrome (p≤0.05). Conclusion Physicians demonstrated a low level of IAP and ACS knowledge. To increase the safety of medical practices and enhance clinical outcomes for patients, awareness should be raised about the proper diagnosis and management of IAP and ACS. Future research should focus on developing effective educational strategies to improve physicians' understanding of IAP and ACS.
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Affiliation(s)
- Rayan Qutob
- Faculty of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia,Adult Critical Care Department, Dr. Sulaiman Al-Habib Medical Group, Riyadh, Saudi Arabia
| | - Alanoud Hassan A Alkhannani
- Faculty of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia,Correspondence: Alanoud Hassan A Alkhannani, Faculty of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia, Tel +966 545436837, Email
| | - Turki Yazeed Alassaf
- Faculty of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Saad Othman Alhokail
- Faculty of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | | | | | - Mashael kamel alqarni
- Faculty of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Yousef Alammari
- Faculty of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Khalid Al Harbi
- Faculty of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Alyaa Elhazmi
- College of Medicine, AlFaisal University, Riyadh, Saudi Arabia
| | | | - Abdullah Alaryni
- Faculty of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Abdullah Alghamdi
- Faculty of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Osamah A Hakami
- Faculty of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
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4
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Hamoud S, Abdelgani S, Mekel M, Kinaneh S, Mahajna A. Gastric and urinary bladder pressures correlate with intra-abdominal pressure in patients with morbid obesity. J Clin Monit Comput 2021; 36:1021-1028. [PMID: 34142275 PMCID: PMC9293835 DOI: 10.1007/s10877-021-00728-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 06/09/2021] [Indexed: 11/13/2022]
Abstract
Intra-abdominal pressure (IAP) affects cardio-respiratory and hemodynamic parameters and can be measured directly or indirectly by measuring gastric or urinary bladder pressure. The aim of this study was to investigate the correlation between IAP, gastric pressure and urinary bladder pressure in patients with morbid obesity, at normal and elevated levels of IAP in two positions. As well, to examine the effects of increasing IAP and patient's position on hemodynamic and respiratory parameters. Twelve patients undergoing laparoscopic bariatric surgery were included. IAP, gastric pressure, and urinary bladder pressure were measured while patients were in the supine position and after 45° anti-Trendelenburg tilt. Mean inspiratory pressure, peak inspiratory pressure, and tidal volume were recorded and assessed. In supine position; directly measured IAP was 9.1 ± 1.8 mmHg, compared to 10 ± 3.6 and 8.9 ± 2.9 mmHg in the stomach and bladder, respectively. Increasing IAP to 15 mmHg resulted in an increased gastric pressure of 17 ± 3.8 mmHg, and urinary bladder pressure of 14.8 ± 3.9 mmHg. Gastric and urinary bladder pressures strongly correlated with IAP (R = 0.875 and 0.847, respectively). With 45° anti-Trendelenburg tilt; directly measured IAP was 9.4 ± 2.2 mmHg, and pressures of 10.8 ± 3.8 mmHg and 9.2 ± 3.8 mmHg were measured in the stomach and the bladder, respectively. Increasing IAP to 15 mmHg resulted in elevating gastric and bladder pressures to 16.6 ± 5.3 and 13.3 ± 4 mmHg, respectively. Gastric and urinary bladder pressures had good correlation with IAP (R = 0.843 and 0.819, respectively). Changing patient position from supine to 45° anti-Trendelenburg position resulted in decreased mean and peak inspiratory pressures, and increased tidal volume. Basal IAP is high in patients with morbid obesity. IAP shows positive correlation to gastric and urinary bladder pressures at both normal and elevated levels of IAP. Anti-Trendelenburg tilt of mechanically ventilated morbidly obese patients resulted in favorable effects on respiratory parameters. Trial Registration: The study was retrospectively registered in the NIH registry. Registration number is pending.
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Affiliation(s)
- Shadi Hamoud
- Department of Internal Medicine E, Rambam Health Care Campus, Haifa, Israel.,Ruth & Bruce Rappaport Faculty of Medicine, Technion- Israel Institute of Technology, Haifa, Israel
| | - Siham Abdelgani
- Department of Internal Medicine A, Rambam Health Care Campus, Haifa, Israel
| | - Michal Mekel
- Ruth & Bruce Rappaport Faculty of Medicine, Technion- Israel Institute of Technology, Haifa, Israel.,Department of General Surgery, Rambam Health Care Campus, POB 9602, 3109601, Haifa, Israel
| | - Safa Kinaneh
- Ruth & Bruce Rappaport Faculty of Medicine, Technion- Israel Institute of Technology, Haifa, Israel.,Department of Physiology, The Ruth & Bruce Rappaport Faculty of Medicine, Technion- Israel Institute of Technology, Haifa, Israel
| | - Ahmad Mahajna
- Ruth & Bruce Rappaport Faculty of Medicine, Technion- Israel Institute of Technology, Haifa, Israel. .,Department of General Surgery, Rambam Health Care Campus, POB 9602, 3109601, Haifa, Israel.
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5
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Montero-Pérez-Barquero M. Importance of intra-abdominal pressure in patients with acute heart failure according to the left ventricular ejection fraction. Rev Clin Esp 2021; 221:404-405. [PMID: 34332702 DOI: 10.1016/j.rceng.2020.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 04/02/2020] [Indexed: 11/16/2022]
Affiliation(s)
- M Montero-Pérez-Barquero
- Departamento de Medicina Interna, IMIBIC/Hospital Reina Sofía, Universidad de Córdoba, Córdoba, Spain.
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6
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Montero-Pérez-Barquero M. Importance of intra-abdominal pressure in patients with acute heart failure according to the left ventricular ejection fraction. Rev Clin Esp 2020; 221:S0014-2565(20)30120-X. [PMID: 32475533 DOI: 10.1016/j.rce.2020.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 04/02/2020] [Indexed: 11/15/2022]
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7
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Chandra Soni S, Mehta N, Ray S, Nundy S. Intra-abdominal hypertension and abdominal compartment syndrome in patients undergoing gastrointestinal surgery. JOURNAL OF CLINICAL AND INVESTIGATIVE SURGERY 2019. [DOI: 10.25083/2559.5555/4.2/101.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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8
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Postoperative Development of Abdominal Compartment Syndrome among Patients Undergoing Endovascular Aortic Repair for Ruptured Abdominal Aortic Aneurysms. Ann Vasc Surg 2018; 49:289-294. [PMID: 29477687 DOI: 10.1016/j.avsg.2018.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 02/13/2018] [Accepted: 02/15/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Abdominal compartment syndrome (ACS) has a reported incidence of 9%-14% among trauma patients. However, in patients with similar hemodynamic changes, the incidence of ACS remains unclear. Our aim was to determine the incidence of ACS among patients undergoing endovascular aortic repair (EVAR) for ruptured abdominal aortic aneurysms (rAAAs) and to identify associated risk factors. METHODS A retrospective review was performed for consecutive patients who underwent EVAR for rAAA from March 2010 to November 2016 at our institution. The development of ACS was diagnosed based on a variety of factors, including bladder pressure, laboratory abnormalities, hemodynamic monitoring, and clinical evaluation. Previously validated risk factors for ACS development in trauma and EVAR patients (preoperative hypotension, aggressive fluid resuscitation, postoperative anemia, use of an aorto-uniiliac graft, and placement of an aortic occlusive balloon) were analyzed. Association between patient characteristics and ACS development was analyzed using the Fisher's exact test. RESULTS During the study period, 25 patients had image-confirmed rAAA and underwent emergent EVAR. Mortality rate was 28% (n = 7), and ACS incidence was 12% (n = 3). Of the analyzed risk factors, hypotension on arrival (P = 0.037), transfusion of 3 or more units of packed red blood cells (P = 0.037), and postoperative anemia (P = 0.02) were all significantly associated with postoperative ACS development. In addition, having greater than 3 of the studied risk factors was associated with increased odds of developing ACS (P = 0.015), and having greater than 4 of the studied risk factors showed the strongest association with ACS development (P = 0.0017). CONCLUSIONS Overresuscitation should be avoided in patients with rAAA. In addition, patients who present with multiple risk factors for ACS should be monitored very closely with serial bladder pressures and may require decompression laparotomy immediately after EVAR.
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9
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Tang H, Liu D, Qi HF, Liang ZP, Zhang XZ, Jiang DP, Zhang LY. Effect of retension sutures on abdominal pressure after abdominal surgery. Chin J Traumatol 2018; 21:20-26. [PMID: 29429775 PMCID: PMC6114125 DOI: 10.1016/j.cjtee.2017.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 09/20/2017] [Accepted: 09/30/2017] [Indexed: 02/04/2023] Open
Abstract
PURPOSE To evaluate the effect of retention sutures on abdominal pressure and postoperative prognosis in abdominal surgery patients. METHODS This prospective cohort study included patients who were admitted to Daping Hospital from May 15, 2014 to October 11, 2014. A total of 57 patients were enrolled, including 18 patients in the "U" type retention suture group, 17 patients in the intermittent retention suture group, and 22 patients in non-retention suture group. The demographic data, clinical data and risk factors for abdominal wound dehiscence were recorded. The bladder pressure (IVP) was monitored preoperatively, intraoperatively, and four days postoperatively. Additionally, the incidence of abdominal wound dehiscence and infection 14 days after the operation was recorded. RESULTS During the operation, the IVP decreased and then increased; it was at its lowest 1 h after the start of the operation (5.3 mmHg ± 3.2 mmHg) and peaked after tension-reducing (8.8 mmHg ± 4.0 mmHg). The IVP values in the "U" type retention suture group and intermittent retention suture group were higher than in the non-retention suture group 4 days after operation (p < 0.005). The Visual Analogue Scale (VAS) pain scores were 3.9 ± 2.2, 3.8 ± 2.0, and 3.0 ± 1.0 in the retention suture group, intermittent retention suture group and non-retention suture group, respectively. The VAS pain scores in the "U" type tension-reducing group and intermittent tension-reducing group were higher than in the non-tension-reducing group (p < 0.005). CONCLUSION Although retention sutures may reduce the incidence of postoperative wound dehiscence in abdominal surgery patients, they can increase the IVP and postoperative pain.
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Affiliation(s)
- Hao Tang
- Trauma Center, State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing 400042, China
| | - Dong Liu
- Trauma Center, State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing 400042, China
| | - Hai-Feng Qi
- Trauma Center, State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing 400042, China
| | - Ze-Ping Liang
- Trauma Center, State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing 400042, China
| | - Xiu-Zhu Zhang
- Trauma Center, State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing 400042, China
| | - Dong-Po Jiang
- Trauma Center, State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing 400042, China
| | - Lian-Yang Zhang
- Trauma Center, State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing 400042, China.
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10
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Seternes A, Rekstad LC, Mo S, Klepstad P, Halvorsen DL, Dahl T, Björck M, Wibe A. Open Abdomen Treated with Negative Pressure Wound Therapy: Indications, Management and Survival. World J Surg 2017; 41:152-161. [PMID: 27541031 DOI: 10.1007/s00268-016-3694-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Open abdomen treatment (OAT) is a significant burden for patients and is associated with considerable mortality. The primary aim of this study was to report survival and cause of mortality after OAT. Secondary aims were to evaluate length of stay (LOS) in intensive care unit (ICU) and in hospital, time to abdominal closure and major complications. METHODS Retrospective review of prospectively registered patients undergoing OAT between October 2006 and June 2014 at Trondheim University Hospital, Norway. RESULTS The 118 patients with OAT had a median age of 63 (20-88) years. OAT indications were abdominal compartment syndrome (ACS) (n = 53), prophylactic (n = 29), abdominal contamination/second look laparotomy (n = 22), necrotizing fasciitis (n = 7), hemorrhage packing (n = 4) and full-thickness wound dehiscence (n = 3). Eight percent were trauma patients. Vacuum-assisted wound closure (VAWC) with mesh-mediated traction (VAWCM) was used in 92 (78 %) patients, the remaining 26 (22 %) had VAWC only. Per-protocol primary fascial closure rate was 84 %. Median time to abdominal closure was 12 days (1-143). LOS in the ICU was 15 (1-89), and in hospital 29 (1-246) days. Eighty-one (68 %) patients survived the hospital stay. Renal failure requiring renal replacement therapy (RRT) (OR 3.9, 95 % CI 1.37-11.11), ACS (OR 3.1, 95 % CI 1.19-8.29) and advanced age (OR 1.045, 95 % CI 1.004-1.088) were independent predictors of mortality in multivariate analysis. The nine patients with an entero-atmospheric fistula (EAF) survived. CONCLUSION Two-thirds of the patients treated with OAT survived. Renal failure with RRT, ACS and advanced age were predictors of mortality, whereas EAF was not associated with increased mortality.
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Affiliation(s)
- A Seternes
- Departments of Vascular Surgery, St. Olavs Hospital, Trondheim University Hospital, Prinsesse Kristinas gate 3, 7006, Trondheim, Norway. .,Departments of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Høgskoleringen 1, 7491, Trondheim, Norway. .,Departments of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), 7006, Trondheim, Norway.
| | - L C Rekstad
- Departments of Gastrointestinal Surgery, St. Olavs Hospital, Trondheim University Hospital, Prinsesse Kristinas gate 3, 7006, Trondheim, Norway
| | - S Mo
- Departments of Anesthesiology and Intensive Care Medicine, St. Olavs Hospital, Trondheim University Hospital, Prinsesse Kristinas gate 3, 7006, Trondheim, Norway
| | - P Klepstad
- Departments of Anesthesiology and Intensive Care Medicine, St. Olavs Hospital, Trondheim University Hospital, Prinsesse Kristinas gate 3, 7006, Trondheim, Norway.,Departments of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), 7006, Trondheim, Norway
| | - D L Halvorsen
- Departments of Urologic Surgery, St. Olavs Hospital, Trondheim University Hospital, Prinsesse Kristinas gate 3, 7006, Trondheim, Norway
| | - T Dahl
- Departments of Vascular Surgery, St. Olavs Hospital, Trondheim University Hospital, Prinsesse Kristinas gate 3, 7006, Trondheim, Norway.,Departments of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), 7006, Trondheim, Norway
| | - M Björck
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, 751 85, Uppsala, Sweden
| | - A Wibe
- Departments of Gastrointestinal Surgery, St. Olavs Hospital, Trondheim University Hospital, Prinsesse Kristinas gate 3, 7006, Trondheim, Norway.,Departments of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Høgskoleringen 1, 7491, Trondheim, Norway
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11
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Prevalence and mortality of abdominal compartment syndrome in severely injured patients: A systematic review. J Trauma Acute Care Surg 2017; 81:585-92. [PMID: 27398983 DOI: 10.1097/ta.0000000000001133] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Abdominal compartment syndrome (ACS) in severely injured patients is associated with high morbidity and mortality. Many efforts have been made to improve outcome of patients with ACS. A treatment algorithm for ACS patients was introduced on January 1, 2005 by the World Society of the Abdominal Compartment Syndrome. The aim of this study was to determine the prevalence and mortality rate of ACS among severely injured patients before and after January 1, 2005 using a systematic literature review. METHOD Databases of Embase, Medline (OvidSP), Web of Science, CINAHL, CENTRAL, PubMed publisher, and Google Scholar were searched for terms related to severely injured patients and ACS. Original studies reporting ACS in trauma patients were considered eligible. Data on study design, population, definitions, prevalence, and mortality rates were extracted. Pooled prevalence and mortality of ACS among severely injured patients were calculated for both time periods using inversed variance weighting assuming a random effects model. Tests for heterogeneity were applied. RESULTS A total of 80 publications were included. Prevalence of studies that finished enrolling patients before January 1, 2005 ranged from 0.5% to 36.4% and 0.0% to 28.0% in studies after that date. For severely injured patients admitted to the ICU, this range was 0.5% to 1.3% before 2005 and 0% in one publication in the second time period. For patients with visceral injuries, ACS prevalence ranged 1.0% to 20.0%; one study in the second time period reported 11.1%. The prevalence among severely injured patients who underwent trauma laparotomy ranged from 0.9% to 36.4% in the first time period. Two studies after January 1, 2005 reported ACS prevalence of 2.3% and 13.2%, respectively. The mortality rate in both time periods ranged between 0.0% and 100.0%. CONCLUSION The overall prevalence of ACS ranged from 0.0% to 36.4%. Future studies are needed to measure the effect of improved trauma care and effectiveness of the World Society of the Abdominal Compartment Syndrome Consensus Statements. LEVEL OF EVIDENCE Systematic review/meta-analysis, level III.
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12
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Shaheen AW, Crandall ML, Nicolson NG, Smith-Singares E, Merlotti GJ, Jalundhwala Y, Issa NM. Abdominal compartment syndrome in trauma patients: New insights for predicting outcomes. J Emerg Trauma Shock 2016; 9:53-7. [PMID: 27162436 PMCID: PMC4843567 DOI: 10.4103/0974-2700.179452] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Context: Abdominal compartment syndrome (ACS) is associated with high morbidity and mortality among trauma patients. Several clinical and laboratory findings have been suggested as markers for ACS, and these may point to different types of ACS and complications. Aims: This study aims to identify the strength of association of clinical and laboratory variables with specific adverse outcomes in trauma patients with ACS. Settings and Design: A 5-year retrospective chart review was conducted at three Level I Trauma Centers in the City of Chicago, IL, USA. Subjects and Methods: A complete set of demographic, pre-, intra- and post-operative variables were collected from 28 patient charts. Statistical Analysis: Pearson's correlation coefficient was used to determine the strength of association between 29 studied variables and eight end outcomes. Results: Thirty-day mortality was associated strongly with the finding of an initial intra-abdominal pressure >20 mmHg and moderately with blunt injury mechanism. A lactic acid >5 mmol/L on admission was moderately associated with increased blood transfusion requirements and with acute renal failure during the hospitalization. Developing ACS within 48 h of admission was moderately associated with increased length of stay in the Intensive Care Unit (ICU), more ventilator days, and longer hospital stay. Initial operative intervention lasting more than 2 h was moderately associated with risk of developing multi-organ failure. Hemoglobin level <10 g/dL on admission, ongoing mechanical ventilation, and ICU stay >7 days were moderately associated with a disposition to long-term support facility. Conclusions: Clinical and lab variables can predict specific adverse outcomes in trauma patients with ACS. These findings may be used to guide patient management, improve resource utilization, and build capacity within trauma centers.
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Affiliation(s)
- Aisha W Shaheen
- Department of Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Marie L Crandall
- Department of Surgery, Feinberg School of Medicine, Northwestern University, New York, USA
| | - Norman G Nicolson
- Department of Surgery, Feinberg School of Medicine, Northwestern University, New York, USA
| | - Eduardo Smith-Singares
- Division of Trauma and Critical Care, Advocate Christ Medical Center, Oak Lawn, Illinois, USA
| | | | - Yash Jalundhwala
- College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Nabil M Issa
- Department of Surgery, Feinberg School of Medicine, Northwestern University, New York, USA
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13
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Hunt L, Frost SA, Newton PJ, Salamonson Y, Davidson PM. A survey of critical care nurses' knowledge of intra-abdominal hypertension and abdominal compartment syndrome. Aust Crit Care 2016; 30:21-27. [PMID: 27036928 DOI: 10.1016/j.aucc.2016.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 01/17/2016] [Accepted: 02/22/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Intra-abdominal hypertension and abdominal compartment syndrome are potentially life threatening conditions. Critical care nurses need to understand the factors that predispose patients to intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS). Predicting and managing IAH and ACS are important to improve health outcomes. AIM The aim of this paper was to (1) assess the knowledge of Australian critical care nurses about current IAH and ACS practice guidelines, measurement techniques, predictors for the development of IAH and ACS and (2) identify barriers in recognizing IAH, ACS and measuring IAP. METHODS Between October 2014 and April 2015 86 registered nurses employed in the area of critical care were recruited via the form to participate in an on-line, 19-item questionnaire. The survey was distributed to critical care nurses via the Australian College of Critical Care Nurses (ACCCN) mailing list and directly to intensive care units via The majority of participants were women (n=62) all participants were registered nurses employed in critical care the response rate was 3.2%. The study design was used to establish demographic data, employment data, and individuals' knowledge related to IAH and ACS. Participants had the option to write hand written responses in addition to selecting a closed question response. RESULTS The results showed that most survey participants were able to identify some obvious causes of IAH. However, less than 20% were able to recognize less apparent indices of risk. A lack of education related to IAP monitoring was identified by nearly half (44.2%) of respondents as the primary barrier to monitoring IAP. CONCLUSION Critical care clinicians' knowledge of IAH and ACS is generally low in the areas of presentation and outcomes of IAH and ACS requiring tailored and targeted educational interventions.
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Affiliation(s)
- Leanne Hunt
- Western Sydney University, School of Nursing and Midwifery, Liverpool Hospital, University of Technology Sydney, Locked Bag 1797, Penrith, NSW 2751, Australia.
| | - Steven A Frost
- Western Sydney University, School of Nursing and Midwifery, Liverpool Hospital, Locked Bag 1797, Penrith, NSW 2751, Australia.
| | - Phillip J Newton
- University of Technology Sydney, Centre for Cardiovascular and Chronic Care, Faculty of Health, PO Box 123, Broadway, NSW 2007, Australia.
| | - Yenna Salamonson
- Western Sydney University, School of Nursing and Midwifery, Centre for Applied Nursing Research (CANR), Ingham Institute for Applied Medical Research, Locked Bag 1797, Penrith, NSW 2751, Australia.
| | - Patricia M Davidson
- Johns Hopkins University, School of Nursing, Centre for Cardiovascular and Chronic Care, Faculty of Health PO Box 123, Broadway, NSW 2007, Australia.
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Starnes DS, Lawrence H, Navaratnam R. Is constipation a trivial matter? BMJ Case Rep 2016; 2016:bcr-2015-213085. [PMID: 26818688 DOI: 10.1136/bcr-2015-213085] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Constipation is a common symptom of patients presenting to the emergency department. If poorly managed, it can have significant consequences. A 50-year-old man was admitted to the emergency department following cardiac arrest. His medical history included a diagnosis of cerebral palsy and multiple admissions to hospital with constipation. Clinical examination revealed a grossly distended and tense abdomen. Circulatory supply to the lower limbs was acutely impaired. CT scan revealed massive dilation of the large bowel due to faecal loading with compromised circulation to the lower limbs. Despite aggressive attempts at resuscitation, the patient continued to deteriorate and passed away. On reflection, a diagnosis of abdominal compartment syndrome secondary to severe constipation was made. This case highlights the vigilance required when managing what is often felt to be a trivial complaint and the considerable consequences when there is a failure to do so.
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Permissible Intraabdominal Hypertension following Complex Abdominal Wall Reconstruction. Plast Reconstr Surg 2016; 136:868-881. [PMID: 26090761 DOI: 10.1097/prs.0000000000001621] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Repair of hernias with loss of domain can lead to elevated intraabdominal pressure. The authors aimed to characterize the effects of elective hernia repair on intraabdominal pressure, as well as its predictors and association with negative outcomes. METHODS Patients undergoing elective hernia repair requiring myofascial release had intraabdominal and pulmonary plateau pressures measured preoperatively, postoperatively, and on the morning of the first postoperative day. Loss of domain was measured by preoperative computed tomography. Outcome measures included predictors of an increase in plateau pressure, respiratory complications, and acute kidney injury. RESULTS Following 50 consecutive cases, diagnoses of intraabdominal hypertension (92 percent), abdominal compartment syndrome (16 percent), and abdominal perfusion pressure less than 60 mmHg (24 percent) were determined. Changes in intraabdominal pressure (preoperative, 12.7 ± 4.0 mmHg; postoperative, 18.2 ± 5.4 mmHg; postoperative day 1, 12.9 ± 5.2 mmHg) and abdominal perfusion pressure (preoperative, 74.7 ± 15.7; postoperative, 70.0 ± 14.4; postoperative day 1, 74.9 ± 11.6 mmHg) consistently resolved by postoperative day 1, and were not associated with respiratory complications or acute kidney injury. Patients who remained intubated postoperatively for an elevation in pulmonary plateau pressure (≥6 mmHg) all demonstrated an improvement in plateau pressure by postoperative day 1 (preoperative, 18.9 ± 4.5 mmHg; postoperative, 27.4 ± 4.0 mmHg; postoperative day 1, 20.1 ± 3.7 mmHg), and could be identified preoperatively as having a hernia volume of greater than 20 percent of the abdominal cavity (p < 0.001), but were still more likely to have postoperative respiratory events (p = 0.01). CONCLUSIONS Elevated intraabdominal pressure following elective hernia repair requiring myofascial releases is common but transient. Change in plateau pressure by 6 mmHg or more following repair can be expected with a loss of domain greater than 20 percent and is a more useful surrogate than intraabdominal pressure measurements with regard to predicting postoperative pulmonary complications. The perception and management of elevated intraabdominal pressure should be considered distinct and "permissible" in this context.
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Eğin S, Açıksarı K, Ercan G, Aydın AF, Üstyol EA, Eser M, Tanrıverdi G, Yanar HT. Effects of pentoxifylline on oxidative stress in rats with abdominal compartment syndrome model. INTERNATIONAL JOURNAL OF SURGERY OPEN 2016. [DOI: 10.1016/j.ijso.2016.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Kuteesa J, Kituuka O, Namuguzi D, Ndikuno C, Kirunda S, Mukunya D, Galukande M. Intra-abdominal hypertension; prevalence, incidence and outcomes in a low resource setting; a prospective observational study. World J Emerg Surg 2015; 10:57. [PMID: 26604981 PMCID: PMC4657315 DOI: 10.1186/s13017-015-0051-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Accepted: 11/19/2015] [Indexed: 12/02/2022] Open
Abstract
Background Intra-abdominal hypertension (IAH) is defined as a sustained elevation in intra-abdominal pressure (IAP) greater than or equal to 12 mmHg. IAH has been shown to cause organ derangements and dysfunction in the body. Objective screening of IAH is neither done early enough nor at all thus leading to significant morbidity and mortality among surgical patients. The epidemiology and outcome of IAH among surgical patients has not been documented in Uganda. The aim of this study was to determine the prevalence, incidence and outcome of intra-abdominal hypertension among patients undergoing emergency laparotomy. Methodology Prospective observational study, conducted from January to April 2015 among patients undergoing emergency laparotomy. Inclusion criteria was; age >7 yrs, scheduled for emergency laparotomy, able to lie supine. Exclusion Criteria: pregnant, failed urethral catheterization, known cardiac, renal and respiratory disorders. Consecutive sampling was used. IAP, blood pressure, heart rate, respiratory rate, Sp02, Serum creatinine, Serum urea, and Urine output were measured preoperatively and postoperatively at 0, 6, 24 and 48 h. IAH was defined as IAP > 12 mmHg on three consecutive readings 3 min apart. Results In total 192 patients were enrolled. Mean age ± SD was 14.25 (±3.16) yrs in the paediatrics and 34.4(±13.72) yrs in the adults with male preponderance 65 and 80.7 % respectively. The prevalence of IAH was 25 % paediatrics and 17.4 % adults and the cumulative incidence after surgery was 20 % paediatrics and 21 % adults. In paediatrics, IAH was associated with mortality at 0 h postoperatively, RRR = 1:24, 95 % CI (1.371–560.178), p-value 0.048. In adults, the statistically significant outcomes associated with IAH were respiratory system dysfunction RRR1:2.783, p-value 0.023, 95 % CI (1.148–6.744) preoperatively and mortality RRR 1:2.933, p-value 0.034, 95 % CI (1.017–8.464) at 6 h, RRR 1:3.769, p-value 0.033, 95 % CI (1.113–12.760) at 24 h postoperatively. Conclusion The prevalence and incidence of IAH in the paediatrics and adults group in our study population were high. IAH was associated with mortality in both adult and paediatrics groups and respiratory system dysfunction in adult group. This calls for objective monitoring of intraabdominal pressure in patients undergoing emergency laparotomy with the aim of reducing associated mortality.
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Affiliation(s)
- Job Kuteesa
- Department of Surgery, College of Health Sciences, Makerere University, Mulago Hill road, P.O Box 7072, Kampala, Uganda East Africa ; Department of Surgery, School of Medicine, College of Health Sciences, Makerere University, P.O Box 7072 Kampala, Uganda
| | - Olivia Kituuka
- Department of Surgery, College of Health Sciences, Makerere University, Mulago Hill road, P.O Box 7072, Kampala, Uganda East Africa
| | - Dan Namuguzi
- Department of Surgery, College of Health Sciences, Makerere University, Mulago Hill road, P.O Box 7072, Kampala, Uganda East Africa
| | - Cynthia Ndikuno
- Department of Nursing, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Samuel Kirunda
- Department of Surgery, College of Health Sciences, Makerere University, Mulago Hill road, P.O Box 7072, Kampala, Uganda East Africa
| | - David Mukunya
- Department of Paediatrics, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Moses Galukande
- Department of Surgery, College of Health Sciences, Makerere University, Mulago Hill road, P.O Box 7072, Kampala, Uganda East Africa
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Chopra SS, Wolf S, Rohde V, Freimann FB. Pressure Measurement Techniques for Abdominal Hypertension: Conclusions from an Experimental Model. Crit Care Res Pract 2015; 2015:278139. [PMID: 26113992 PMCID: PMC4465705 DOI: 10.1155/2015/278139] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 05/24/2015] [Indexed: 11/17/2022] Open
Abstract
Introduction. Intra-abdominal pressure (IAP) measurement is an indispensable tool for the diagnosis of abdominal hypertension. Different techniques have been described in the literature and applied in the clinical setting. Methods. A porcine model was created to simulate an abdominal compartment syndrome ranging from baseline IAP to 30 mmHg. Three different measurement techniques were applied, comprising telemetric piezoresistive probes at two different sites (epigastric and pelvic) for direct pressure measurement and intragastric and intravesical probes for indirect measurement. Results. The mean difference between the invasive IAP measurements using telemetric pressure probes and the IVP measurements was -0.58 mmHg. The bias between the invasive IAP measurements and the IGP measurements was 3.8 mmHg. Compared to the realistic results of the intraperitoneal and intravesical measurements, the intragastric data showed a strong tendency towards decreased values. The hydrostatic character of the IAP was eliminated at high-pressure levels. Conclusion. We conclude that intragastric pressure measurement is potentially hazardous and might lead to inaccurately low intra-abdominal pressure values. This may result in missed diagnosis of elevated abdominal pressure or even ACS. The intravesical measurements showed the most accurate values during baseline pressure and both high-pressure plateaus.
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Affiliation(s)
- Sascha Santosh Chopra
- Department of General, Visceral and Transplantation Surgery, Charité-University Medicine Berlin, 13353 Berlin, Germany
| | - Stefan Wolf
- Department of Neurosurgery, Charité-University Medicine Berlin, 13353 Berlin, Germany
| | - Veit Rohde
- Department of Neurosurgery, University Medicine Göttingen, Georg-August University, 37099 Göttingen, Germany
| | - Florian Baptist Freimann
- Department of Neurosurgery, University Medicine Göttingen, Georg-August University, 37099 Göttingen, Germany
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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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Aik-Yong C, Ye-Xin K, Yi NS, Hway WT. Abdominal compartment syndrome: Incidence and prognostic factors influencing survival in Singapore. Indian J Crit Care Med 2014; 18:648-52. [PMID: 25316974 PMCID: PMC4195194 DOI: 10.4103/0972-5229.142173] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Aim of Study: Abdominal compartment syndrome (ACS) is a distinct clinical entity in the critically ill-patient, which leads to end-organ dysfunction. However, data on the incidence of ACS is scarce, and this is also likely contributed by under-diagnosis of this clinical condition. This study reports all cases of ACS in a tertiary institution in Singapore over 10 years, and evaluates prognostic factors affecting survival. Materials and Methods: This retrospective clinical study included 17 patients with ACS, of which 13 underwent decompressive laparotomy, over a 10 years period. Univariate and multivariate analyses of prognostic factors predicting mortality was performed using Chi-square or Fisher-exact test as appropriate. Results: Mean arterial pressure was significantly improved postoperatively, and intra-abdominal pressure and positive end-expiratory pressure significantly decreased. Overall mortality was 47.1%. Advanced age of more than 65 years, gender, large volume resuscitation of more than 3.5 L over 24 h, three or more co-morbidities, requirement of inotropes, usage of mechanical ventilation, and the presence of concurrent lung and renal dysfunction were not adverse prognostic indicators of poorer outcome. The occurrence of multiple relook laparotomies was shown to be the only independent prognostic factor predicting a favorable outcome among these patients on univariate and multivariate analyses. The incidence of ACS accounts for only 0.1% of all Intensive Care Unit admissions during the study period of 10 years, likely due to under-diagnosis. Conclusion: We believe that a protocol for a focused measurement in high-risk groups will increase the diagnostic yield of this condition. Multiple laparotomies for abdominal decompression can lead to improved survival.
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Affiliation(s)
- Chok Aik-Yong
- Department of General Surgery, Singapore General Hospital, Singapore
| | - Koh Ye-Xin
- Department of General Surgery, Singapore General Hospital, Singapore
| | - Ng Shin Yi
- Department of Anaesthesia and Critical Care, Singapore General Hospital, Singapore
| | - Wong Ting Hway
- Department of General Surgery, Singapore General Hospital, Singapore
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Prise en charge des pathologies réanimatoires et chirurgicales au cours des futures missions d’exploration spatiale. ACTA ACUST UNITED AC 2014. [DOI: 10.1007/s13546-014-0899-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
INTRODUCTION Current treatment of the abdominal compartment syndrome (ACS) is based on consensus definitions but several questions regarding fluid regime or critical level of intra-abdominal hypertension (IAH)) remain unsolved. It is questionable whether these issues can be addressed in prospective randomized trials in the near future. This review aimed to summarize current animal models and to outline requirements for the best model. METHODS PubMed® data base was searched for articles describing animal models of ACS. RESULTS 25 articles were found. ACS in animals has not been defined yet. Investigations varied considerably regarding the experimental design. Animals were rats, rabbits, dogs and pigs with a bodyweight from 200g to 70 kg. IAP increase varied from 20 to 50 mmHg. The time period of IAH ranged between 30 min and 24h. The time between the IAH insult and organ dysfunction varied between 15 min and 18h. Investigations demonstrated that IAH is able to induce loss of intravascular volume, organ hypoperfusion, ischemic organ damage and multiple organ failure within 4 to 6h. CONCLUSION In contrast to IAH or pneumoperitoneum for surgical exposure, ACS in an animal may be stated if an artificially increased IAP leads to circulatory, respiratory and renal insufficiency. A next step in animal research would be the development of a "pathological" model in which haemorrhage or systemic inflammation together with resuscitation lead to abdominal fluid accumulation and increased intra-abdominal pressure.
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Chiaka Ejike J, Humbert S, Bahjri K, Mathur M. Outcomes of children with abdominal compartment syndrome. Acta Clin Belg 2014; 62 Suppl 1:141-8. [PMID: 24881711 DOI: 10.1179/acb.2007.62.s1.018] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
INTRODUCTION Abdominal compartment syndrome (ACS) is a problem across all critical care scenarios and is associated with a high mortality. It has not been well described in pediatric populations. OBJECTIVE To describe the occurrence of ACS in a subset of critically ill pediatric patients and determine its effects on mortality and length of pediatric intensive care stay (PICU LOS). We also aimed to find predictors of mortality and development of ACS. SETTING 25 bed tertiary pediatric intensive care unit. PATIENTS PATIENTS less than 50 kg on mechanical ventilation and a urethral catheter. MEASUREMENTS Intra-abdominal pressures (IAP) were monitored using the intra-vesical technique. ACS was defined as IAP of >12mmHg associated with new organ dysfunction or failure. Demographics, physiologic measures of organ dysfunction, PICU LOS and mortality were monitored. MAIN RESULTS 14 (4.7%) of 294 eligible patients had ACS. Mortality was 50% among those with ACS versus 8.2% without (p<.001). PICU LOS stay did not differ between groups. No difference in mortality or PICU LOS was seen in primary versus secondary ACS or in patients who underwent abdominal decompression compared to those without decompression. IAP and ACS were independent predictors of mortality (odds ratio 1.53, 95% CI, 1.17 - 1.99 and 9.09, 95% CI, 1.07 - 76.84) respectively. IAP and a PRISM score of ≥17 were predictive of developing ACS. CONCLUSIONS ACS is a clinical problem that increases the risk of mortality in critically ill children. IAP and PRISM scores may help identify children likely to develop ACS.
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Piffaretti G, Caronno R, Tozzi M, Lomazzi C, Rivolta N, Castelli P. Endovascular versus open repair of ruptured abdominal aortic aneurysms. Expert Rev Cardiovasc Ther 2014; 4:839-52. [PMID: 17173500 DOI: 10.1586/14779072.4.6.839] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Although major improvement has occurred to make elective repair of abdominal aortic aneurysms a safe procedure, the incidence of ruptured abdominal aortic aneurysms and mortality rates are still disappointing. Endovascular abdominal aortic aneurysm repair has produced quantum changes in aneurysm treatment. The successful application of the endovascular approach for the treatment of abdominal aortic aneurysms in the elective setting has prompted a strong interest regarding its possible use in dealing with the long-standing challenge of a ruptured abdominal aortic aneurysm. Since the first report, several centers have reported results and a wide spectrum of opinion regarding its application, with special consideration to logistical and practical barriers for appropriate utilization. The purpose of this article is to review all the available literature on the endovascular repair of ruptured abdominal aortic aneurysms and to analyze the most recent trends in their management, with special consideration given to comparing results of conventional and endovascular approaches.
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Affiliation(s)
- Gabriele Piffaretti
- University of Insubria, Vascular Surgery-Department of Surgery, Viale Borri 57 21100, Varese, Italy.
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Abstract
Abdominal compartment syndrome is defined as sustained intra-abdominal pressure greater than 20 mm Hg (with or without abdominal perfusion pressure <60 mm Hg) associated with new organ failure or dysfunction. The syndrome is associated with 90% to 100% mortality if not recognized and treated in a timely manner. Nurses are responsible for accurately measuring intra-abdominal pressure in children with abdominal compartment syndrome and for alerting physicians about important changes. This article provides relevant definitions, outlines risk factors for abdominal compartment syndrome developing in children, and discusses an instructive case involving an adolescent with abdominal compartment syndrome. Techniques for measuring intra-abdominal pressure, normal ranges, and the importance of monitoring in the critical care setting for timely identification of intra-abdominal hypertension and abdominal compartment syndrome also are discussed.
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Affiliation(s)
- Jennifer Newcombe
- Pediatric Cardiothoracic Surgery, School of Nursing, Loma Linda University, Loma Linda, California, USA.
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Henwood PC, Peak DA, Gonen L, Nadel ES, Brown DFM. Shock one week after abdominal surgery. J Emerg Med 2013; 45:702-5. [PMID: 23988142 DOI: 10.1016/j.jemermed.2013.05.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 05/01/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Patricia C Henwood
- Division of Emergency Medicine, Harvard Medical School, Boston, Massachusetts; Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts; Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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Wang MG, Tian ML, Zhao XF, Nie YS, Chen J, Shen YM. Effectiveness and safety of n-butyl-2-cyanoacrylate medical adhesive for noninvasive patch fixation in laparoscopic inguinal hernia repair. Surg Endosc 2013; 27:3792-8. [DOI: 10.1007/s00464-013-2970-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 04/03/2013] [Indexed: 10/26/2022]
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Abstract
Abstract
Postoperative pulmonary complications are responsible for significant increases in hospital cost as well as patient morbidity and mortality; respiratory muscle dysfunction represents a contributing factor. Upper airway dilator muscles functionally resist the upper airway collapsing forces created by the respiratory pump muscles. Standard perioperative medications (anesthetics, sedatives, opioids, and neuromuscular blocking agents), interventions (patient positioning, mechanical ventilation, and surgical trauma), and diseases (lung hyperinflation, obesity, and obstructive sleep apnea) have differential effects on the respiratory muscle subgroups. These effects on the upper airway dilators and respiratory pump muscles impair their coordination and function and can result in respiratory failure. Perioperative management strategies can help decrease the incidence of postoperative respiratory muscle dysfunction. Such strategies include minimally invasive procedures rather than open surgery, early and optimal mobilizing of respiratory muscles while on mechanical ventilation, judicious use of respiratory depressant anesthetics and neuromuscular blocking agents, and noninvasive ventilation when possible.
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Identifying the association among risk factors and mortality in trauma patients with intra-abdominal hypertension and abdominal compartment syndrome. J Trauma Nurs 2013; 19:182-9. [PMID: 22955716 DOI: 10.1097/jtn.0b013e318261d2f1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Intra-abdominal hypertension and abdominal compartment syndrome (ACS) have become key players in increasing mortality among critically ill trauma patients. Many risk factors place the trauma patient at risk for developing ACS. Very few studies exist to establish a predictive relationship between any one risk factor and mortality among these patients. A retrospective, nonexperimental, descriptive project considering preidentified risk factors and their direct association with mortality in patients exhibiting intra-abdominal hypertension and ACS was carried out in an urban level 1 trauma center. Polytransfusion was strongly predicted among those with ACS for mortality (P < .001). Mortality was strongly associated with a reported history of diabetes (P < .05). The total amount of blood products showed a perfect correlation with death as well (r = 1.0, P < .001).
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Young AJ, Weber W, Wolfe L, Ivatury RR, Duane TM. One Elevated Bladder Pressure Measurement May Not be Enough to Diagnose Abdominal Compartment Syndrome. Am Surg 2013. [DOI: 10.1177/000313481307900223] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Bladder pressure measurements (BPMs) are considered a key component in the diagnosis of abdominal compartment syndrome (ACS). The purpose of this observational review was to determine risk factors of ACS and associated mortality with particular focus on the role of BPM. A retrospective trauma registry and chart review was performed on trauma patients from January 2003 through December 2010. Comparisons were made between patients with and without ACS. There were 3172 patients included in the study of whom 46 had ACS. Patients with ACS were younger, more severely injured, with longer lengths of stay. Logistic regression determined Injury Severity Score (ISS) and urinary catheter days as independent predictors of ACS, whereas independent predictors of mortality included age, ISS, and ACS. Subset analysis demonstrated no association between BPM 20 mmHg or greater and diagnosis of ACS versus no ACS. Logistic regression indicated independent predictors of mortality were number of BPM 20 mmHg or greater and age. Patients with ACS are more severely injured with worse outcomes. An isolated BPM 20 mmHg or greater was not associated with ACS and may be inadequate to independently diagnose ACS. These findings suggest the need for repeat measurements with early intervention if they remain elevated in an effort to decrease mortality associated with ACS.
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Affiliation(s)
- Andrew Joseph Young
- From the Division of Trauma/Critical Care and Emergency Surgery, Medical College of Virginia, Physicians and Hospitals, Virginia Commonwealth University Health System, Richmond, Virginia
| | - William Weber
- From the Division of Trauma/Critical Care and Emergency Surgery, Medical College of Virginia, Physicians and Hospitals, Virginia Commonwealth University Health System, Richmond, Virginia
| | - Luke Wolfe
- From the Division of Trauma/Critical Care and Emergency Surgery, Medical College of Virginia, Physicians and Hospitals, Virginia Commonwealth University Health System, Richmond, Virginia
| | - Rao R. Ivatury
- From the Division of Trauma/Critical Care and Emergency Surgery, Medical College of Virginia, Physicians and Hospitals, Virginia Commonwealth University Health System, Richmond, Virginia
| | - Therese Marie Duane
- From the Division of Trauma/Critical Care and Emergency Surgery, Medical College of Virginia, Physicians and Hospitals, Virginia Commonwealth University Health System, Richmond, Virginia
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Bosch L, Rivera del Álamo MM, Andaluz A, Monreal L, Torrente C, García-Arnas F, Fresno L. Effects of ovariohysterectomy on intra-abdominal pressure and abdominal perfusion pressure in cats. Vet Rec 2012; 171:622. [DOI: 10.1136/vr.100791] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- L. Bosch
- Servei d'Emergències i Cures Intensives, Fundació Hospital Clínic Veterinari, Edifici V; Campus Universitari; Universitat Autònoma de Barcelona; Cerdanyola del Vallès Barcelona 08193 Spain
| | - M. M. Rivera del Álamo
- Servei de Reproducció, Fundació Hospital Clínic Veterinari, Edifici V; Campus Universitari; Universitat Autònoma de Barcelona; Cerdanyola del Vallès Barcelona 08193 Spain
| | - A. Andaluz
- Servei de Cirurgia, Fundació Hospital Clínic Veterinari, Edifici V; Campus Universitari; Universitat Autònoma de Barcelona; Cerdanyola del Vallès Barcelona 08193 Spain
| | - L. Monreal
- Servei de Cirurgia, Fundació Hospital Clínic Veterinari, Edifici V; Campus Universitari; Universitat Autònoma de Barcelona; Cerdanyola del Vallès Barcelona 08193 Spain
| | - C. Torrente
- Servei d'Emergències i Cures Intensives, Fundació Hospital Clínic Veterinari, Edifici V; Campus Universitari; Universitat Autònoma de Barcelona; Cerdanyola del Vallès Barcelona 08193 Spain
| | - F. García-Arnas
- Servei de Cirurgia, Fundació Hospital Clínic Veterinari, Edifici V; Campus Universitari; Universitat Autònoma de Barcelona; Cerdanyola del Vallès Barcelona 08193 Spain
| | - L. Fresno
- Servei de Cirurgia, Fundació Hospital Clínic Veterinari, Edifici V; Campus Universitari; Universitat Autònoma de Barcelona; Cerdanyola del Vallès Barcelona 08193 Spain
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Hunter B, Tod L, Ghosh J. Retroperitoneal haematoma causing gastric outflow obstruction following endovascular repair of a ruptured abdominal aortic aneurysm. BMJ Case Rep 2012; 2012:bcr2012007311. [PMID: 23162028 PMCID: PMC4543560 DOI: 10.1136/bcr-2012-007311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 74-year-old man presented with back pain and collapse. A ruptured infrarenal abdominal aortic aneurysm was successfully managed by endovascular aneurysm repair. Postoperatively, he developed gastric outlet obstruction owing to duodenal compression from the unevacuated retroperitoneal haematoma. In the absence of abdominal compartment syndrome, conservative management with gastric decompression and parenteral nutrition led to a full recovery.
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Affiliation(s)
- Benjamin Hunter
- Department of Vascular Surgery, University Hospital of South Manchester, Manchester, UK
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Plante A, Ro E, Rowbottom JR. Hemodynamic and related challenges: monitoring and regulation in the postoperative period. Anesthesiol Clin 2012; 30:527-554. [PMID: 22989593 DOI: 10.1016/j.anclin.2012.07.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The clinician caring for patients in the immediate postoperative period must maintain a high index of suspicion for the development of complications. Evolving illness manifests itself throughout the continuum of care and must be recognized and aggressively managed to ensure optimal outcome. This article discusses common hemodynamic problems encountered in the postanesthesia care unit. These problems are presented in a clinical framework that is familiar to experienced practitioners and recognizable to trainees. This article reviews of these common problems including relevant physiologic principles; effects on hemodynamics; and a logical approach to evaluation, monitoring, and management of a complex postoperative patient.
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Affiliation(s)
- Andrew Plante
- Department of Anesthesiology & Perioperative Medicine, University Hospitals, Case Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, USA
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Starkopf J, Tamme K, Blaser AR. Should we measure intra-abdominal pressures in every intensive care patient? Ann Intensive Care 2012; 2 Suppl 1:S9. [PMID: 22873425 PMCID: PMC3390289 DOI: 10.1186/2110-5820-2-s1-s9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Intra-abdominal pressure (IAP) is seldom measured by default in intensive care patients. This review summarises the current evidence on the prevalence and risk factors of intra-abdominal hypertension (IAH) to assist the decision-making for IAP monitoring.IAH occurs in 20% to 40% of intensive care patients. High body mass index (BMI), abdominal surgery, liver dysfunction/ascites, hypotension/vasoactive therapy, respiratory failure and excessive fluid balance are risk factors of IAH in the general ICU population. IAP monitoring is strongly supported in mechanically ventilated patients with severe burns, severe trauma, severe acute pancreatitis, liver failure or ruptured aortic aneurysms. The risk of developing IAH is minimal in mechanically ventilated patients with positive end-expiratory pressure < 10 cmH2O, PaO2/FiO2 > 300, and BMI < 30 and without pancreatitis, hepatic failure/cirrhosis with ascites, gastrointestinal bleeding or laparotomy and the use of vasopressors/inotropes on admission. In these patients, omitting IAP measurements might be considered.In conclusions, clear guidelines to select the patients in whom IAP measurements should be performed cannot be given at present. In addition to IAP measurements in at-risk patients, a clinical assessment of the signs of IAH should be a part of every ICU patient's bedside evaluation, leading to prompt IAP monitoring in case of the slightest suspicion of IAH development.
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Affiliation(s)
- Joel Starkopf
- Department of Anaesthesiology and Intensive Care, University of Tartu, 8 L. Puusepa Str, 51014, Tartu, Estonia
- Clinic of Anaesthesiology and Intensive Care, Tartu University Hospital, 8 L. Puusepa Str, 51014, Tartu, Estonia
| | - Kadri Tamme
- Department of Anaesthesiology and Intensive Care, University of Tartu, 8 L. Puusepa Str, 51014, Tartu, Estonia
- Clinic of Anaesthesiology and Intensive Care, Tartu University Hospital, 8 L. Puusepa Str, 51014, Tartu, Estonia
| | - Annika Reintam Blaser
- Department of Anaesthesiology and Intensive Care, University of Tartu, 8 L. Puusepa Str, 51014, Tartu, Estonia
- Department of Intensive Care Medicine, University Hospital (Inselspital) and University of Bern, 3010 Bern, Switzerland
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Kaussen T, Otto J, Steinau G, Höer J, Srinivasan PK, Schachtrupp A. Recognition and management of abdominal compartment syndrome among German anesthetists and surgeons: a national survey. Ann Intensive Care 2012; 2 Suppl 1:S7. [PMID: 22873423 PMCID: PMC3390300 DOI: 10.1186/2110-5820-2-s1-s7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Abdominal compartment syndrome (ACS) is a life threatening condition that may affect any critically ill patient. Little is known about the recognition and management of ACS in Germany. METHODS A questionnaire was mailed to departments of surgery and anesthesia from German hospitals with more than 450 beds. RESULTS Replies (113) were received from 222 eligible hospitals (51%). Most respondents (95%) indicated that ACS plays a role in their clinical practice. Intra-abdominal pressure (IAP) is not measured at all by 26%, while it is routinely done by 30%. IAP is mostly (94%) assessed via the intra-vesical route. Of the respondents, 41% only measure IAP in patients expected to develop ACS; 64% states that a simpler, more standardized application of IAP measurement would lead to increased use in daily clinical practice. CONCLUSIONS German anesthesiologists and surgeons are familiar with ACS. However, approximately one fourth never measures IAP, and there is considerable uncertainty regarding which patients are at risk as well as how often IAP should be measured in them.
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Affiliation(s)
- Torsten Kaussen
- Department of Pediatric Cardiology and Intensive Care, University Children's Hospital, Hannover Medical School (MHH), OE 6730, Carl-Neuberg St. 1, 30625 Hannover, Germany
| | - Jens Otto
- Department of Surgery, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Gerd Steinau
- Department of Surgery, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Jörg Höer
- Department of Surgery, Hochtaunus-Kliniken Bad Homburg, Urseler Str. 33, 61348- Bad Homburg v. d. Höhe, Germany
| | - Pramod Kadaba Srinivasan
- Institute of Experimental Animal Science, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52070 Aachen, Germany
| | - Alexander Schachtrupp
- Department of Surgery, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074 Aachen, Germany
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Intracranial hypertension secondary to abdominal compartment syndrome in a girl with giant ovarian cystic mass. Indian J Pediatr 2012; 79:541-2. [PMID: 21842281 DOI: 10.1007/s12098-011-0549-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2010] [Accepted: 07/22/2011] [Indexed: 11/27/2022]
Abstract
The abdominal compartment syndrome (ACS) is a potentially fatal entity that occurs as a result of an acute increase in intra-abdominal pressure (IAP). The authors report on a girl with a giant ovarian cystic mass, and clinical signs of ACS and intracranial hypertension (ΙΗ). The possible mechanism of IH secondary to ACS is discussed.
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Shen YM, Sun WB, Chen J, Liu SJ, Wang MG. NBCA medical adhesive (n-butyl-2-cyanoacrylate) versus suture for patch fixation in Lichtenstein inguinal herniorrhaphy: A randomized controlled trial. Surgery 2012; 151:550-5. [DOI: 10.1016/j.surg.2011.09.031] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Accepted: 09/22/2011] [Indexed: 11/26/2022]
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Cheatham ML, Safcsak K. Percutaneous catheter decompression in the treatment of elevated intraabdominal pressure. Chest 2011; 140:1428-1435. [PMID: 21903735 DOI: 10.1378/chest.10-2789] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Intraabdominal hypertension (IAH) and abdominal compartment syndrome (ACS) traditionally have been treated surgically through emergent laparotomy. Intensivist-performed bedside drainage of free intraperitoneal fluid or blood (percutaneous catheter decompression [PCD]) has been advocated as a less-invasive alternative to open abdominal decompression (OAD). METHODS A single-center disease and severity of illness-matched case-control comparison of 62 patients with IAH/ACS treated with PCD vs traditional OAD was performed. The relative efficacy of each treatment in reducing elevated intraabdominal pressure (IAP) and improving organ dysfunction was assessed. Physiologic and demographic predictors of successful PCD therapy were determined. RESULTS PCD and OAD both were effective in significantly decreasing IAP and peak inspiratory pressure as well as in increasing abdominal perfusion pressure. PCD potentially avoided the need for subsequent OAD in 25 of 31 patients (81%) treated. Successful PCD therapy was associated with fluid drainage of > 1,000 mL or a decrease in IAP of > 9 mm Hg in the first 4 h postdecompression. CONCLUSIONS Intensivist-performed PCD is an effective and less-invasive technique for treating patients with IAH/ACS where free intraperitoneal fluid or blood is present as determined by bedside ultrasonography. Failure to drain at least 1,000 mL of fluid and decrease IAP by at least 9 mm Hg in the first 4 h postdecompression is associated with PCD failure and should prompt urgent OAD.
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Affiliation(s)
- Michael L Cheatham
- Department of Surgical Education, Orlando Regional Medical Center, Orlando, FL.
| | - Karen Safcsak
- Department of Surgical Education, Orlando Regional Medical Center, Orlando, FL
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Abdominal compartment syndrome secondary to chronic constipation. Case Rep Pediatr 2011; 2011:562730. [PMID: 22606517 PMCID: PMC3350058 DOI: 10.1155/2011/562730] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Accepted: 07/03/2011] [Indexed: 11/17/2022] Open
Abstract
Abdominal compartment syndrome (ACS) is defined as an elevated intraabdominal pressure with evidence of organ dysfunction. The majority of published reports of ACS are in neonates with abdominal wall defects and in adults following trauma or burns, but it is poorly described in children. We describe the unusual presentation of an 11-year-old boy with a long history of chronic constipation who developed acute ACS requiring resuscitative measures and emergent disimpaction. He presented with a 2-week history of increasing abdominal pain, nausea, diminished appetite and longstanding encopresis. On exam, he was emaciated with a massively distended abdomen with a palpable fecaloma. Abdominal XR confirmed these findings. Within 24 hours of presentation, he became tachycardic and oliguric with orthostatic hypotension. Following two enemas, he acutely deteriorated with severe hypotension, marked tachycardia, acute respiratory distress, and a declining mental status. Endotracheal intubation, fluid boluses, and vasopressors were commenced, followed by emergent surgical fecal disimpaction. This resulted in rapid improvement in vital signs. He has been thoroughly investigated and no other condition apart from functional constipation has been identified. Although ACS secondary to constipation is extremely unusual, this case illustrates the need to actively treat constipation and what can happen if it is not.
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Khan S, Verma AK, Ahmad SM, Ahmad R. Analyzing intra-abdominal pressures and outcomes in patients undergoing emergency laparotomy. J Emerg Trauma Shock 2011; 3:318-25. [PMID: 21063552 PMCID: PMC2966562 DOI: 10.4103/0974-2700.70747] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2009] [Accepted: 01/02/2010] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Studies have documented the impact of intra-abdominal hypertension (IAH) on virtually every organ. However, it still remains strangely underdiagnosed. The aims of the study were to assess, in patients undergoing emergency laparotomy, whether intra-abdominal pressure (IAP) is an independent predictor of morbidity and mortality, to evaluate the effects of IAH, and to identify hidden cases of abdominal compartment syndrome (ACS). MATERIALS AND METHODS The study comprised 197 patients undergoing emergency laparotomy. IAP was measured preoperatively and then postoperatively at 0, 6, and 24 hours. Duration of hospital stay, occurrence of burst abdomen, and mortality were noted as outcomes. RESULTS At admission, incidence of IAH was 80%. No significant association was found between IAP and occurrence of burst abdomen (P > 0.1). IAP was found to be a significant predictor of mortality in patients undergoing laparotomy (P < 0.001). Elevated IAP was found to affect all the organ systems adversely. The incidence of post-op ACS was 3.05% in the general population and 13.16% in trauma patients. The mortality rate for this subgroup was 100%. CONCLUSIONS IAP is a significant predictor of mortality in patients undergoing laparotomy. IAH has detrimental effects on various organ systems. A more frequent monitoring with prompt decompression may be helpful in decreasing the mortality rate. Further studies are required to establish a screening protocol in patients undergoing laparotomy to detect and manage cases of IAH and ACS.
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Affiliation(s)
- Shehtaj Khan
- Department of Surgery, J. N. Medical College, AMU, Aligarh-202002, Uttar Pradesh, India
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Long-term enteral arginine supplementation in rats with intestinal ischemia and reperfusion. J Surg Res 2011; 175:67-75. [PMID: 21470625 DOI: 10.1016/j.jss.2011.02.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Revised: 11/23/2010] [Accepted: 02/03/2011] [Indexed: 11/21/2022]
Abstract
BACKGROUND The effects of short-term enteral arginine supplementation on intestinal ischemia-reperfusion (IR) injury have been widely studied, especially the ischemic preconditioning supplementation. The aim of this study was to investigate the effects of long-term intra-duodenal supplementation of arginine on intestinal morphology, arginine-associated amino acid metabolism, and inflammatory responses in rats with intestinal IR. MATERIALS AND METHODS Male Wistar rats with or without three hours of ileal ischemia underwent duodenal cannulation for continuous infusion of formula with 2% arginine or commercial protein powder for 7 d. The serological examinations, plasma amino acid and cytokine profiles, and intestinal morphology were assessed. RESULTS Intestinal IR injury had significant impacts on the decreases in circulating red blood cells, hemoglobin, ileum mass, and villus height and crypt depth of the distal jejunum. In addition, arginine supplementation decreased serum cholesterol and increased plasma arginine concentrations. In rats with intestinal IR injury, arginine supplementation significantly decreased serum nitric oxide, plasma citrulline and ornithine, and the mucosal protein content of the ileum. CONCLUSIONS These results suggest that long-term intra-duodenal arginine administration may not have observable benefits on intestinal morphology or inflammatory response in rats with intestinal ischemia and reperfusion injury. Therefore, the necessity of long-term arginine supplementation for patients with intestinal ischemia and reperfusion injury remains questionable and requires further investigation.
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Ejike JC, Newcombe J, Baerg J, Bahjri K, Mathur M. Understanding of Abdominal Compartment Syndrome among Pediatric Healthcare Providers. Crit Care Res Pract 2010; 2010:876013. [PMID: 20981270 PMCID: PMC2958672 DOI: 10.1155/2010/876013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Accepted: 07/13/2010] [Indexed: 01/17/2023] Open
Abstract
Background. The sparse reporting of abdominal compartment syndrome (ACS) in the pediatric literature may reflect inadequate awareness and recognition among pediatric healthcare providers (HCP). Purpose. To assess awareness of ACS, knowledge of the definition and intraabdominal pressure (IAP) measurement techniques used among pediatric HCP. Method. A written survey distributed at two pediatric critical care conferences. Results. Forty-seven percent of 1107 questionnaires were completed. Participants included pediatric intensivists, pediatric nurses, and others. Seventy-seven percent (n = 513) of participants had heard of ACS. Only 46.8% defined ACS correctly. The threshold IAP value used to define ACS was variable among participants. About one-quarter of participants (83/343), had never measured IAP. Conclusion. Twenty-three percent of HCP surveyed were unaware of ACS. Criteria used to define ACS were variable. Focused education on recognition of ACS and measuring IAP should be promoted among pediatric HCP.
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Affiliation(s)
- J. Chiaka Ejike
- Department of Pediatrics, Division of Pediatric Critical Care, School of Medicine, Loma Linda University, 11175 Campus Street, Suite A1117, Coleman Pavilion, Loma Linda, CA 92354, USA
| | - Jennifer Newcombe
- Department of Nursing, Loma Linda University Children's Hospital, Loma Linda, CA 92354, USA
| | - Joanne Baerg
- Department of Surgery, School of Medicine, Loma Linda University, Loma Linda, CA 92354, USA
| | - Khaled Bahjri
- Department of Epidemiology and Biostatistics, School of Public Health, Loma Linda University, Loma Linda, CA 92354, USA
| | - Mudit Mathur
- Department of Pediatrics, Division of Pediatric Critical Care, School of Medicine, Loma Linda University, 11175 Campus Street, Suite A1117, Coleman Pavilion, Loma Linda, CA 92354, USA
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Abstract
PURPOSE OF REVIEW Swelling is inexorably linked to shock and resuscitation in trauma. In many forms, swelling complicates and interacts with traumatic injury to raise pressures in the abdomen, resulting in intraabdominal hypertension, which may overtly manifest as abdominal compartment syndrome (ACS) driving multiple organ failure. Despite renewed clinical interest in posttraumatic intraabdominal pressure, there remains a chiasm between knowledge of the risks and clinical interventions to mitigate them. This review provides a concise overview of definitions, risk factors, diagnosis and management using an illustrative trauma case. RECENT FINDINGS Intraabdominal pressure commonly increases following trauma, wherein ACS may manifest earlier than generally appreciated and complicate other insults such as shock and hemorrhage. Contemporary resuscitation strategies may exacerbate intraabdominal hypertension, particularly massive crystalloid resuscitation. Although unproven, the recent transition to crystalloid restriction and high plasma resuscitation strategies may influence the prevalence of ACS. Nonetheless, aggressive intraabdominal pressure monitoring should be mandatory in the critically ill. Despite potential nonoperative options, decompressive laparotomy remains the only definitive but often morbid treatment. SUMMARY ACS results from many dysfunctions acting in concert with each other in self-propagating vicious cycles. Starting with greater awareness, it is imperative that the growing knowledge should be translated into clinical practice.
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Rader RA, Johnson JA. Original Study: Determination of normal intra-abdominal pressure using urinary bladder catheterization in clinically healthy cats. J Vet Emerg Crit Care (San Antonio) 2010; 20:386-92. [DOI: 10.1111/j.1476-4431.2010.00552.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Is the evolving management of intra-abdominal hypertension and abdominal compartment syndrome improving survival? Crit Care Med 2010; 38:402-7. [PMID: 20095067 DOI: 10.1097/ccm.0b013e3181b9e9b1] [Citation(s) in RCA: 155] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE The diagnosis and management of intra-abdominal hypertension and abdominal compartment syndrome have changed significantly over the past decade with improved understanding of the pathophysiology and appropriate treatment of these disease processes. Serial intra-abdominal pressure measurements, nonoperative pressure-reducing interventions, and early abdominal decompression for refractory intra-abdominal hypertension or abdominal compartment syndrome are all key elements of this evolving strategy. DESIGN Prospective, observational study. SETTING Tertiary referral/level I trauma center. PATIENTS Four hundred seventy-eight consecutive patients requiring an open abdomen for the management of intra-abdominal hypertension or abdominal compartment syndrome. INTERVENTIONS Patients were managed by a defined group of surgical intensivists using established definitions and an evidence-based management algorithm. Both univariate and multivariate analyses were performed to identify patient and management factors associated with improved survival. MEASUREMENTS AND MAIN RESULTS Whereas patient demographics and severity of illness remained unchanged over the 6-yr study period, the use of a continually revised intra-abdominal hypertension/abdominal compartment syndrome management algorithm significantly increased patient survival to hospital discharge from 50% to 72% (p = .015). Clinically significant decreases in resource utilization and an increase in same-admission primary fascial closure from 59% to 81% were recognized. Development of abdominal compartment syndrome, prophylactic use of an open abdomen to prevent development of intra-abdominal hypertension/abdominal compartment syndrome, and use of a multi-modality surgical/medical management algorithm were identified as independent predictors of survival. CONCLUSIONS A comprehensive evidence-based management strategy that includes early use of an open abdomen in patients at risk significantly improves survival from intra-abdominal hypertension/abdominal compartment syndrome. This improvement is not achieved at the cost of increased resource utilization and is associated with an increased rate of primary fascial closure.
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Kimball EJ, Adams DM, Kinikini DV, Mone MC, Alder SC. Delayed abdominal closure in the management of ruptured abdominal aortic aneurysm. Vascular 2010; 17:309-15. [PMID: 19909677 DOI: 10.2310/6670.2009.00048] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The objective of this study was to compare initial use of the open abdomen using the vacuum-pack technique followed by delayed abdominal closure with standard primary abdominal closure in the treatment of ruptured abdominal aortic aneurysm (rAAA) repair. A retrospective review identified 122 rAAA cases, which were divided into two management eras: era 1 (primarily closed) and era 2 (47% open abdomen).One hundred three patients were included in this review: 58 in era 1 and 45 in era 2. Evidence of one of three ischemia-reperfusion (IR) criteria, preoperative hypotension, estimated blood loss > or = 6 L, or intraoperative resuscitation with > or = 12 L, predicted mortality. These criteria were also used as surrogate clinical markers for abdominal compartment syndrome. The in-hospital mortality was higher in those with at least one IR criterion: 43% versus 10% (p = .0003). In those with at least one IR criterion, the initial 24-hour mortality was 21% for era 1 versus 0% for era 2 (p = .03), and the 30-day mortality was 40% for era 1 and 32% for era 2 (p = .77).Three IR criteria were identified and were associated with increased mortality. Patients with these risk factors who were treated with delayed abdominal closure had an improved acute survival rate and a trend for improved long-term survival.
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Batacchi S, Matano S, Nella A, Zagli G, Bonizzoli M, Pasquini A, Anichini V, Tucci V, Manca G, Ban K, Valeri A, Peris A. Vacuum-assisted closure device enhances recovery of critically ill patients following emergency surgical procedures. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2009; 13:R194. [PMID: 19961614 PMCID: PMC2811940 DOI: 10.1186/cc8193] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2009] [Revised: 11/04/2009] [Accepted: 12/05/2009] [Indexed: 12/12/2022]
Abstract
Introduction Critically ill surgical patients frequently develop intra-abdominal hypertension (IAH) leading to abdominal compartment syndrome (ACS) with subsequent high mortality. We compared two temporary abdominal closure systems (Bogota bag and vacuum-assisted closure (VAC) device) in intra-abdominal pressure (IAP) control. Methods This prospective study with a historical control included 66 patients admitted to a medical and surgical intensive care unit (ICU) of a tertiary care referral center (Careggi Hospital, Florence, Italy) from January 2006 to April 2009. The control group included patients consecutively treated with the Bogota bag (Jan 2006-Oct 2007), whereas the prospective group was comprised of patients treated with a VAC. All patients underwent abdominal decompressive surgery. Groups were compared based upon their IAP, SOFA score, serial arterial lactates, the duration of having their abdomen open, the need for mechanical ventilation (MV) along with length of ICU and hospital stay and mortality. Data were collected from the time of abdominal decompression until the end of pressure monitoring. Results The Bogota and VAC groups were similar with regards to demography, admission diagnosis, severity of illness, and IAH grading. The VAC system was more effective in controlling IAP (P < 0.01) and normalizing serum lactates (P < 0.001) as compared to the Bogota bag during the first 24 hours after surgical decompression. There was no significant difference between the SOFA scores. When compared to the Bogota, the VAC group had a faster abdominal closure time (4.4 vs 6.6 days, P = 0.025), shorter duration of MV (7.1 vs 9.9 days, P = 0.039), decreased ICU length of stay (LOS) (13.3 vs 19.2 days, P = 0.024) and hospital LOS (28.5 vs 34.9 days; P = 0.019). Mortality rate did not differ significantly between the two groups. Conclusions Patients with abdominal compartment syndrome who were treated with VAC decompression had a faster abdominal closure rate and earlier discharge from the ICU as compared to similar patients treated with the Bogota bag.
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Affiliation(s)
- Stefano Batacchi
- Anaesthesia and Intensive Care Unit of Emergency Department, Careggi Teaching Hospital, Viale Morgagni 85, 50139, Florence, Italy.
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Abstract
BACKGROUND The abdominal compartment syndrome (ACS) is a life-threatening condition and may affect any critically ill patient. Little is known about the recognition and management of the ACS in Germany. METHODS A postal questionnaire was sent to departments of surgery and anesthesia of German hospitals with more than 450 beds. RESULTS From the 222 eligible hospitals a total of 113 replies were received. Most respondents (95%) indicated that the ACS plays a role in their clinical practice. Measurement of intra-abdominal pressure (IAP) is not performed by 26% while it is routinely done by 30%. Intra-abdominal pressure is mostly (94%) assessed via the bladder pressure. Of the respondents 41% measure IAP only in those patients thought likely to develop ACS. Risk factors of the ACS would lead to IAP monitoring in 10-23% of cases. The majority (86%) would require signs of organ dysfunction together with exceeding the IAD threshold in order to opt for a surgical decompression. The attitude towards the critical threshold (>20 mmHg or >25 mmhg) divided respondents into two groups of similar size (39% compared to 47%, respectively). CONCLUSIONS German anesthesiologists and surgeons are familiar with the ACS. However, about one-quarter never measure IAP and there is a considerable variance as to which patients are at risk to develop ACS and how often IAP should be measured in these patients. This could indicate a lack of acceptance or simply a persisting need for more data concerning the avoidance and treatment of the ACS.
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