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Jaan A, Sarfraz Z, Farooq U, Malik S, Ur Rahman A, Okolo P. Incidence, implications and predictors of abdominal compartment syndrome in acute pancreatitis: A nationwide analysis. Pancreatology 2024; 24:370-377. [PMID: 38431446 DOI: 10.1016/j.pan.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/26/2024] [Accepted: 02/16/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Acute pancreatitis (AP) often presents with varying severity, with a small fraction evolving into severe AP, and is associated with high mortality. Complications such as intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are intricately associated with AP. OBJECTIVE To assess the clinical implications and predictors of ACS in AP patients. METHODS We conducted a retrospective study using the National Inpatient Sample (NIS) database on adult AP patients, further stratified by the presence of concurrent ACS. The data extraction included demographics, underlying comorbidities, and clinical outcomes. Multivariate linear and logistic regression analyses were performed using STATA (v.14.2). RESULTS Of the 1,099,175 adult AP patients, only 1,090 (0.001%) exhibited ACS. AP patients with ACS had elevated inpatient mortality and all major complications, including septic shock, acute respiratory distress syndrome (ARDS), requirement for total parenteral nutrition (TPN), and intensive care unit (ICU) admission (P < 0.01). These patients also exhibited increased odds of requiring pancreatic drainage and necrosectomy (P < 0.01). Predictor analysis identified blood transfusion, obesity (BMI ≥30), and admission to large teaching hospitals as factors associated with the development of ACS in AP patients. Conversely, age, female gender, biliary etiology of AP, and smoking were found less frequently in patients with ACS. CONCLUSION Our study highlights the significant morbidity, mortality, and healthcare resource utilization associated with the concurrence of ACS in AP patients. We identified potential factors associated with ACS in AP patients. Significantly worse outcomes in ACS necessitate the need for early diagnosis, meticulous monitoring, and targeted therapeutic interventions for AP patients at risk of developing ACS.
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Affiliation(s)
- Ali Jaan
- Department of Internal Medicine, Rochester General Hospital, NY, USA.
| | - Zouina Sarfraz
- Department of Medicine, Fatima Jinnah Medical University, Lahore, Pakistan
| | - Umer Farooq
- Department of Gastroenterology, Saint Louis University, MO, USA
| | - Sheza Malik
- Department of Internal Medicine, Rochester General Hospital, NY, USA
| | - Asad Ur Rahman
- Department of Gastroenterology, Cleveland Clinic Florida, FL, USA
| | - Patrick Okolo
- Department of Gastroenterology, Rochester General Hospital, NY, USA
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Plourde C, Beauchamp FO, Brocks R, Thibault C. Successful decompressive laparotomy in a neonate with abdominal compartment syndrome on extracorporeal membrane oxygenation following congenital diaphragmatic hernia repair. Perfusion 2024; 39:607-611. [PMID: 36537252 DOI: 10.1177/02676591221147436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
Abdominal compartment syndrome (ACS) is a rare complication of extracorporeal membrane oxygenation (ECMO) and is associated with high morbidity and mortality. Despite being the treatment of choice for ACS, decompressive laparotomy (DL) has been a matter of debate in children supported with ECMO due to high bleeding risk and presumed futility. We report the first neonatal DL for ACS while on ECMO following congenital diaphragmatic hernia (CDH) repair. Given its excellent outcomes, our case challenges current literature and supports prompt bedside laparotomy to treat ACS on neonatal ECMO.
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Affiliation(s)
- Camille Plourde
- Division of Pediatric General Surgery, Department of Surgery, CHU Sainte-Justine, Montreal, QC, Canada
| | - Francis-Olivier Beauchamp
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, CHU Sainte-Justine, Montreal, QC, Canada
| | - Rebecca Brocks
- Division of Pediatric General Surgery, Department of Surgery, CHU Sainte-Justine, Montreal, QC, Canada
| | - Céline Thibault
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, CHU Sainte-Justine, Montreal, QC, Canada
- CHUSJ Research Center, Université de Montréal, Montreal, QC, Canada
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3
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Zhang Y, Luo S, Xie Y, Wang Y, Fang Y, Wang S, Deng L. Postoperative intra-abdominal hypertension predicts worse hospital outcomes in children after cardiac surgery: a pilot study†. Interdiscip Cardiovasc Thorac Surg 2024; 38:ivae019. [PMID: 38318959 PMCID: PMC10882438 DOI: 10.1093/icvts/ivae019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 12/22/2023] [Accepted: 02/02/2024] [Indexed: 02/07/2024]
Abstract
OBJECTIVES Our goal was to determine the incidence and characteristics of postoperative intra-abdominal hypertension (IAH) in paediatric patients undergoing open-heart surgery. METHODS This single-centre study included consecutive children (aged <16 years) who underwent open-heart surgery between July 2020 and February 2021. Patients who entered the study were followed until in-hospital death or hospital discharge. The study consisted of 2 parts. Part I was a prospective observational cohort study that was designed to discover the association between exposures and IAH. Postoperative intra-abdominal pressure was measured immediately after admission to the intensive care unit and every 6 h thereafter. Part II was a cross-sectional study to compare the hospital-related adverse outcomes between the IAH and the no-IAH cohorts. RESULTS Postoperatively, 24.7% (38/154) of the patients exhibited IAH, whereas 3.9% (6/154) developed abdominal compartment syndrome. The majority (29/38, 76.3%) of IAH cases occurred within the first 24 h in the intensive care unit. Multivariable analysis showed that the Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery score [odds ratio (OR) = 1.86, 95% confidence interval (CI) 1.23-2.83, P = 0.004], right-sided heart lesion (OR = 5.60, 95% CI 2.34-13.43, P < 0.001), redo sternotomy (OR = 4.35, 95% CI 1.64-11.57, P = 0.003), high baseline intra-abdominal pressure (OR = 1.43, 95% CI 1.11-1.83, P = 0.005), prolonged cardiopulmonary bypass duration (OR = 1.01, 95% CI 1.00-1.01, P = 0.005) and deep hypothermic circulatory arrest (OR = 5.14, 95% CI 1.15-22.98, P = 0.032) were independent predictors of IAH occurrence. IAH was associated with greater inotropic support (P < 0.001), more gastrointestinal complications (P = 0.001), sepsis (P = 0.003), multiple organ dysfunction syndrome (P < 0.001) and prolonged intensive care unit stay (z = -4.916, P < 0.001) and hospitalization (z = -4.710, P < 0.001). The occurrence of a composite outcome (P = 0.009) was significantly increased in patients with IAH. CONCLUSIONS IAH is common in children undergoing cardiac surgery and is associated with worse hospital outcomes. Several factors may be associated with the development of IAH, including basic cardiac physiology and perioperative factors. TRIAL INFORMATION This study was registered in the Chinese Clinical Trial Registry (Trial number: ChiCTR2000034322)URL site: https://www.chictr.org.cn/hvshowproject.html?id=41363&v=1.4.
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Affiliation(s)
- Yunyi Zhang
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Shuhua Luo
- Department of Cardiovascular Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Yuxuan Xie
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Yue Wang
- Department of Cardiovascular Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Yibing Fang
- Department of Cardiovascular Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Shouping Wang
- Department of Intensive Care Medicine, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Lijing Deng
- Department of Intensive Care Medicine, West China Hospital of Sichuan University, Chengdu, 610041, China
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Abdelmotaal AM, Abdelsalam AM, Bakry SAD, Abdel Hafiez RH, Mabrouk AR. Effect of Hydroxyethyl starch (HES) versus 5% albumin solution on intra-abdominal pressure in severe burn patients: A prospective randomized clinical trial. Burns 2024; 50:197-203. [PMID: 37833147 DOI: 10.1016/j.burns.2023.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 06/08/2023] [Accepted: 06/15/2023] [Indexed: 10/15/2023]
Abstract
INTRODUCTION Massive burn patients are at risk of developing intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) as a complication of resuscitation. OBJECTIVE This study aimed to evaluate the effect of Hydroxyethyl starch (HES) versus 5% albumin solution on intra-abdominal pressure (IAP) in massive burn patients. METHODS This was a prospective randomized clinical trial carried on at Ain Shams University (ASU) burn unit for 2 years. Where adult patients with burns more than 20% of TBSA were equally randomized into HES group or albumin group. RESULTS Fifty-two patients were equally randomized into 2 groups. We found no difference in age, sex, weight, type of burn, and TBSA between the two groups. The mean total resuscitation fluid volume in the first 48 h was 213 ml/kg and 206.2 ml/kg for the HES group and the albumin group respectively (p = 0.674). IAP statistically was non-significantly higher in the HES group. We found no statistical difference between the two groups as regards the renal function tests. CONCLUSION Both HES and 5% albumin solution are effective and safe colloids for burn resuscitation. As regards the IAP, it seems that both 5% albumin and HES have comparable effect regarding IAH in severely burn patients. Both HES and 5% albumin were partially equal in terms of renal involvement and vital data stability.
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Affiliation(s)
- Amr Mahmoud Abdelmotaal
- Plastic, burn, and maxillofacial surgery Department, Faculty of Medicine, Ain Shams University, Egypt.
| | - Ahmed Mohamed Abdelsalam
- Plastic, burn, and maxillofacial surgery Department, Faculty of Medicine, Ain Shams University, Egypt
| | - Sameh Adel Desawy Bakry
- Plastic, burn, and maxillofacial surgery Department, Faculty of Medicine, Ain Shams University, Egypt
| | - Rania Hassan Abdel Hafiez
- Anesthesia, critical care, and pain management Department, Faculty of Medicine, Ain Shams University, Egypt
| | - Amr Reda Mabrouk
- Plastic, burn, and maxillofacial surgery Department, Faculty of Medicine, Ain Shams University, Egypt
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Caruso M, Rinaldo C, Iacobellis F, Dell'Aversano Orabona G, Grimaldi D, Di Serafino M, Schillirò ML, Verde F, Sabatino V, Camillo C, Ponticiello G, Romano L. Abdominal compartment syndrome: what radiologist needs to know. Radiol Med 2023; 128:1447-1459. [PMID: 37747669 DOI: 10.1007/s11547-023-01724-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 09/05/2023] [Indexed: 09/26/2023]
Abstract
The intra-abdominal hypertension (IAH) and the abdominal compartment syndrome (ACS) are life-threatening conditions with a significant rate of mortality; therefore, early detection is paramount in their optimal management. IAH is diagnosed when the intra-abdominal pressure (IAP) is more than 12 mmHg. It can occur when the intra-abdominal volume increases (ileus, ascites, trauma, pancreatitis, etc.) and/or the abdominal wall compliance decreases. IAH can cause decreased venous flow, low cardiac output, renal impairment, and decreased respiratory compliance. Consequently, these complications can lead to multiple organ failure and induce the abdominal compartment syndrome (ACS) when IAP rises above 20 mmHg. The diagnosis is usually made with intravesical pressure measurement. However, this measurement was not always possible to obtain; therefore, alternative diagnostic techniques should be considered. In this setting, computed tomography (CT) may play a crucial role, allowing the detection and characterization of pathological conditions that may lead to IAH. This review is focused on the pathogenesis, clinical features, and radiological findings of ACS, because their presence allows radiologists to raise the suspicion of IAH/ACS in critically ill patients, guiding the most appropriate treatment.
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Affiliation(s)
- Martina Caruso
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, 80131, Naples, Italy.
| | - Chiara Rinaldo
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, 80131, Naples, Italy
| | - Francesca Iacobellis
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, 80131, Naples, Italy
| | | | - Dario Grimaldi
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, 80131, Naples, Italy
| | - Marco Di Serafino
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, 80131, Naples, Italy
| | - Maria Laura Schillirò
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, 80131, Naples, Italy
| | - Francesco Verde
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, 80131, Naples, Italy
| | - Vittorio Sabatino
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, 80131, Naples, Italy
| | - Costanza Camillo
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, 80131, Naples, Italy
| | - Gianluca Ponticiello
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, 80131, Naples, Italy
| | - Luigia Romano
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, 80131, Naples, Italy
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Tanabe T, Tsukuda G, Hobo T, Yokoyama N, Inoue H. Abdominal compartment syndrome as a complication of endoscopic carbon dioxide insufflation in a patient with malignant bowel obstruction: a case report. Surg Case Rep 2023; 9:203. [PMID: 37987864 PMCID: PMC10663415 DOI: 10.1186/s40792-023-01783-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 11/15/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND A self-expandable metal stent is often placed as a bridge to elective surgical treatment of left-sided malignant obstruction of the colon because it allows for primary anastomosis without the need for a temporary stoma, which has a positive impact on the patient's quality of life. However, although a relatively safe procedure, colonic stenting can have complications that require emergency surgery. This case report describes a rare case of abdominal compartment syndrome that occurred as a complication of endoscopic insufflation during colonic stenting. CASE PRESENTATION The patient was a 72-year-old woman who presented complaining of several days of constipation and loss of appetite. Computed tomography of the abdomen revealed obstruction of the sigmoid colon by a tumor. There were no symptoms or computed tomography findings to suggest perforation. Therefore, an attempt was made to insert a self-expandable metal stent. Acute respiratory disturbance and a change in consciousness occurred during the stenting procedure, with marked abdominal distention. Abdominal compartment syndrome was diagnosed and treated by decompressive laparotomy. CONCLUSIONS To the best of our knowledge, this is the first reported case of abdominal compartment syndrome as a complication of endoscopic insufflation during colonic stenting. The possibility of abdominal compartment syndrome should be considered if acute respiratory disturbance or altered consciousness occurs during endoscopic procedure in a patient with malignant bowel obstruction.
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Affiliation(s)
- Taro Tanabe
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, 5-1-38 Toyosu, Koto-ku, Tokyo, 135-8577, Japan.
| | - Genki Tsukuda
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, 5-1-38 Toyosu, Koto-ku, Tokyo, 135-8577, Japan
| | - Takahiro Hobo
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, 5-1-38 Toyosu, Koto-ku, Tokyo, 135-8577, Japan
| | - Noboru Yokoyama
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, 5-1-38 Toyosu, Koto-ku, Tokyo, 135-8577, Japan
| | - Haruhiro Inoue
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, 5-1-38 Toyosu, Koto-ku, Tokyo, 135-8577, Japan
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Michaud A. Prone restraint death: Possible role of the Valsalva maneuver. Med Sci Law 2023; 63:324-333. [PMID: 36949719 DOI: 10.1177/00258024231162841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
There is an on-going debate about the safety of prone restraint and the exact role of the prone position in physical restraint death. Cardiac arrest in prone restraint death is essentially the end-result of a violent physical altercation wherein a combative individual suddenly loses consciousness while trying to counteract an opposing force. The direct correlations of increased static weight force with decreased inferior vena cava diameter, decreased cardiac output, and decreased stroke volume in prone restraint studies suggest that decreased venous return and decreased cardiac output could have a significant role to play in prone restraint death. Although the degree of changes observed in those studies might not be sufficient to cause cardiac arrest, they could predispose people who instinctively try to free themselves of the restraints to severe complications. The Valsalva maneuver, or forceful expiration against a closed airway, is frequently performed spontaneously in daily activities involving straining and resistance exercise, but has never been considered in restraint death. Pre-existing diminished venous return could increase the risk of major complications in individuals performing the Valsalva maneuver. A substantial decrease in venous return and cardiac output could increase the risk of cerebral hypoperfusion, loss of consciousness, hypoventilation, and sudden death. By increasing the risk of increased intra-abdominal pressure and its negative effect on venous return, high body mass index may be a significant risk factor in prone restraint death. The Valsalva maneuver may have different roles in prone restraint cardiac arrest and might be overlooked in prone restraint death.
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Nasa P, Chanchalani G, Juneja D, Malbrain MLNG. Surgical decompression for the management of abdominal compartment syndrome with severe acute pancreatitis: A narrative review. World J Gastrointest Surg 2023; 15:1879-1891. [PMID: 37901738 PMCID: PMC10600763 DOI: 10.4240/wjgs.v15.i9.1879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/20/2023] [Accepted: 08/01/2023] [Indexed: 09/21/2023] Open
Abstract
Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) play a pivotal role in the pathophysiology of severe acute pancreatitis (SAP) and contribute to new-onset and persistent organ failure. The optimal management of ACS involves a multi-disciplinary approach, from its early recognition to measures aiming at an urgent reduction of intra-abdominal pressure (IAP). A targeted literature search from January 1, 2000, to November 30, 2022, revealed 20 studies and data was analyzed on the type and country of the study, patient demographics, IAP, type and timing of surgical procedure performed, post-operative wound management, and outcomes of patients with ACS. There was no randomized controlled trial published on the topic. Decompressive laparotomy is effective in rapidly reducing IAP (standardized mean difference = 2.68, 95% confidence interval: 1.19-1.47, P < 0.001; 4 studies). The morbidity and complications of an open abdomen after decompressive laparotomy should be weighed against the inadequately treated but, potentially lethal ACS. Disease-specific patient selection and the role of less-invasive decompressive measures, like subcutaneous linea alba fasciotomy or component separation techniques, is lacking in the 2013 consensus management guidelines by the Abdominal Compartment Society on IAH and ACS. This narrative review focuses on the current evidence regarding surgical decompression techniques for managing ACS in patients with SAP. However, there is a lack of high-quality evidence on patient selection, timing, and modality of surgical decompression. Large prospective trials are needed to identify triggers and effective and safe surgical decompression methods in SAP patients with ACS.
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Affiliation(s)
- Prashant Nasa
- Department of Critical Care Medicine, NMC Specialty Hospital, Dubai 7832, United Arab Emirates
- Department of Internal Medicine, College of Medicine and Health Sciences, Al Ain 15551, United Arab Emirates
| | - Gunjan Chanchalani
- Department of Critical Care Medicine, K.J. Somaiya Hospital and Research Centre, Mumbai 400022, India
| | - Deven Juneja
- Institute of Critical Care Medicine, Max Super Specialty Hospital, New Delhi 110017, India
| | - Manu LNG Malbrain
- First Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, Lublin 20-954, Poland
- Executive Administration, International Fluid Academy, Lovenjoel 3360, Belgium
- Medical Data Management, Medaman, Geel 2440, Belgium
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Takei Y, Tezuka M, Saito S, Ogasawara T, Seki M, Kato T, Kanno Y, Hirota S, Shibasaki I, Fukuda H. A protocol-based treatment for ruptured abdominal aortic aneurysm contributed to improving aorta-related mortality: a retrospective cohort study. BMC Cardiovasc Disord 2023; 23:436. [PMID: 37658328 PMCID: PMC10474727 DOI: 10.1186/s12872-023-03473-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 08/25/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND Recent guidelines state that improving the survival rate of patients with ruptured abdominal aortic aneurysm (rAAA) requires a protocol or algorithm for the emergency management of these patients. We aimed to investigate whether introducing a protocol treatment for rAAA improves clinical outcomes compared with the pre-protocol strategy. METHODS At our institution, 92 patients treated for rAAA between June 2008 and August 2022 were retrospectively analyzed. In 2014, the protocol-based treatment was introduced comprising a transfer algorithm to shorten the time to proximal control, use of an endovascular occlusion balloon, strict indications for endovascular aortic aneurysm repair (EVAR) or open surgical repair, and perioperative care, including for abdominal compartment syndrome (ACS). Clinical outcomes were compared between the protocol and pre-protocol group, including operative status, all-cause mortality, and rAAA-related death at 30-day, in-hospital, and 1-year postoperative follow-ups. RESULTS Overall, 52 and 40 patients received the protocol-based and pre-protocol treatments, respectively. EVAR was more frequently performed in the protocol group. The rate of achieving time to proximal control was significantly faster, and the transfusion volume was lower in the protocol group. ACS occurred more frequently in the protocol group with a higher EVAR. No difference was found in all-cause mortality between the two groups. The protocol group exhibited fewer rAAA-related deaths than the pre-protocol group during the following time points: 30 days (9.6% vs. 22.5%), during the hospital stay (11.5% vs. 30.0%), and 1 year (14.5% vs. 31.5%). CONCLUSIONS The protocol-based treatment improved the survival rate of patients with rAAA.
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Affiliation(s)
- Yusuke Takei
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University Graduate School of Medicine, 880 Kitakobayashi, Mibu-Machi, Simotuga-gun, Tochigi, 321-0293, Japan.
| | - Masahiro Tezuka
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University Graduate School of Medicine, 880 Kitakobayashi, Mibu-Machi, Simotuga-gun, Tochigi, 321-0293, Japan
| | - Shunsuke Saito
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University Graduate School of Medicine, 880 Kitakobayashi, Mibu-Machi, Simotuga-gun, Tochigi, 321-0293, Japan
| | - Takeshi Ogasawara
- Mathematics and Statistics Section, Department of Fundamental Education, Dokkyo Medical University, 880 Kitakobayashi, Mibu-Machi, Simotuga-gun, Tochigi, 321-0293, Japan
| | - Masahiro Seki
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University Graduate School of Medicine, 880 Kitakobayashi, Mibu-Machi, Simotuga-gun, Tochigi, 321-0293, Japan
| | - Takashi Kato
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University Graduate School of Medicine, 880 Kitakobayashi, Mibu-Machi, Simotuga-gun, Tochigi, 321-0293, Japan
| | - Yasuyuki Kanno
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University Graduate School of Medicine, 880 Kitakobayashi, Mibu-Machi, Simotuga-gun, Tochigi, 321-0293, Japan
| | - Shotaro Hirota
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University Graduate School of Medicine, 880 Kitakobayashi, Mibu-Machi, Simotuga-gun, Tochigi, 321-0293, Japan
| | - Ikuko Shibasaki
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University Graduate School of Medicine, 880 Kitakobayashi, Mibu-Machi, Simotuga-gun, Tochigi, 321-0293, Japan
| | - Hirotsugu Fukuda
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University Graduate School of Medicine, 880 Kitakobayashi, Mibu-Machi, Simotuga-gun, Tochigi, 321-0293, Japan
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10
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Pereira RA, Virella D, Perdigoto R, Marcelino P, Saliba F, Germano N. Continuous passive paracentesis versus large-volume paracentesis in the prevention and treatment of intra-abdominal hypertension in the critically ill cirrhotic patient with ascites (COPPTRIAHL): study protocol for a randomized controlled trial. Trials 2023; 24:534. [PMID: 37582719 PMCID: PMC10426145 DOI: 10.1186/s13063-023-07541-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 07/25/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Critically ill patients with cirrhosis and ascites are at high risk for intra-abdominal hypertension (IAH) which increases mortality. Clinical guidelines recommend maintaining intra-abdominal pressure (IAP) below 16 mmHg; nonetheless, more than three quarters of critically ill patients with cirrhosis develop IAH during their first week of ICU stay. Standard-of-care intermittent large-volume paracentesis (LVP) relieves abdominal wall tension, reduces IAP, optimizes abdominal perfusion pressure, and is associated with short-term improvement in renal and pulmonary dysfunction. However, there is no evidence of the superiority of different paracentesis strategies in the prevention and treatment of IAH in critically ill patients with cirrhosis. This trial aims to compare the outcomes of continuous passive paracentesis versus LVP in the prevention and treatment of IAH in patients with cirrhosis and ascites. METHODS An investigator-initiated, open label, randomized controlled trial, set in a general ICU specialized in liver disease, was initiated in August 2022, with an expected duration of 36 months. Seventy patients with cirrhosis and ascites will be randomly assigned, in a 1:1 ratio, to receive one of two methods of therapeutic paracentesis. A stratified randomization method, with maximum creatinine and IAP values as strata, will homogenize patient baseline characteristics before trial group allocation, within 24 h of admission. In the control group, LVP will be performed intermittently according to clinical practice, with a maximum duration of 8 h, while, in the intervention group, continuous passive paracentesis will drain ascitic fluid for up to 7 days. The primary endpoint is serum creatinine concentration, and secondary endpoints include IAP, measured creatinine clearance, daily urine output, stage 3 acute kidney injury and multiorgan dysfunction assessed at day 7 after enrollment, as well as 28-day mortality rate and renal replacement therapy-free days, and length-of-stay. Prespecified values will be used in case of renal replacement therapy or, beforehand ICU discharge, liver transplant and death. Safety analysis will include paracentesis-related complication rate and harm. Data will be analyzed with an intention-to-treat approach. DISCUSSION This is the first trial to compare the impact of different therapeutic paracentesis strategies on organ dysfunction and outcomes in the prevention and treatment of IAH in critically ill patients with cirrhosis and ascites. TRIAL REGISTRATION ClinicalTrials.gov NCT04322201 . Registered on 20 December 2019.
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Affiliation(s)
- Rui Antunes Pereira
- Unidade de Cuidados Intensivos Polivalente 7, Hospital de Curry Cabral, Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal
| | - Daniel Virella
- Unidade Funcional de Neonatologia, Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal
| | - Rui Perdigoto
- Unidade de Transplante, Hospital de Curry Cabral, Centro Hospitalar Universitário Lisboa Central; Nova Medical School, Lisboa, Portugal
| | - Paulo Marcelino
- Unidade de Cuidados Intensivos Polivalente 4, Hospital de Santa Marta, Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal
| | - Faouzi Saliba
- Hôpital Paul Brousse, Hepato-Biliary Center, Université Paris Saclay, INSERM Unit 1193, Villejuif, France
| | - Nuno Germano
- Unidade de Cuidados Intensivos Polivalente 7, Hospital de Curry Cabral, Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal
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11
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Pinto GCC, Gaiga LDC, de Moura MP, Troster EJ. Incidence and risk factors of abdominal compartment syndrome in pediatric oncology patients: a prospective cohort study. Eur J Pediatr 2023; 182:3611-3617. [PMID: 37227502 DOI: 10.1007/s00431-023-05013-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 04/29/2023] [Accepted: 05/01/2023] [Indexed: 05/26/2023]
Abstract
Abdominal compartment syndrome (ACS) has been the subject of increasing research over the past decade owing to its effects on morbidity and mortality in critically ill patients. This study aimed to determine the incidence and risk factors of ACS in patients in an onco-hematological pediatric intensive care unit in a middle-income country and to analyze patient outcomes. This prospective cohort study was conducted between May 2015 and October 2017. Altogether, 253 patients were admitted to the PICU, and 54 fulfilled the inclusion criteria for intra-abdominal pressure (IAP) measurements. IAP was measured using the intra-bladder indirect technique with a closed system (AbViser AutoValve®, Wolfle Tory Medical Inc., USA) in patients with clinical indications for indwelling bladder catheterization. Definitions from the World Society for ACS were used. The data were entered into a database and analyzed. The median age was 5.79 years, and the median pediatric risk of mortality score was 7.1. The incidence of ACS was 27.7%. Fluid resuscitation was a significant risk factor for ACS in the univariate analysis. The mortality rates in the ACS and non-ACS groups were 46.6% and 17.9%, respectively (P < 0.05). This is the first study of ACS in critically ill children with cancer. Conclusion: The incidence and mortality rates were high, justifying IAP measurement in children with ACS risk factors.
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12
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Demma JA, Gefen R, Shpigelman O, Pikarsky A, Almogy G. Giant inguinal hernia repair using standard transverse inguinal incision with mesh. A retrospective case control study. BMC Surg 2023; 23:178. [PMID: 37370017 DOI: 10.1186/s12893-023-02084-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 06/17/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Giant inguinal hernia (GIH) is a rare condition in the developed world, and the literature is scarce. Case reports describe different techniques in an attempt to prevent abdominal compartment syndrome (ACS). We aimed to review our experience with GIH repair. METHOD A retrospective review of the medical records of all consecutive patients who underwent a tension-free mesh GIH repair using a transverse inguinal incision between 2014 and 2021 at a tertiary university referral center. In brief, the technique included head-down positioning, maximal pre-incision reduction of hernia contents, and repair with mesh. Follow-up was conducted in outpatient clinic. We compared the results to a time-based open standard inguinal hernia repair group (control group). RESULTS During the study period, 58 patients underwent an open GIH repair with mesh without abdominal preparation. 232 patients were included in the control group. The mean surgery duration was 125.5 min in the GIH group and 84 min in the control group (p < 0.001). Bowel resection was not necessary in any case. In-hospital complication rates were 13.8% vs. 5.6% in the GIH and control groups, respectively (p = 0.045). Early complication rates (up to 30 days post-operatively) were 62.1% vs. 14.7% in the GIH and control groups, respectively (p < 0.001). Late complications rate was similar (p = 0.476). ACS and mortality were not reported. No recurrence event was reported in the GIH group. CONCLUSION Tension-free mesh repair for GIH using a standard transverse inguinal incision is feasible and safe and there is no need for abdominal cavity preparation. Early complications are more common than in the control group, but there were no higher rate of late or severe complications and no recurrence event.
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Affiliation(s)
- Jonathan Abraham Demma
- Department of General Surgery and Traumatology, Hadassah Medical Center and Faculty of Medicine, Hadassah Hebrew University Medical Center, Kalman Ya'akov Man St, Jerusalem, Israel.
| | - Rachel Gefen
- Department of General Surgery and Traumatology, Hadassah Medical Center and Faculty of Medicine, Hadassah Hebrew University Medical Center, Kalman Ya'akov Man St, Jerusalem, Israel
| | - Ofek Shpigelman
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Alon Pikarsky
- Department of General Surgery and Traumatology, Hadassah Medical Center and Faculty of Medicine, Hadassah Hebrew University Medical Center, Kalman Ya'akov Man St, Jerusalem, Israel
| | - Gidon Almogy
- Department of General Surgery and Traumatology, Hadassah Medical Center and Faculty of Medicine, Hadassah Hebrew University Medical Center, Kalman Ya'akov Man St, Jerusalem, Israel
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13
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Bozer J, Rodgers B, Qureshi N, Griffin K, Kenney B. Incidence and Mortality of Pediatric Abdominal Compartment Syndrome. J Surg Res 2023; 285:59-66. [PMID: 36640611 DOI: 10.1016/j.jss.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 11/21/2022] [Accepted: 12/14/2022] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Abdominal compartment syndrome (ACS) is the presence of intra-abdominal hypertension with systemic, multiorgan effects and is associated with high mortality, yet the national incidence and mortality rates of pediatric ACS remain unknown. The aim of this study is to evaluate the incidence and mortality of pediatric ACS over a 13-year period across multiple children's hospitals and between individual children's hospitals in the United States. METHODS We performed a retrospective cohort study on children (aged < 18 y) with ACS in the Pediatric Health Information Systems database from 2007 to 2019. We identified ACS patients by International Classification of Diseases codes in the ninth and 10th revision. The primary outcomes were incidence and mortality, which were analyzed by year, age, and hospital of admission. RESULTS Across 49 children's hospitals, we identified 2887 children with ACS from 2007 to 2019 in the Pediatric Health Information Systems database. The overall incidence of ACS was 0.17% and the overall mortality was 48.87%. There was no significant difference in annual incidence (P = 0.12) or mortality (P = 0.39) over the study period. There was no difference in incidence across age group (P = 0.38); however, mortality in patients 0-30 d old (58.61%) was significantly higher than older age groups (P < 0.0001). The hospital-specific incidence (0.04%-0.46%) and mortality (28.57%-71.43%) varied widely. CONCLUSIONS The annual incidence and mortality of pediatric ACS are unchanged from 2007 to 2019. ACS mortality remains high, especially in neonatal intensive care unit patients. No obvious correlation is seen between incidence rates and mortality. Differing hospital-specific incidence and mortality could suggest inconsistencies between institutions that affect pediatric ACS care, perhaps with respect to recognition and diagnosis.
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Affiliation(s)
- Jordan Bozer
- The Ohio State University, College of Medicine, Columbus, Ohio.
| | - Brandon Rodgers
- The Ohio State University, College of Medicine, Columbus, Ohio
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14
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Wiegandt P, Jack T, von Gise A, Seidemann K, Boehne M, Koeditz H, Beerbaum P, Sasse M, Kaussen T. Awareness and diagnosis for intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) in neonatal (NICU) and pediatric intensive care units (PICU) - a follow-up multicenter survey. BMC Pediatr 2023; 23:82. [PMID: 36800953 PMCID: PMC9936744 DOI: 10.1186/s12887-023-03881-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 02/02/2023] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND Constantly elevated intra-abdominal pressure (IAH) can lead to abdominal compartment syndrome (ACS), which is associated with organ dysfunction and even multiorgan failure. Our 2010 survey revealed an inconsistent acceptance of definitions and guidelines among pediatric intensivists regarding the diagnosis and treatment of IAH and ACS in Germany. This is the first survey to assess the impact of the updated guidelines on neonatal/pediatric intensive care units (NICU/PICU) in German-speaking countries after WSACS published those in 2013. METHODS We conducted a follow-up survey and sent 473 questionnaires to all 328 German-speaking pediatric hospitals. We compared our findings regarding awareness, diagnostics and therapy of IAH and ACS with the results of our 2010 survey. RESULTS The response rate was 48% (n = 156). The majority of respondents was from Germany (86%) and working in PICUs with mostly neonatal patients (53%). The number of participants who stated that IAH and ACS play a role in their clinical practice rose from 44% in 2010 to 56% in 2016. Similar to the 2010 investigations, only a few neonatal/pediatric intensivists knew the correct WSACS definition of an IAH (4% vs 6%). Different from the previous study, the number of participants who correctly defined an ACS increased from 18 to 58% (p < 0,001). The number of respondents measuring intra-abdominal pressure (IAP) increased from 20 to 43% (p < 0,001). Decompressive laparotomies (DLs) were performed more frequently than in 2010 (36% vs. 19%, p < 0,001), and the reported survival rate was higher when a DL was used (85% ± 17% vs. 40 ± 34%). CONCLUSIONS Our follow-up survey of neonatal/pediatric intensivists showed an improvement in the awareness and knowledge of valid definitions of ACS. Moreover, there has been an increase in the number of physicians measuring IAP in patients. However, a significant number has still never diagnosed IAH/ACS, and more than half of the respondents have never measured IAP. This reinforces the suspicion that IAH and ACS are only slowly coming into the focus of neonatal/pediatric intensivists in German-speaking pediatric hospitals. The goal should be to raise awareness of IAH and ACS through education and training and to establish diagnostic algorithms, especially for pediatric patients. The increased survival rate after conducting a prompt DL consolidates the impression that the probability of survival can be increased by timely surgical decompression in the case of full-blown ACS.
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Affiliation(s)
- Paul Wiegandt
- grid.10423.340000 0000 9529 9877Department of Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Carl-Neuberg-Street 1, 30625 Hannover, Germany
| | - Thomas Jack
- grid.10423.340000 0000 9529 9877Department of Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Carl-Neuberg-Street 1, 30625 Hannover, Germany
| | - Alexander von Gise
- grid.10423.340000 0000 9529 9877Department of Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Carl-Neuberg-Street 1, 30625 Hannover, Germany
| | - Kathrin Seidemann
- grid.10423.340000 0000 9529 9877Department of Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Carl-Neuberg-Street 1, 30625 Hannover, Germany
| | - Martin Boehne
- grid.10423.340000 0000 9529 9877Department of Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Carl-Neuberg-Street 1, 30625 Hannover, Germany
| | - Harald Koeditz
- grid.10423.340000 0000 9529 9877Department of Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Carl-Neuberg-Street 1, 30625 Hannover, Germany
| | - Philipp Beerbaum
- grid.10423.340000 0000 9529 9877Department of Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Carl-Neuberg-Street 1, 30625 Hannover, Germany
| | - Michael Sasse
- grid.10423.340000 0000 9529 9877Department of Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Carl-Neuberg-Street 1, 30625 Hannover, Germany
| | - Torsten Kaussen
- Department of Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Carl-Neuberg-Street 1, 30625, Hannover, Germany.
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15
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Khanna AK, Minear S, Kurz A, Moll V, Stanton K, Essakalli L, Prabhakar A; Predict AKI Group. Intra-abdominal hypertension in cardiac surgery patients: a multicenter observational sub-study of the Accuryn registry. J Clin Monit Comput 2023; 37:189-99. [PMID: 35695943 DOI: 10.1007/s10877-022-00878-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 05/06/2022] [Indexed: 01/24/2023]
Abstract
Intra-abdominal hypertension (IAH) is frequently present in the critically ill and is associated with increased morbidity and mortality. Conventionally, intermittent 'spot-check' manual measurements of bladder pressure in those perceived as high risk are used as surrogates for intra-abdominal pressure (IAP). True patterns of IAH remain unknown. We explored the incidence of IAH in cardiac surgery patients and describe the intra-and postoperative course of IAP using a novel, high frequency, automated bladder pressure measurement system. Sub-analysis of a prospective, multicenter, observational study (NCT04669548) conducted in three large academic medical centers. Continuous urinary output (CUO) and IAP measurements were observed using the Accuryn Monitoring System (Potrero Medical, Hayward, CA). Data collected included demographics, hemodynamic support, and high-frequency IAP and CUO. One Hundred Thirty-Seven cardiac surgery patients were analyzed intraoperatively and followed 48 h postoperatively in the intensive care unit. Median age was 66.4 [58.3, 72.0] years, and 61% were men. Median Foley catheter dwell time was 56.0 [46.8, 77.5] hours, and median baseline IAP was 6.3 [4.0, 8.1] mmHg. 93% (128/137) of patients were in IAH grade I, 82% (113/137) in grade II, 39% (53/137) in grade III, and 5% (7/137) in grade IV for at least 12 cumulative hours. For maximum consecutive duration of IAH, 84% (115/137) of patients spent at least 12 h in grade I, 62% (85/137) in grade II, 18% (25/137) in grade III, and 2% (3/137) in grade IV IAH. During the first 48 h after cardiac surgery, IAH is common and persistent. Improved and automated monitoring of IAP will increase the detection of IAH-which normally would remain undetected using traditional intermittent monitoring methods.
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16
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Skoog P, Seilitz J, Oikonomakis I, Hörer TM, Nilsson KF. NO-Donation Increases Visceral Circulation in a Porcine Model of Abdominal Hypertension. J Cardiovasc Transl Res 2023; 16:42-50. [PMID: 36036860 PMCID: PMC9944725 DOI: 10.1007/s12265-022-10299-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 07/28/2022] [Indexed: 10/15/2022]
Abstract
Intraabdominal hypertension (IAH) is negative for outcome after intensive care. Little research has focused on medical intervention to improve visceral circulation during IAH. A nitric oxide (NO)-donor was compared with placebo in 25 pigs; each pig was randomized into three groups: PDNO (NO-donor), Control (placebo), or Sham. IAH was induced by CO2 insufflation to 30 mmHg. Sham group had surgical preparation only. Blood gases, invasive venous and arterial blood pressure, intestinal microcirculation and superior mesenteric blood flow were measured. The PDNO group had significantly increased intestinal microcirculation compared with Controls during IAH (last hour, P = 0.009). The mean arterial pressure and abdominal perfusion pressures (APP) were decreased, and the cardiac index were increased in the PDNO group. Also, systemic and pulmonary vascular resistances were lower in the PDNO group compared with Controls. These experimental findings indicate that NO should be further explored with potential application to improve intestinal microcirculation in IAH patients.
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Affiliation(s)
- Per Skoog
- Department of Vascular Surgery and Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital and Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
| | - Jenny Seilitz
- Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Ioannis Oikonomakis
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Tal M Hörer
- Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Kristofer F Nilsson
- Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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17
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Zhou H, Zhang Z, Yang S, Gong X, Liu Y, Du G, Chen J. Logistic regression analysis of risk factors for intra-abdominal hypertension after giant ventral hernia repair: a retrospective cohort study. Hernia 2022; 27:305-309. [PMID: 36169738 DOI: 10.1007/s10029-022-02667-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/17/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Intra-abdominal hypertension (IAH) is a classical complication after giant ventral hernia surgery and may lead to abdominal compartment syndrome (ACS). Assessment of risk factors and prevention of IAH/ACS are essential for hernia surgeons. METHODS We performed a retrospective study including 58 giant ventral hernia patients in our center between Jan 1, 2017, and Mar 1, 2022, we recorded age, gender, chronic obstructive pulmonary disease (COPD), coronary heart disease (CHD), hypertension, type 2 diabetes mellitus (T2DM), hypoproteinemia, body mass index (BMI), the ratio of hernia sac volume to abdominal cavity volume (HSV/ACV), defect width, tension reduction procedure (TRP), positive fluid balance (PFB) and IAH of these patients and analyzed the data using univariate and multivariate logistic regression to screen the risk factors for IAH after surgery. RESULTS The multivariate analysis showed that HSV/ACV ≥ 25%, hypoproteinemia, and PFB were independent risk factors for the occurrence of IAH after giant ventral hernia repair (P = 0.025, 0.016, 0.017, respectively). We did not find any correlation between postoperative IAH and the patient's age, gender, COPD, CHD, hypertension, T2DM, BMI, defect width, TRP, and PFB. CONCLUSION Identifying risk factors is of great significance for the early identification and prevention of IAH/ACS. We found that HSV/ACV ≥ 25%, hypoproteinemia, and PFB were independent risk factors for IAH after giant ventral hernia repair.
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Affiliation(s)
- H Zhou
- The Third Clinical Medical School of Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Z Zhang
- The Third Clinical Medical School of Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - S Yang
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, No. 5 JingYuan Road, Shijingshan District, Beijing, 100043, China
| | - X Gong
- Department of Radiology, Beijing Chao-Yang Hospital, No. 5 JingYuan Road, Shijingshan District, Beijing, 100043, China
| | - Y Liu
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, No. 5 JingYuan Road, Shijingshan District, Beijing, 100043, China
| | - G Du
- Department of Radiology, Lin Yi Geriatric Hospital, Lanshan District, Linyi, 276003, China
| | - J Chen
- The Third Clinical Medical School of Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China.
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, No. 5 JingYuan Road, Shijingshan District, Beijing, 100043, China.
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Brown J, Warnock B, Turk E, Hobson MJ, Friedman ML, Gray BW. Open abdomen during extracorporeal membrane oxygenation is a safe and effective treatment for abdominal compartment syndrome. J Pediatr Surg 2022; 57:216-222. [PMID: 34953565 DOI: 10.1016/j.jpedsurg.2021.11.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 10/04/2021] [Accepted: 11/17/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND/PURPOSE Decompressive laparotomy and open abdomen for abdominal compartment syndrome have been historically avoided during Extracorporeal Membrane Oxygenation (ECMO) due to seemingly elevated risks of bleeding and infection. Our goal was to evaluate a cohort of pediatric respiratory ECMO patients who underwent decompressive laparotomy with open abdomen at a single institution and to compare these patients to ECMO patients without open abdomen. METHODS We reviewed all pediatric respiratory ECMO (30 days-18 years) patients treated with decompressive laparotomy with open abdomen at Riley Hospital for Children (1/2000-12/2019) and compared these patients to concurrent respiratory ECMO patients with closed abdomen. We excluded patients with surgical cardiac disease. We assessed demographics, ECMO data, and outcomes and defined significance as p = 0.05. RESULTS 6 of 81 ECMO patients were treated with decompressive laparotomy and open abdomen. Open and closed abdomen groups had similar age (p = 0.223) and weight (0.286) at cannulation, but the open abdomen group had a higher reliance on vasoactive medications (Vasoactive Inotropic Score, p = 0.040). Open abdomen group survival was similar to closed abdomen patients (66.7%, vs 62.7%, p = 1). Open abdomen patients had lower incidence of ECMO complications (33.3% vs 83.6%, p = 0.014), but the groups had similar bleeding complications (p = 0.412) and PRBC transfusion volume (p = 0.941). CONCLUSION/IMPACT Pediatric ECMO patients with open abdomen after decompressive laparotomy had similar survival, blood products administered, and complications as those with a closed abdomen. An open abdomen is not a contra-indication to ECMO support in pediatric respiratory patients and should be considered in select patients.
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Affiliation(s)
- Joshua Brown
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Brielle Warnock
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Eamaan Turk
- Dow Medical College, Karachi, Sindh, Pakistan
| | - Michael J Hobson
- Indiana University School of Medicine, Department of Pediatrics, Division of Pediatric Critical Care, 705 Riley Hospital Drive RI5900, Indianapolis, IN, 46202, USA; Riley Hospital for Children, Section of Pediatric Critical Care, 705 Riley Hospital Drive, Phase 2, Suite 4900, Indianapolis, IN, 46202, USA
| | - Matthew L Friedman
- Indiana University School of Medicine, Department of Pediatrics, Division of Pediatric Critical Care, 705 Riley Hospital Drive RI5900, Indianapolis, IN, 46202, USA; Riley Hospital for Children, Section of Pediatric Critical Care, 705 Riley Hospital Drive, Phase 2, Suite 4900, Indianapolis, IN, 46202, USA
| | - Brian W Gray
- Riley Hospital for Children, Section of Pediatric Surgery, 705 Riley Hospital Drive RI2500, Indianapolis, IN, 46202, USA; Indiana University, School of Medicine, Department of Surgery, 545 Barnhill Dr., Emerson Hall, Indianapolis, IN, 46202, USA.
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19
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Maze Y, Tokui T, Kawaguchi T, Murakami M, Inoue R, Hirano K, Sato K, Tamura Y. Open abdominal management after ruptured abdominal aortic aneurysm repair: from a single-center study in Japan. Surg Today 2022; 53:420-427. [PMID: 35984520 PMCID: PMC10042970 DOI: 10.1007/s00595-022-02574-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 07/24/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE We investigated the utility of the open abdominal management (OA) technique for ruptured abdominal aortic aneurysm (rAAA). METHODS Between January 2016 and August 2021, 33 patients underwent open surgery for rAAA at our institution. The patients were divided into OA (n = 12) and non-OA (n = 21) groups. We compared preoperative characteristics, operative data, and postoperative outcomes between the two groups. The intensive care unit management and abdominal wall closure statuses of the OA group were evaluated. RESULTS The OA group included significantly more cases of a preoperative shock than the non-OA group. The operation time was also significantly longer in the OA group than in the non-OA group. The need for intraoperative fluids, amount of bleeding, and need for blood transfusion were significantly higher in the OA group than in the non-OA group. Negative pressure therapy (NPT) systems are useful in OA. In five of the six survivors in the OA group, abdominal closure was able to be achieved using components separation (CS) technique. CONCLUSIONS NPT and the CS technique may increase the abdominal wall closure rate in rAAA surgery using OA and are expected to improve outcomes.
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Affiliation(s)
- Yasumi Maze
- Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital, 1-471-2 Funae, Ise, Mie, 516-8512, Japan.
| | - Toshiya Tokui
- Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital, 1-471-2 Funae, Ise, Mie, 516-8512, Japan
| | - Teruhisa Kawaguchi
- Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital, 1-471-2 Funae, Ise, Mie, 516-8512, Japan
| | - Masahiko Murakami
- Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital, 1-471-2 Funae, Ise, Mie, 516-8512, Japan
| | - Ryosai Inoue
- Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital, 1-471-2 Funae, Ise, Mie, 516-8512, Japan
| | - Koji Hirano
- Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital, 1-471-2 Funae, Ise, Mie, 516-8512, Japan
| | - Keita Sato
- Department of Surgery, Ise Red Cross Hospital, Ise, Mie, Japan
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Hassan A, Lawlis S, Landmann A, Ruiz-Elizalde A, Middleman A. Not just an upset stomach: gastric perforation in a patient with anorexia nervosa. Eat Weight Disord 2022; 27:1907-1911. [PMID: 34731455 DOI: 10.1007/s40519-021-01312-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 09/20/2021] [Indexed: 10/19/2022] Open
Abstract
Gastric perforation in patients with anorexia nervosa is a rare entity associated with high morbidity and mortality [Norris in Int J Eat Disord 49:216-237, 2016]. In cases reported in the literature, the perforation was often preceded by a binge episode, and the subsequent clinical presentation was rapid and acutely deteriorating with a fatality rate as high as 80% [Norris in Int J Eat Disord 49:216-237, 2016, Pitre in J Med Case Rep 15:61, 2021]. We present a case of gastric perforation in the context of restrictive anorexia nervosa unique both for the absence of a premorbid binge episode as well as delayed clinical manifestations of medical distress, leading to abdominal compartment syndrome.Level IV Evidence obtained from multiple time series analysis such as case studies.
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Affiliation(s)
- Ahmad Hassan
- The University of Oklahoma, Oklahoma City, OK, USA.
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Łagosz P, Sokolski M, Biegus J, Tycinska A, Zymlinski R. Elevated intra-abdominal pressure: A review of current knowledge. World J Clin Cases 2022; 10:3005-3013. [PMID: 35647129 PMCID: PMC9082714 DOI: 10.12998/wjcc.v10.i10.3005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 09/20/2021] [Accepted: 02/23/2022] [Indexed: 02/06/2023] Open
Abstract
Elevated intra-abdominal pressure (IAP) is a known cause of increased morbidity and mortality among critically ill patients. Intra-abdominal hypertension (IAH) and abdominal compartment syndrome can lead to rapid deterioration of organ function and the development of multiple organ failure. Raised IAP affects every system and main organ in the human body. Even marginally sustained IAH results in malperfusion and may disrupt the process of recovery. Yet, despite being so common, this potentially lethal condition often goes unnoticed. In 2004, the World Society of the Abdominal Compartment Syndrome, an international multidisciplinary consensus group, was formed to provide unified definitions, improve understanding and promote research in this field. Simple, reliable and nearly costless standardized methods of non-invasive measurement and monitoring of bladder pressure allow early recognition of IAH and timely optimized management. The correct, structured approach to treatment can have a striking effect and fully restore homeostasis. In recent years, significant progress has been made in this area with the contribution of surgeons, internal medicine specialists and anesthesiologists. Our review focuses on recent advances in order to present the complex underlying pathophysiology and guidelines concerning diagnosis, monitoring and treatment of this life-threatening condition.
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Affiliation(s)
- Piotr Łagosz
- Department of Heart Diseases, Wroclaw Medical University, Wroclaw 50-367, Poland
- Institute of Heart Diseases, University Clinical Hospital, Wroclaw 50-556, Poland
| | - Mateusz Sokolski
- Department of Heart Diseases, Wroclaw Medical University, Wroclaw 50-367, Poland
- Institute of Heart Diseases, University Clinical Hospital, Wroclaw 50-556, Poland
| | - Jan Biegus
- Department of Heart Diseases, Wroclaw Medical University, Wroclaw 50-367, Poland
- Institute of Heart Diseases, University Clinical Hospital, Wroclaw 50-556, Poland
| | - Agnieszka Tycinska
- Department of Cardiology, Medical University of Bialystok, Bialystok 15-089, Poland
| | - Robert Zymlinski
- Department of Heart Diseases, Wroclaw Medical University, Wroclaw 50-367, Poland
- Institute of Heart Diseases, University Clinical Hospital, Wroclaw 50-556, Poland
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Copur S, Berkkan M, Hasbal NB, Basile C, Kanbay M. Abdominal compartment syndrome: an often overlooked cause of acute kidney injury. J Nephrol 2022. [PMID: 35380354 DOI: 10.1007/s40620-022-01314-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 03/19/2022] [Indexed: 10/18/2022]
Abstract
Abdominal compartment syndrome (ACS) is defined as any organ dysfunction caused by intra-abdominal hypertension (IAH), referred as intra-abdominal pressure (IAP) ≥ 12 mm Hg according to the World Society of Abdominal Compartment Syndrome. Abdominal compartment syndrome develops in most cases when IAP rises above 20 mmHg. Abdominal compartment syndrome, while being a treatable and even preventable condition if detected early in the stage of intra-abdominal hypertension, is associated with high rates of morbidity and mortality if diagnosis is delayed: therefore, early detection is essential. Acute kidney injury (AKI) is a common comorbidity, affecting approximately one in every five hospitalized patients, with a higher incidence in surgical patients. AKI in response to intra-abdominal hypertension develops as a result of a decline in cardiac output and compression of the renal vasculature and renal parenchyma. In spite of the high incidence of intra-abdominal hypertension, especially in surgical patients, its potential role in the pathophysiology of AKI has been investigated in very few clinical studies and is commonly overlooked in clinical practice despite being potentially treatable and reversible. Aim of the present review is to illustrate the current evidence on the pathophysiology, diagnosis and therapy of intra-abdominal hypertension and abdominal compartment syndrome in the context of AKI.
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Ney JP, Moll V, Kimball EJ. Urinary catheter monitoring of intra-abdominal pressure after major abdominal surgery, a cost-benefit analysis. J Med Econ 2022; 25:412-420. [PMID: 35282753 DOI: 10.1080/13696998.2022.2053383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To estimate costs and benefits associated with measurement of intra-abdominal pressure (IAP). METHODS We built a cost-benefit analysis from the hospital facility perspective and time horizon limited to hospitalization for patients undergoing major abdominal surgery for the intervention of urinary catheter monitoring of IAP. We used real-world data estimating the likelihood of intra-abdominal hypertension (IAH), abdominal compartment syndrome (ACS), and acute kidney injury (AKI) requiring renal replacement therapy (RRT). Costs included catheter costs (estimated $200), costs of additional intensive care unit (ICU) days from IAH and ACS, and costs of CRRT. We took the preventability of IAH/ACS given early detection from a trial of non-surgical interventions in IAH. We evaluated uncertainty through probabilistic sensitivity analysis and the effect of individual model parameters on the primary outcome of cost savings through one-way sensitivity analysis. RESULTS In the base case, urinary catheter monitoring of IAP in the perioperative period of major abdominal surgery had 81% fewer cases of IAH of any grade, 64% fewer cases of AKI, and 96% fewer cases of ACS. Patients had 1.5 fewer ICU days attributable to IAH (intervention 1.6 days vs. control of 3.1 days) and a total average cost reduction of $10,468 (intervention $10,809, controls $21,277). In Monte Carlo simulation, 86% of 1,000 replications were cost-saving, for a mean cost savings of $10,349 (95% UCI $8,978, $11,720) attributable to real-time urinary catheter monitoring of intra-abdominal pressure. One-way factor analysis showed the pre-test probability of IAH had the largest effect on cost savings and the intervention was cost-neutral at a prevention rate as low as 2%. CONCLUSIONS In a cost-benefit model using real-world data, the potential average in-hospital cost savings for urinary catheter monitoring of IAP for early detection and prevention of IAH, ACS, and AKI far exceed the cost of the catheter.
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Affiliation(s)
- John P Ney
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Vanessa Moll
- Department of Anesthesiology, Division of Critical Care Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Edward J Kimball
- Depts of Surgery and Critical Care, University of Utah, Salt Lake City, UT, USA
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Glasser JG. Abdominal compartment syndrome complicating necrotizing enterocolitis: A case report. Ann Med Surg (Lond) 2021; 71:102961. [PMID: 34840739 PMCID: PMC8606709 DOI: 10.1016/j.amsu.2021.102961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 10/13/2021] [Accepted: 10/14/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction There are several disease entities subsumed under the heading Necrotizing Enterocolitis (NEC): 1 The infectious enterocolitis that causes bowel necrosis. 2 Spontaneous Intestinal Perforation which is linked to the use of Indocin to hasten closure of a patent ductus arteriosus (PDA); the perforation occurs in bowel that is well perfused and viable. 3 Perforations that occur in bowel that is obstructed by thick or inspissated meconium (Awolaran and Sheth, Sept 2021) [1]. 4 The uncommon variant that is associated with the abdominal compartment syndrome. Case report A case is presented in which a preemie suddenly developed massive abdominal distension. The neonatologist embarked upon the usual work-up and therapeutic interventions but was stymied by the inability to pass an orogastric tube to relieve the abdominal distension. Discussion The purpose of this report is not to criticize the neonatologist, but to emphasize the difference between this case, complicated by the abdominal compartment syndrome, and the usual case of NEC. Conclusion This is an unusual manifestation of NEC; and in my experience, it is uniformly fatal. Like many diseases with a fulminant course, our therapeutic efforts seem always too little, too late. Perhaps, by calling attention to this unusual association, its dismal outcome may be altered. A preemie may suddenly become septic and develop abdominal distension. Is this primary enterocolitis or ileus secondary to a septic focus elsewhere? The abdominal radiographs may have a soap bubble appearance - generalized dilatation of the intestine and thinning of the bowel wall. In addition to being a sign of sepsis, abdominal distension may become a deleterious component in its pathogenesis. The abdominal compartment syndrome, by decreasing venous return and limiting diaphragmatic excursion, exacerbates cardiorespiratory failure. Neonatologists use familiar, safe modalities - pharmacopeia and ventilation - to prepare their fragile patients for surgery. By diminishing the intra-abdominal pressure, laparotomy works in tandem with these modalities. Venous return and cardiac output are improved (metabolic acidosis); and diaphragmatic excursion and ventilation are facilitated (respiratory acidosis).
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Han J, Gangalam V, Wilson P. Advanced squamous cell carcinoma arising in a laparostomy site. Ann R Coll Surg Engl 2021; 104:35-36. [PMID: 34825574 DOI: 10.1308/rcsann.2021.0150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Chronic wounds occur as a result of a disordered healing process. They can be associated with complications such as chronic pain and infection, but also rarely lead to malignant transformation. There have been few cases of squamous cell carcinomas arising in a surgical wound. We present the case of a 67-year-old patient who developed an advanced invasive squamous cell carcinoma seven years post laparostomy for abdominal compartment syndrome. Surgical resection was not possible due to the advanced stage of the malignancy. This case highlights the importance of good wound care, suspecting malignant development in a non-healing chronic surgical wound site, and the importance of using histological analysis to inform surgery when involving a chronic wound.
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Affiliation(s)
- J Han
- Royal Lancaster Infirmary, UK
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26
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Regli A, Ahmadi-Noorbakhsh S, Musk GC, Reese DJ, Herrmann P, Firth MJ, Pillow JJ. Computed tomographic assessment of lung aeration at different positive end-expiratory pressures in a porcine model of intra-abdominal hypertension and lung injury. Intensive Care Med Exp 2021; 9:52. [PMID: 34608559 PMCID: PMC8489364 DOI: 10.1186/s40635-021-00416-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 09/21/2021] [Indexed: 11/18/2022] Open
Abstract
Background Intra-abdominal hypertension (IAH) is common in critically ill patients and is associated with increased morbidity and mortality. High positive end-expiratory pressures (PEEP) can reverse lung volume and oxygenation decline caused by IAH, but its impact on alveolar overdistension is less clear. We aimed to find a PEEP range that would be high enough to reduce atelectasis, while low enough to minimize alveolar overdistention in the presence of IAH and lung injury. Methods Five anesthetized pigs received standardized anesthesia and mechanical ventilation. Peritoneal insufflation of air was used to generate intra-abdominal pressure of 27 cmH2O. Lung injury was created by intravenous oleic acid. PEEP levels of 5, 12, 17, 22, and 27 cmH2O were applied. We performed computed tomography and measured arterial oxygen levels, respiratory mechanics, and cardiac output 5 min after each new PEEP level. The proportion of overdistended, normally aerated, poorly aerated, and non-aerated atelectatic lung tissue was calculated based on Hounsfield units. Results PEEP decreased the proportion of poorly aerated and atelectatic lung, while increasing normally aerated lung. Overdistension increased with each incremental increase in applied PEEP. “Best PEEP” (respiratory mechanics or oxygenation) was higher than the “optimal CT inflation PEEP range” (difference between lower inflection points of atelectatic and overdistended lung) in healthy and injured lungs. Conclusions Our findings in a large animal model suggest that titrating a PEEP to respiratory mechanics or oxygenation in the presence of IAH is associated with increased alveolar overdistension. Supplementary Information The online version contains supplementary material available at 10.1186/s40635-021-00416-5.
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Affiliation(s)
- Adrian Regli
- Department of Intensive Care, Fiona Stanley Hospital, Murdoch Drive, Murdoch, WA, 6150, Australia. .,Medical School, Division of Emergency Medicine, The University of Western Australia, 35 Stirling Highway, Crawley, 6009, Australia. .,Medical School, The University of Notre Dame Australia, 19 Mouat Street, Fremantle, 6959, Australia. .,School of Human Sciences, The University of Western Australia, 35 Stirling Highway, Crawley, 6009, Australia.
| | - Siavash Ahmadi-Noorbakhsh
- School of Human Sciences, The University of Western Australia, 35 Stirling Highway, Crawley, 6009, Australia
| | - Gabrielle Christine Musk
- Animal Care Services, The University of Western Australia, 35 Stirling Highway, Crawley, 6009, Australia.,School of Veterinary and Life Sciences, Murdoch University, Nyarrie Drive, Murdoch, 6150, Australia
| | - David Joseph Reese
- VetCT Consultants in Telemedicine PTY LTD, 185-187 High Street, Fremantle, 6160, Australia
| | - Peter Herrmann
- Department of Anaesthesiology, Emergency and Intensive Care Medicine, University of Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Martin Joseph Firth
- Centre for Applied Statistics, Department of Mathematics and Statistics, The University of Western Australia, 35 Stirling Highway, Crawley, 6009, Australia
| | - J Jane Pillow
- School of Human Sciences, The University of Western Australia, 35 Stirling Highway, Crawley, 6009, Australia
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Smit M, van Meurs M, Zijlstra JG. Intra-abdominal hypertension and abdominal compartment syndrome in critically ill patients: A narrative review of past, present, and future steps. Scand J Surg 2021; 111:14574969211030128. [PMID: 34605332 DOI: 10.1177/14574969211030128] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND OBJECTIVE Intra-abdominal hypertension is frequently present in critically ill patients and is an independent predictor for mortality. In this narrative review, we aim to provide a comprehensive overview of current insights into intra-abdominal pressure monitoring, intra-abdominal hypertension, and abdominal compartment syndrome. The focus of this review is on the pathophysiology, risk factors and outcome of intra-abdominal hypertension and abdominal compartment syndrome, and on therapeutic strategies, such as non-operative management, surgical decompression, and management of the open abdomen. Finally, future steps are discussed, including propositions of what a future guideline should focus on. CONCLUSIONS Pathological intra-abdominal pressure is a continuum ranging from mild intra-abdominal pressure elevation without clinically significant adverse effects to substantial increase in intra-abdominal pressure with serious consequences to all organ systems. Intra-abdominal pressure monitoring should be performed in all patients at risk of intra-abdominal hypertension. Although continuous intra-abdominal pressure monitoring is feasible, this is currently not standard practice. There are a number of effective non-operative medical interventions that may be performed early in the patient's course to reduce intra-abdominal pressure and decrease the need for surgical decompression. Abdominal decompression can be life-saving when abdominal compartment syndrome is refractory to non-operative treatment and should be performed expeditiously. The objectives of open abdomen management are to prevent fistula and to achieve delayed fascial closure at the earliest possible time. There is still a lot to learn and change. The 2013 World Society of Abdominal Compartment Syndrome guidelines should be updated and multicentre studies should evaluate the effect of intra-abdominal hypertension treatment on patient outcome.
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Affiliation(s)
- Marije Smit
- Department of Critical Care, University Medical Center Groningen, University of Groningen, BA 49, PO Box 30001, 9700 RB Groningen, The Netherlands
| | - Matijs van Meurs
- Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jan G Zijlstra
- Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Silveira LGT, Brocca IC, Moraes ES, Brandão MB, Nogueira RJN, de Souza TH. Hemodynamic effects of increased intra-abdominal pressure in critically ill children. J Pediatr (Rio J) 2021; 97:564-570. [PMID: 33358965 PMCID: PMC9432225 DOI: 10.1016/j.jped.2020.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/23/2020] [Accepted: 11/23/2020] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To evaluate the influence of intra-abdominal pressure on the cardiac index (CI) at different intra-abdominal hypertension grades achieved when performing an abdominal compression maneuver (ACM). Evaluating the effectiveness of the ACM in distending the left internal jugular vein (LIJV). METHODS Prospective observational study conducted in the PICU of a quaternary care teaching hospital. Participants underwent the ACM and the IAP was measured with an indwelling urinary catheter. At each IAH grade reached during the ACM, the CI was measured by transthoracic echocardiography and the LIJV cross-sectional area (CSA) was determined by ultrasonography. RESULTS Twenty-four children were included (median age and weight of 3.5 months and 6.37kg, respectively). The median CI observed at baseline and during IAH grades I, II, III, and IV were 3.65L/min/m2 (IQR 3.12-4.03), 3.38L/min/m2 (IQR 3.04-3.73), 3.16L/min/m2 (IQR 2.70-3.53), 2.89L/min/m2 (IQR 2.38-3.22), and 2.42L/min/m2 (IQR 1.91-2.79), respectively. A 25% increase in the LIJV CSA area was achieved in 14 participants (58%) during the ACM. CONCLUSION The ACM significantly increases IAP, causing severe reversible impairment in the cardiovascular system and is effective in distending the LIJV in just over half of the subjects. Even low levels of HIA can result in significant cardiac dysfunction in children. Therefore, health professionals should be aware of the negative hemodynamic repercussions caused by the increased IAP.
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Affiliation(s)
- Letícia G T Silveira
- Universidade Estadual de Campinas (UNICAMP), Hospital das Clínicas, Departamento de Pediatria, Unidade de Terapia Intensiva Pediátrica, Campinas, SP, Brazil
| | - Isabela C Brocca
- Universidade Estadual de Campinas (UNICAMP), Hospital das Clínicas, Departamento de Pediatria, Unidade de Terapia Intensiva Pediátrica, Campinas, SP, Brazil
| | - Erika S Moraes
- Universidade Estadual de Campinas (UNICAMP), Hospital das Clínicas, Escola de Enfermagem, Unidade de Terapia Intensiva Pediátrica, Campinas, SP, Brazil
| | - Marcelo B Brandão
- Universidade Estadual de Campinas (UNICAMP), Hospital das Clínicas, Departamento de Pediatria, Unidade de Terapia Intensiva Pediátrica, Campinas, SP, Brazil
| | - Roberto J N Nogueira
- Universidade Estadual de Campinas (UNICAMP), Hospital das Clínicas, Departamento de Pediatria, Unidade de Terapia Intensiva Pediátrica, Campinas, SP, Brazil; Faculdade de Ciências Médicas São Leopoldo Mandic, Departamento de Pediatria, Campinas, SP, Brazil
| | - Tiago Henrique de Souza
- Universidade Estadual de Campinas (UNICAMP), Hospital das Clínicas, Departamento de Pediatria, Unidade de Terapia Intensiva Pediátrica, Campinas, SP, Brazil.
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Ersryd S, Baderkhan H, Djavani Gidlund K, Björck M, Gillgren P, Bilos L, Wanhainen A. Risk Factors for Abdominal Compartment Syndrome After Endovascular Repair for Ruptured Abdominal Aortic Aneurysm: A Case Control Study. Eur J Vasc Endovasc Surg 2021; 62:400-407. [PMID: 34244093 DOI: 10.1016/j.ejvs.2021.05.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 02/23/2021] [Accepted: 05/09/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Ruptured abdominal aortic aneurysms (rAAA) are treated by endovascular aneurysm repair (rEVAR) increasingly often. Despite rEVAR being a minimally invasive method, abdominal compartment syndrome (ACS) remains a significant post-operative threat. The aim of this study was to investigate risk factors for ACS after rEVAR, including aortic morphological features. METHODS The Swedish vascular registry (Swedvasc) was assessed for ACS after rEVAR in the period 2008 - 2015. All patients identified were compared with controls (i.e., patients who did not develop ACS after rEVAR), matched by centre and repair date. Case records were reviewed, and radiology images analysed in a core laboratory. Comparisons were performed with respect to physiological and radiological risk factors. RESULTS The study population consisted of 40 patients with ACS and 68 controls. Pre-operatively, patients with ACS had a lower blood pressure (BP) than controls (median 70 mmHg vs. 97 mmHg; p < .001). Intra-operatively, they had aortic balloon occlusion more often (55.0% vs. 10.3%; p < .001) and received more transfusions than controls (median nine units of packed red blood cells [pRBC] vs. two units; p < .001). Ninety-seven per cent of those who developed ACS had a pre-operative BP < 70 mmHg, aortic balloon occlusion, or received more than five pRBC unit transfusions. Treatment outside the instructions for use did not differ between patients and controls (57.5% vs. 54.4%; p = .84), and neither did the pre-operative patency of the inferior mesenteric artery (57.1% vs. 63.9%; p = .52) nor the number of visible lumbar arteries on pre-operative imaging (2 vs. 4; p = .014). In multivariable logistic regression, the number of intra-operative transfusions were predictive of ACS (p < .001), while pre-operative hypotension (p = .32) and aortic balloon occlusion (p = .018) were not. CONCLUSION ACS after rEVAR is mainly associated with physiological factors and is unlikely to develop without the presence of a pre-operative BP < 70 mmHg, the need for an aortic occlusion balloon, or more than five intra-operative pRBC unit transfusions. Treatment outside the IFU or any other morphological factor were not associated with a risk of ACS.
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Affiliation(s)
- Samuel Ersryd
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden; Centre for Research and Development, Uppsala University/County Council of Gävleborg, Gävle, Sweden.
| | - Hassan Baderkhan
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - Khatereh Djavani Gidlund
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden; Centre for Research and Development, Uppsala University/County Council of Gävleborg, Gävle, Sweden
| | - Martin Björck
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - Peter Gillgren
- Unit for Vascular Surgery, Department of Surgery, Södersjukhuset, Stockholm, Sweden
| | - Linda Bilos
- Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University Hospital, Örebro, Sweden
| | - Anders Wanhainen
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden
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Husu HL, Leppäniemi AK, Mentula PJ. Who would benefit from open abdomen in severe acute pancreatitis?-a matched case-control study. World J Emerg Surg 2021; 16:32. [PMID: 34112205 PMCID: PMC8194042 DOI: 10.1186/s13017-021-00376-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 05/26/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Selection of patients for open abdomen (OA) treatment in severe acute pancreatitis (SAP) is challenging. Treatment related morbidity and risk of adverse events are high; however, refractory abdominal compartment syndrome (ACS) is potentially lethal. Factors influencing the decision to initiate OA treatment are clinically important. We aimed to study these factors to help understand what influences the selection of patients for OA treatment in SAP. METHODS A single center study of patients with SAP that underwent OA treatment compared with conservatively treated matched controls. RESULTS Within study period, 47 patients treated with OA were matched in a 1:1 fashion with conservatively treated control patients. Urinary output under 20 ml/h (OR 5.0 95% CI 1.8-13.7) and ACS (OR 4.6 95% CI 1.4-15.2) independently associated with OA treatment. Patients with OA treatment had significantly more often visceral ischemia (34%) than controls (6%), P = 0.002. Mortality among patients with visceral ischemia was 63%. Clinically meaningful parameters predicting developing ischemia were not found. OA treatment associated with higher overall 90-day mortality rate (43% vs 17%, P = 0.012) and increased need for necrosectomy (55% vs 21%, P = 0.001). Delayed primary fascial closure was achieved in 33 (97%) patients that survived past OA treatment. CONCLUSION Decreased urine output and ACS were independently associated with the choice of OA treatment in patients with SAP. Underlying visceral ischemia was strikingly common in patients undergoing OA treatment, but predicting ischemia in these patients seems difficult.
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Affiliation(s)
- Henrik Leonard Husu
- Department of Gastrointestinal Surgery, University of Helsinki and Helsinki University Hospital, P.O. Box 340, FI-00029 HUS, Helsinki, Finland.
| | - Ari Kalevi Leppäniemi
- Department of Gastrointestinal Surgery, University of Helsinki and Helsinki University Hospital, P.O. Box 340, FI-00029 HUS, Helsinki, Finland
| | - Panu Juhani Mentula
- Department of Gastrointestinal Surgery, University of Helsinki and Helsinki University Hospital, P.O. Box 340, FI-00029 HUS, Helsinki, Finland
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Kaussen T, Gutting M, Lasch F, Boethig D, von Gise A, Dingemann J, Koeditz H, Jack T, Sasse M, Beerbaum P, Boehne M. Continuous intra-gastral monitoring of intra-abdominal pressure in critically ill children: a validation study. Intensive Care Med Exp 2021; 9:24. [PMID: 34027617 PMCID: PMC8141480 DOI: 10.1186/s40635-021-00386-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 04/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In critically ill children, detection of intra-abdominal hypertension (IAH > 10 mmHg) and abdominal compartment syndrome (ACS = IAH + organ dysfunction) is paramount and usually monitored through intra-vesical pressures (IVP) as current standard. IVP, however, carries important disadvantages, being time-consuming, discontinuous, with infection risk through observer-dependent manipulation, and ill-defined for catheter sizes. Therefore, we sought to validate air-capsule-based measurement of intra-gastric pressure (ACM-IGP). METHODS We prospectively compared ACM-IGP with IVP both in vivo and in vitro (water column), according to Abdominal-Compartment-Society validation criteria. We controlled for patient age, admission diagnosis, gastric filling/propulsive medication, respiratory status, sedation levels and transurethral catheters, all influencing intra-abdominal pressure (IAP). RESULTS In tertiary care PICU setting, finally, n = 97 children were enrolled (median age, 1.3 years [range 0 days-17 years], LOS-PICU 8.0 [1-332] days, PRISM-III-Score 13 [0-35]). In n = 2.770 measurements pairs, median IAP was 6.7 [0.9-23.0] mmHg, n = 38 (39%) children suffered from IAH > 10 mmHg, n = 4 from ACS. In vitro against water column, ACM-IGP correlated perfectly (r2 0.99, mean bias - 0.1 ± 0.5 mmHg, limits of agreement (LOA) - 1.1/+ 0.9, percentage error [PE] 12%) as compared with IVP (r2 0.98, bias + 0.7 ± 0.6 mmHg, LOA - 0.5/+ 1.9, PE 15%). With larger IVP catheters at higher pressure levels, IVP underestimated pressures against water column. In vivo, agreement between either technique was strong (r2 0.95, bias 0.3 ± 0.8 mmHg, LOA - 1.3/+ 1.9 mmHg, PE 23%). No impact of predefined control variables on measurement agreement was observed. CONCLUSIONS In a large PICU population with high IAH prevalence, ACM-IGP agreed favourably with IVP. More widespread usage of ACM-IGP may improve detection rates of ACS in critically ill children. Trial registration WHO-ICTRP-No. DRKS00006556 (German Clinical Trial Register). Registered 12th September 2014, URL: https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00006556.
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Affiliation(s)
- T Kaussen
- Department of Paediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany. .,Department of Paediatric Cardiology and Intensive Care Medicine, Hannover Medical School, University Children's Hospital, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - M Gutting
- Department of Paediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
| | - F Lasch
- Institute of Biometry, Hannover Medical School, Hannover, Germany
| | - D Boethig
- Department of Paediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
| | - A von Gise
- Department of Paediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
| | - J Dingemann
- Department of Paediatric Surgery, Hannover Medical School, Hannover, Germany
| | - H Koeditz
- Department of Paediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
| | - T Jack
- Department of Paediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
| | - M Sasse
- Department of Paediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
| | - P Beerbaum
- Department of Paediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
| | - M Boehne
- Department of Paediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
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Leon M, Chavez L, Surani S. Abdominal compartment syndrome among surgical patients. World J Gastrointest Surg 2021; 13:330-339. [PMID: 33968300 PMCID: PMC8069070 DOI: 10.4240/wjgs.v13.i4.330] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/25/2021] [Accepted: 03/22/2021] [Indexed: 02/06/2023] Open
Abstract
Abdominal compartment syndrome (ACS) develops when organ failure arises secondary to an increase in intraabdominal pressure. The abdominal pressure is determined by multiple factors such as blood pressure, abdominal compliance, and other factors that exert a constant pressure within the abdominal cavity. Several conditions in the critically ill may increase abdominal pressure compromising organ perfusion that may lead to renal and respiratory dysfunction. Among surgical and trauma patients, aggressive fluid resuscitation is the most commonly reported risk factor to develop ACS. Other conditions that have also been identified as risk factors are ascites, hemoperitoneum, bowel distention, and large tumors. All patients with abdominal trauma possess a higher risk of developing intra-abdominal hypertension (IAH). Certain surgical interventions are reported to have a higher risk to develop IAH such as damage control surgery, abdominal aortic aneurysm repair, and liver transplantation among others. Close monitoring of organ function and intra-abdominal pressure (IAP) allows clinicians to diagnose ACS rapidly and intervene with target-specific management to reduce IAP. Surgical decompression followed by temporary abdominal closure should be considered in all patients with signs of organ dysfunction. There is still a great need for more studies to determine the adequate timing for interventions to improve patient outcomes.
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Affiliation(s)
- Monica Leon
- Department of Medicine, Centro Medico ABC, Ciudad de Mexico 01120, Mexico
| | - Luis Chavez
- Department of Medicine, University of Texas, El Paso, TX 79905, United States
| | - Salim Surani
- Department of Medicine, Texas A&M University, Corpus Christi, TX 78405, United States
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Evola G, Ferrara F, Scravaglieri M, Trusso Zirna E, Sarvà S, Piazza L. Idiopathic giant pancreatic pseudocyst presenting in emergency with abdominal compartment syndrome and intestinal occlusion: Case report and review of the literature. Int J Surg Case Rep 2021; 81:105812. [PMID: 33887838 PMCID: PMC8049989 DOI: 10.1016/j.ijscr.2021.105812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 03/20/2021] [Indexed: 11/08/2022] Open
Abstract
Idiopathic giant pancreatic pseudocyst (IGPP) is a rare pancreatic disease. Diagnosis of IGPP in emergency [[1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19]] is a challenge because of its rarity, the absence of history of pancreatitis and specific symptoms and signs. IGPP may cause intestinal obstruction, intra-abdominal hypertension and abdominal compartment syndrome requiring a decompressive laparotomy. Distal pancreaticosplenectomy may be the correct treatment of undiagnosed IGPP if there is suspicion or inability to exclude a malignant cystic pancreatic neoplasm.
Introduction and importance This is the first case of idiopathic giant pancreatic pseudocyst (IGPP) causing intestinal occlusion, intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) reported in the literature. Diagnosis of IGPP in emergency is a challenge because of its rarity and the absence of a history of pancreatitis or pancreatic trauma and specific clinical presentation. Abdominal contrast-enhanced computed tomography (CECT) represents the gold standard in diagnosing of pancreatic cyst (PP). Different types of treatment of PP are reported in the literature. Case presentation A 52-year-old Caucasian female was admitted to the Emergency Department with a three-day history of abdominal pain, inability to pass gas or stool, nausea and vomiting, oliguria and a seven-day history of abdominal swelling and swollen legs. Physical examination revealed abdominal distention, abdominal pain, swelling in the legs. CECT showed a voluminous cystic pancreatic mass suspected of neoplasm. Laboratory tests reported high serum levels of BUN, creatinine and C-reactive protein and neutrophilic leukocytosis. After preoperative diagnosis of ACS, the patient was taken to the operating room for pancreatic resection. The postoperative course was uneventful. Diagnosis of IGPP was made by histopathological examination. Clinical discussion IGPP is difficult to diagnose in emergency. Although different types of drainage of IGPP are described in the literature, pancreatic resection represents the treatment of choice when a cystic pancreatic neoplasm cannot be excluded. Conclusion IGPP is a rare disease that may cause intestinal occlusion, IAH and ACS. Pancreatic resection if necessary is safe and therapeutic with acceptable morbidity and mortality.
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Affiliation(s)
- Giuseppe Evola
- General and Emergency Surgery Department, Garibaldi Hospital, Piazza Santa Maria di Gesù 5, 95100, Catania, Italy.
| | - Francesco Ferrara
- General and Emergency Surgery Department, Garibaldi Hospital, Piazza Santa Maria di Gesù 5, 95100, Catania, Italy
| | - Mario Scravaglieri
- General and Emergency Surgery Department, Garibaldi Hospital, Piazza Santa Maria di Gesù 5, 95100, Catania, Italy
| | - Ezio Trusso Zirna
- General and Emergency Surgery Department, Garibaldi Hospital, Piazza Santa Maria di Gesù 5, 95100, Catania, Italy
| | - Salvatore Sarvà
- General and Emergency Surgery Department, Garibaldi Hospital, Piazza Santa Maria di Gesù 5, 95100, Catania, Italy
| | - Luigi Piazza
- General and Emergency Surgery Department, Garibaldi Hospital, Piazza Santa Maria di Gesù 5, 95100, Catania, Italy
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Mokhtari S, Abualtayef T, El Arabi S, Ben Chaib R, Benzirar A, El Mahi O. Acute Abdominal Compartment Syndrome complicating a chronic mesenteric ischemia revascularization. Int J Surg Case Rep 2021; 81:105801. [PMID: 33770634 PMCID: PMC8024655 DOI: 10.1016/j.ijscr.2021.105801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 03/16/2021] [Accepted: 03/17/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Abdominal Compartment Syndrome (ACS) is a pathological condition that results from an increase in pressure within the abdomen associated with organ failure. It can be acute or chronic, primary or secondary. ACS poses a serious diagnostic challenge for physicians as the clinical presentation is varied and can mimic other medical pathologies. To prevent a multi-organ failure and ultimately death due to this disease, the World Society of Abdominal Compartment Syndrome (WSACS) suggested clinical criteria and biology tests to facilitate an early diagnosis of acute ACS. CASE PRESENTATION We report a case of 61 year-old man diagnosed with chronic mesenteric ischemia that has been successfully treated by prosthetic bypass. The postoperative period was eventual, the patient presented complications corresponding essentially to a manifest acute ACS. The treatment consisted on abdominal decompression and resuscitation measures. CONCLUSIONS An early diagnosis of ACS disease for an appropriate therapeutic initiation is mandatory to prevent its complications and save the patient's life prognosis.
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Affiliation(s)
- Sara Mokhtari
- Vascular Surgery Department, Mohammed VI University Hospital Center, Oujda, Morocco; Mohammed 1st University, Faculty of Medicine and Pharmacy of Oujda, Morocco.
| | - Taha Abualtayef
- Vascular Surgery Department, Mohammed VI University Hospital Center, Oujda, Morocco; Mohammed 1st University, Faculty of Medicine and Pharmacy of Oujda, Morocco.
| | - Soumia El Arabi
- Mohammed 1st University, Faculty of Medicine and Pharmacy of Oujda, Morocco; Radiology Department, Mohammed VI University Hospital Center, Oujda, Morocco.
| | - Rajae Ben Chaib
- Mohammed 1st University, Faculty of Medicine and Pharmacy of Oujda, Morocco; Emergency and Anesthesiology Department, Mohammed VI University Hospital Center, Oujda, Morocco.
| | - Adnane Benzirar
- Vascular Surgery Department, Mohammed VI University Hospital Center, Oujda, Morocco; Mohammed 1st University, Faculty of Medicine and Pharmacy of Oujda, Morocco.
| | - Omar El Mahi
- Vascular Surgery Department, Mohammed VI University Hospital Center, Oujda, Morocco; Mohammed 1st University, Faculty of Medicine and Pharmacy of Oujda, Morocco.
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Strang SG, Breederveld RS, Cleffken BI, Verhofstad MHJ, Van Waes OJF, Van Lieshout EMM. Prevalence of intra-abdominal hypertension and markers for associated complications among severe burn patients: a multicenter prospective cohort study (BURNIAH study). Eur J Trauma Emerg Surg 2021; 48:1137-1149. [PMID: 33721051 PMCID: PMC9001214 DOI: 10.1007/s00068-021-01623-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 02/10/2021] [Indexed: 10/25/2022]
Abstract
PURPOSE Severely burned patients are at risk for intra-abdominal hypertension (IAH) and associated complications such as organ failure, abdominal compartment syndrome (ACS), and death. The aim of this study was to determine the prevalence of IAH among severely burned patients. The secondary aim was to determine the value of urinary intestinal fatty acid binding protein (I-FABP) as early marker for IAH-associated complications. METHODS A prospective observational study was performed in two burn centers in the Netherlands. Fifty-eight patients with burn injuries ≥ 15% of total body surface area (TBSA) were included. Intra-abdominal pressure (IAP) and urinary I-FABP, measured every 6 h during 72 h. Prevalence of IAH, new organ failure and ACS, and the value of urinary intestinal fatty acid binding protein (I-FABP) as early marker for IAH-associated complications were determined. RESULTS Thirty-one (53%) patients developed IAH, 17 (29%) patients developed new organ failure, but no patients developed ACS. Patients had burns of 29% (P25-P75 19-42%) TBSA. Ln-transformed levels of urinary I-FABP and IAP were inversely correlated with an estimate of - 0.06 (95% CI - 0.10 to - 0.02; p = 0.002). Maximal urinary I-FABP levels had a fair discriminatory ability for patients with IAH with an area under the ROC curve of 74% (p = 0.001). Urinary I-FABP levels had no predictive value for IAH or new organ failure in severe burn patients. CONCLUSIONS The prevalence of IAH among patients with ≥ 15% TBSA burned was 53%. None of the patients developed ACS. A relevant diagnostic or predictive value of I-FABP levels in identifying patients at risk for IAH-related complications, could not be demonstrated. LEVEL OF EVIDENCE Level III, epidemiologic and diagnostic prospective observational study.
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Affiliation(s)
- Steven G Strang
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Roelf S Breederveld
- Burn Center, Red Cross Hospital, Beverwijk, The Netherlands.,Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Michael H J Verhofstad
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Oscar J F Van Waes
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Esther M M Van Lieshout
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
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36
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Dietz UA, Baur J, Piso RJ, Willms A, Schwab R, Wiegering A. [Laparostoma-Avoidance and treatment of complications]. Chirurg 2021; 92:283-96. [PMID: 33351159 DOI: 10.1007/s00104-020-01322-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The open abdomen (OA) is an established concept for treating severe abdominal diseases. The most frequent reasons for placement of an open abdomen are abdominal sepsis (e.g. from intestinal perforation or anastomotic leakage), severe abdominal organ injury and abdominal compartment syndrome. The pathophysiology is much more complex than the surgeon's eye can see in an OA. The temporary closure of the abdominal wall ensures sufficient drainage of infected ascites, protection of the intestinal loops and conditioning of the abdominal wall in order to be able carry out definitive closure of the abdominal wall at the end of the surgical treatment. Negative peritoneal pressure therapy combined with fascia traction (with or without mesh) is well-established in the management of an open abdomen.
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Tayebi S, Gutierrez A, Mohout I, Smets E, Wise R, Stiens J, Malbrain MLNG. A concise overview of non-invasive intra-abdominal pressure measurement techniques: from bench to bedside. J Clin Monit Comput 2021; 35:51-70. [PMID: 32700152 PMCID: PMC7889558 DOI: 10.1007/s10877-020-00561-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 07/14/2020] [Indexed: 11/30/2022]
Abstract
This review presents an overview of previously reported non-invasive intra-abdominal pressure (IAP) measurement techniques. Each section covers the basic physical principles and methodology of the various measurement techniques, the experimental results, and the advantages and disadvantages of each method. The most promising non-invasive methods for IAP measurement are microwave reflectometry and ultrasound assessment, in combination with an applied external force.
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Affiliation(s)
- Salar Tayebi
- Department of Electronics and Informatics, Vrije Universiteit Brussel, Pleinlaan 2, 1050 Brussels, Belgium
| | - Adrian Gutierrez
- Department of Electronics and Informatics, Vrije Universiteit Brussel, Pleinlaan 2, 1050 Brussels, Belgium
| | - Ikram Mohout
- Department of Electronics and Informatics, Vrije Universiteit Brussel, Pleinlaan 2, 1050 Brussels, Belgium
| | - Evelien Smets
- Department of Electronics and Informatics, Vrije Universiteit Brussel, Pleinlaan 2, 1050 Brussels, Belgium
| | - Robert Wise
- Adult Intensive Care, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford, England
- Discipline of Anaesthesia and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Johan Stiens
- Department of Electronics and Informatics, Vrije Universiteit Brussel, Pleinlaan 2, 1050 Brussels, Belgium
| | - Manu L. N. G. Malbrain
- Intensive Care Unit, ICU Director, University Hospital Brussel (UZB), Laarbeeklaan 101, 1090 Jette, Belgium
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090 Jette, Belgium
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da Costa KM, Saxena AK. Congenital diaphragmatic hernia repair analysis in relation to postoperative abdominal compartment syndrome and delayed abdominal closure. Updates Surg 2021. [PMID: 33507516 DOI: 10.1007/s13304-021-00980-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 01/12/2021] [Indexed: 01/07/2023]
Abstract
AIM Limited abdominal space in congenital diaphragmatic hernia (CDH) might result in abdominal compartment syndrome (ACS) and require delayed abdominal closure (DAC). This study reviewed outcomes in pediatric ACS/DAC after CDH repair. METHODS Medline/PubMed, Scopus, Web of Science, Ovid and Lilacs databases were reviewed. Data from studies published in English/Spanish/Portuguese between 1990-2020 was collected. Results are presented as descriptive statistics. RESULTS Sixteen reports offered 118 children, 112 (94.9%) being neonates. There were six ACS (5.1%) and 112 DAC (94.9%). Regarding ACS, the diagnosis was made clinically (n = 4; 66.7%), using Doppler scans (n = 1; 16.7%) or bladder pressure measurement (n = 1; 16.7%). There was one (16.7%) lethal outcome. The rationale to perform DAC was not clearly stated, and measurement of abdominal pressure was not mentioned in all reports. Silo was the preferred approach in 36 children (32.1%), followed by skin closure only (n = 16; 14.3%), vacuum (n = 10; 8.9%), fascia patch and skin closure (n = 5; 4.5%), fascia patch and vacuum dressing (n = 1; 0.9%), fasciotomy (n = 1; 0.9%); with no DAC technique reported in 43 patients (38.4%). Complications after DAC were reported in nine children (8.1%). One DAC using vacuum dressing that was clinically diagnosed with ACS required silo placement. There were 19 (17%) lethal outcomes. CONCLUSIONS ACS/DAC after CDH repair are reported more frequently in neonates (112/118; 94.9%). There is no clear rationale stated behind the decision to perform DAC, with the silo being the preferred approach. Criteria need to be worked for DAC in CDH with large herniated content and small volume abdomen to prevent ACS.
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Po PL, Bai HF, Lin CH, Lin CC. Pneumomediastinum that progression to tension pneumoperitoneum after bronchioloalveolar lavage: A case report. Respir Med Case Rep 2021; 32:101341. [PMID: 33489748 PMCID: PMC7811029 DOI: 10.1016/j.rmcr.2021.101341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/27/2020] [Accepted: 01/02/2021] [Indexed: 11/18/2022] Open
Abstract
Background Pneumomediastinum is an abnormal accumulation of air within the mediastinum. Herein, we report a rare case in which a patient initially developed pneumomediastinum and extensive subcutaneous emphysema after bronchoscopic bronchioloalveolar lavage (BAL). The condition then progressed to abdominal compartment syndrome leading to death. Case presentation An 80-year-old man with acute respiratory failure caused by severe pneumonia and septic shock, was admitted to our intensive care unit. Bronchoscopic BAL was performed for microbiological specimen collection. The patient developed subcutaneous emphysema after the procedure, and pneumomediastinum was identified on subsequent chest radiography. The patient initially received supportive care. However, he experienced persistent hypotension, which did not respond to vigorous fluid replacement and high dose vasopressor treatment. Physical examination revealed distended, tense abdomen with diffuse tympanic sound upon percussion. Computer tomography scan showed extensive subcutaneous emphysema, massive air accumulation in the retroperitoneal cavity, near total collapse of the inferior vena cava, and left sided shifting of intra-abdominal organs. The impression was tension pneumoperitoneum with abdominal compartment syndrome. The patient eventually died of refractory hypotension. Conclusions Iatrogenic injury is a rare condition. The common complications include hypoxia, bleeding, infection, arrhythmia, subcutaneous emphysema, and pneumomediastinum, and these can be managed conservatively. However, more complex and life-threatening conditions can be caused by tracheal perforation or alveolar rupture, and can lead to pneumothorax, pneumoperitoneum, or even abdominal compartment syndrome. A high level of suspicion is needed for early detection, and immediate decompression is required to prevent death.
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Affiliation(s)
- Pien-Lung Po
- Division of Chest Medicine, Department of Internal Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, ROC
| | - Hsueh-Fen Bai
- Division of Chest Medicine, Department of Internal Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, ROC
- Corresponding author. Division of Chest Medicine, Department of Internal Medicine, Shin-Kong Wu Ho-Su Memorial Hospital 95, Wen-Chang Rd, Shih-Lin, Taipei 111, Taiwan.
| | - Chia-Heng Lin
- Division of Chest Medicine, Department of Internal Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, ROC
| | - Chen-Chun Lin
- Division of Chest Medicine, Department of Internal Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, ROC
- Fu-Jen Catholic University School of Medicine, Taipei, Taiwan, ROC
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Tyson N, Efthymiou C. Predictive risk factors for intra-abdominal hypertension after cardiac surgery. Interact Cardiovasc Thorac Surg 2021; 32:719-723. [PMID: 33471093 DOI: 10.1093/icvts/ivaa336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 11/30/2020] [Accepted: 12/12/2020] [Indexed: 11/14/2022] Open
Abstract
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was is it possible to identify predictive risk factors for the development of intra-abdominal hypertension (IAH) or abdominal compartment syndrome after cardiac surgery. Altogether 131 papers were found using the reported search, of which 7 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. A total of 755 patients were included, with the incidence of IAH between 26.9% and 83.3%. The limited evidence on IAH after cardiac surgery should be interpreted with caution. Obesity is a strong predictor of postoperative IAH, although not confined to a central pattern and body mass index is correlated with intra-abdominal pressure (IAP). Prolonged cardiopulmonary bypass and aortic cross-clamp time predisposed to IAH in 4 cohorts. IAH in cardiac surgery patients is associated with hepatic and renal impairment, and corresponding biochemical markers may be helpful in screening, although lacking specificity. In contrast to the development of IAH in other settings, the evidence for the role of fluid balance is poor. Accurate prediction of IAH remains elusive. Based on the available evidence, routine IAP measurement should be considered postoperatively in patients with obesity, particularly those with renal or hepatic impairment, prolonged cardiopulmonary bypass or operative time, requiring vasopressor support, to prevent the deleterious effects of IAH.
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Affiliation(s)
- Nathan Tyson
- Department of Cardiac Surgery, Glenfield Hospital, Leicester, UK
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Singh B, Gowda AM, Kaur P, Guragai N, Mechineni A, Maroules M. Hypertriglyceridemia induced pancreatitis complicated by compartment syndrome and managed by surgical decompression and plasmapheresis. Radiol Case Rep 2021; 16:618-620. [PMID: 33425085 PMCID: PMC7785884 DOI: 10.1016/j.radcr.2020.12.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 12/19/2020] [Accepted: 12/25/2020] [Indexed: 11/20/2022] Open
Abstract
Hypertriglyceridemia (HTG) is an uncommon but well-established cause of acute pancreatitis. The patients with pancreatitis are at risk for both local and systemic complications. Abdominal compartment syndrome is underdiagnosed and undertreated in this patient population. We report a case of 39-year-old male with medical history of diabetes mellitus who presented with abdominal pain and was diagnosed with HTG induced pancreatitis, complicated by abdominal compartment syndrome requiring surgical decompression and plasmapheresis.
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Affiliation(s)
- Balraj Singh
- Hematology Oncology, Saint Joseph's University Medical Center, 703 Main Street, Paterson 07503 NJ, USA
- Corresponding author.
| | - Anusha Manje Gowda
- Hematology Oncology, Saint Joseph's University Medical Center, 703 Main Street, Paterson 07503 NJ, USA
| | - Parminder Kaur
- Cardiology, Saint Joseph's University Medical Center, Paterson 07503 NJ, USA
| | - Nirmal Guragai
- Cardiology, Saint Joseph's University Medical Center, Paterson 07503 NJ, USA
| | - Ashesha Mechineni
- Internal Medicine, Saint Joseph's University Medical Center, Paterson 07503 NJ, USA
| | - Michael Maroules
- Hematology Oncology, Saint Joseph's University Medical Center, 703 Main Street, Paterson 07503 NJ, USA
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Patel A, Davis C, Davis T. Percutaneous catheter drainage of secondary abdominal compartment syndrome: A case report. Radiol Case Rep 2021; 16:670-672. [PMID: 33488896 PMCID: PMC7809214 DOI: 10.1016/j.radcr.2021.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 12/30/2020] [Accepted: 01/02/2021] [Indexed: 11/06/2022] Open
Abstract
Abdominal compartment syndrome can be a lethal entity when not treated in a timely fashion. Current standard of care involves emergent decompressive laparotomy by the surgical team. In this case, a 52-year-old male who developed abdominal compartment syndrome secondary to hemoperitoneum underwent emergent drain placement as decompressive laparotomy was not an optimal option for management. Little literature exists on the utility of drain placement or paracentesis for decompression in overall patient morbidity and mortality. However, when necessary, drain placement shows similar outcomes when compared to the standard of care. Interventional radiologists are uniquely positioned to provide drainage guided management for abdominal compartment syndrome in emergent settings.
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Modares M, Tabari M. Phlegmonous gastritis complicated by abdominal compartment syndrome: a case report. BMC Surg 2021; 21:5. [PMID: 33397326 PMCID: PMC7784299 DOI: 10.1186/s12893-020-00999-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 12/03/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Phlegmonous gastritis (PG) is a rare, suppurative bacterial infection of the gastric wall, which may rapidly evolve into fatal septicemia. The etiology and pathogenesis are poorly understood; however, multiple risk factors have been cited in current literature. Most cases have been diagnosed at autopsy, and occasionally at laparotomy, as the clinical presentation is often variable. CASE PRESENTATION We report a case of a 67-year-old male presenting with intractable nausea, vomiting, and epigastric pain following an uneventful upper gastrointestinal (GI) endoscopy. Diagnostic workup including contrast tomography (CT) and endoscopic assessment was in keeping with PG. This was subsequently followed by development of abdominal compartment syndrome (ACS) and clinical deterioration necessitating surgical resection of the stomach. CONCLUSION This case emphasizes the importance of early diagnosis of this potentially fatal infection that can follow endoscopic procedures and illustrates ACS and septic shock as serious complications. There is currently no consensus on the proper management of PG; however, in this case, a combination of surgery and antibiotics provided a favourable outcome. Limited number of cases of PG have been reported in literature, and to our knowledge, this is the first reported case of PG with subsequent ACS as an acute complication.
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Affiliation(s)
- Mana Modares
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Mohammad Tabari
- Department of Surgery, Scarborough Health Network, University of Toronto, 3030 Lawrence Avenue East, suite 414, Toronto, ON, M1P 2T7, Canada.
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Ersryd S, Djavani Gidlund K, Wanhainen A, Björck M. Surveillance to detect colonic ischemia with extraluminal pH measurement after open surgery for abdominal aortic aneurysm. J Vasc Surg 2021; 74:97-104. [PMID: 33307162 DOI: 10.1016/j.jvs.2020.11.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 11/09/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Colonic ischemia (CI) is a life-threatening complication after aortic surgery. Postoperative surveillance of colonic perfusion might be warranted. The aim of the present study was to evaluate the safety and feasibility of postoperative extraluminal pH measurement (pHe) using colonic tonometry after open abdominal aortic aneurysm (AAA) repair. METHODS Before closing the abdomen after open AAA repair, a tonometric catheter was placed transabdominally in contact with the sigmoid colon serosa, similar to a drainage catheter. Extraluminal partial pressure of carbon dioxide was measured postoperatively and combined with arterial blood gas analysis to calculate the pHe. The measurements were repeated every 4 hours with simultaneous intra-abdominal pressure measurements. The threshold for colonic malperfusion was set at pHe <7.2. RESULTS A total of 27 patients were monitored, 12 had undergone surgery for ruptured AAAs and 15 for intact AAAs. Of the 27 patients, 4 developed clinically significant CI requiring surgery. All four cases were preceded by a prolonged (>5 hours) pHe <7.2 indicating malperfusion. A fifth patient, who, during monitoring, had had the lowest pHe of 7.21, developed mild CI with the onset after completion of monitoring, which was successfully managed conservatively. Seven patients who had had brief durations (<5 hours) of pHe <7.2 did not develop clinical signs of CI or any related adverse events. CONCLUSIONS Measurements of pHe using colonic tonometry indicated malperfusion in all four patients who had developed clinically significant CI. A shorter duration of low pHe was well tolerated without any signs of CI. Measurement of pHe was safe and reliable for the surveillance of colonic perfusion after open aortic surgery, indicating a promising technique. However, larger studies are needed.
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Henry R, Ghafil C, Golden A, Berry E, Grabo D, Matsushima K, Clark D, Inaba K, Carey J, Strumwasser A. A Novel Abdominal Decompression Technique to Treat Compartment Syndrome After Burn Injury. J Surg Res 2021; 260:448-53. [PMID: 33276982 DOI: 10.1016/j.jss.2020.11.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/12/2020] [Accepted: 11/01/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND Prevalence of abdominal compartment syndrome (ACS) is estimated to be 4%-17% in severely burned patients. Although decompressive laparotomy can be lifesaving for ACS patients, severe complications are associated with this technique, especially in burn populations. This study outlines a new technique of releasing intraabdominal pressure without resorting to decompressive laparotomy. MATERIALS AND METHODS Ten fresh tissue cadavers were studied; none of whom had had prior abdominal surgery. Using Veress needles, abdomens were insufflated to 30 mm Hg and subsequently connected to arterial pressure transducers. Two techniques were then used to incise fascia. First, large skin flaps were raised from a midline incision (n = 5). Second, small 2 cm cutdowns at the proximal and distal extent of midaxillary, subcostal, and inguinal incisional sites were made, followed by tunneling a subfascial plane using an aortic clamp with fascial incisions made through the grooves of a tunneled vein stripper (n = 5). Pressures were recorded in the sequence of incisions mentioned previously. RESULTS The open midline flap technique decreased abdominal pressure from a mean pressure of 30 ± 1.8 mm Hg to 6.9 ± 5.0 mm Hg (P < 0.01). The minimally invasive technique decreased intraabdominal pressure from 30 ± 0.9 to 5.8 ± 5.2 mm Hg (P < 0.01). This technique significantly reduced intraabdominal pressure via extraperitoneal component separation and fascial release at the midaxillary, subxiphoid, and inguinal regions. CONCLUSIONS This technique offers the benefit of reducing the morbidity, mortality, and complications associated with an open abdomen, which may be beneficial in the burn injury population.
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Willms AG, Schwab R, von Websky MW, Berrevoet F, Tartaglia D, Sörelius K, Fortelny RH, Björck M, Monchal T, Brennfleck F, Bulian D, Beltzer C, Germer CT, Lock JF. Factors influencing the fascial closure rate after open abdomen treatment: Results from the European Hernia Society (EuraHS) Registry : Surgical technique matters. Hernia 2020; 26:61-73. [PMID: 33219419 PMCID: PMC8881440 DOI: 10.1007/s10029-020-02336-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 11/02/2020] [Indexed: 01/09/2023]
Abstract
Purpose Definitive fascial closure is an essential treatment objective after open abdomen treatment and mitigates morbidity and mortality. There is a paucity of evidence on factors that promote or prevent definitive fascial closure. Methods A multi-center multivariable analysis of data from the Open Abdomen Route of the European Hernia Society included all cases between 1 May 2015 and 31 December 2019. Different treatment elements, i.e. the use of a visceral protective layer, negative-pressure wound therapy and dynamic closure techniques, as well as patient characteristics were included in the multivariable analysis. The study was registered in the International Clinical Trials Registry Platform via the German Registry for Clinical Trials (DRK00021719). Results Data were included from 630 patients from eleven surgical departments in six European countries. Indications for OAT were peritonitis (46%), abdominal compartment syndrome (20.5%), burst abdomen (11.3%), abdominal trauma (9%), and other conditions (13.2%). The overall definitive fascial closure rate was 57.5% in the intention-to-treat analysis and 71% in the per-protocol analysis. The multivariable analysis showed a positive correlation of negative-pressure wound therapy (odds ratio: 2.496, p < 0.001) and dynamic closure techniques (odds ratio: 2.687, p < 0.001) with fascial closure and a negative correlation of intra-abdominal contamination (odds ratio: 0.630, p = 0.029) and the number of surgical procedures before OAT (odds ratio: 0.740, p = 0.005) with DFC. Conclusion The clinical course and prognosis of open abdomen treatment can significantly be improved by the use of treatment elements such as negative-pressure wound therapy and dynamic closure techniques, which are associated with definitive fascial closure. Electronic supplementary material The online version of this article (10.1007/s10029-020-02336-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- A G Willms
- Department of General, Visceral and Thoracic Surgery, German Armed Forces Central Hospital of Koblenz, Rübenacher Str. 170, 56072, Koblenz, Germany
| | - R Schwab
- Department of General, Visceral and Thoracic Surgery, German Armed Forces Central Hospital of Koblenz, Rübenacher Str. 170, 56072, Koblenz, Germany
| | - M W von Websky
- Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - F Berrevoet
- Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - D Tartaglia
- Emergency Surgery Unit, Cisanello University Hospital, Via Paradisa 1, 56124, Pisa, Italy
| | - K Sörelius
- Department of Vascular Surgery, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark
| | - R H Fortelny
- Department of General, Visceral and Oncological Surgery, Wilhelminenspital, 1160, Vienna, Austria.,Medical Faculty, Sigmund Freud University of Vienna, 1020, Vienna, Austria
| | - M Björck
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, SE 751 85, Uppsala, Sweden
| | - T Monchal
- Department of General Surgery, Sainte Anne Military Hospital, 2 Boulevard Sainte-Anne, 83000, Toulon, France
| | - F Brennfleck
- Department of Surgery, Regensburg University Hospital, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - D Bulian
- Department of Abdominal, Tumor, Transplant and Vascular Surgery, Cologne-Merheim Medical Center, Witten/Herdecke University, Ostmerheimer Str. 200, 51109, Cologne, Germany
| | - C Beltzer
- Department of General, Visceral and Thoracic Surgery, German Armed Forces Hospital of Ulm, Oberer Eselsberg, Ulm, Germany
| | - C T Germer
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital of Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - J F Lock
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital of Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany.
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Usuda D, Takanaga K, Sangen R, Higashikawa T, Kinami S, Saito H, Kasamaki Y. Abdominal compartment syndrome due to extremely elongated sigmoid colon and rectum plus fecal impaction caused by disuse syndrome and diabetic neuropathy: a case report and review of the literature. J Med Case Rep 2020; 14:219. [PMID: 33183343 PMCID: PMC7664064 DOI: 10.1186/s13256-020-02566-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 10/28/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Abdominal compartment syndrome (ACS) is defined as a sustained raised level of intra-abdominal pressure more than 20 mmHg with or without abdominal perfusion pressure less than 60 mmHg and the development of new end-organ failure. Abdominal surgery, major trauma, volvulus, ileus, distended abdomen, fecal impaction, acute pancreatitis, liver dysfunction, sepsis, shock, obesity, and age have all been reported as risk factors. Herein, we report the severest known case of ACS due to extremely elongated sigmoid colon and rectum plus fecal impaction caused by disuse syndrome and diabetic neuropathy, together with a brief review of the literature. CASE PRESENTATION A 48-year-old Asian man suffering from shock was transported by ambulance to our hospital. His medical history included hypoglycemic encephalopathy sequelae, disuse syndrome, type 2 diabetic neuropathy, and constipation. He recovered consciousness in the ambulance, and his physical examination as well as laboratory findings were normal. X-ray and dynamic computed tomography revealed a thickened gut wall, and an extremely dilated sigmoid colon and rectum filled with a massive amount of stool as well as gas, compressing other intra-abdominal organs. We diagnosed the patient with transient vasovagal syncope, together with ACS, due to extremely elongated sigmoid colon and rectum plus fecal impaction, caused by anorectal disturbance derived from disuse syndrome and diabetic neuropathy. We first repeated stool extraction for bowel decompression and he subsequently became symptom-free, after which we performed a colostomy on the 28th hospital day. The postoperative course was uncomplicated, and he was discharged on the 44th hospital day. CONCLUSIONS Clinicians need to keep ACS in mind as a differential diagnosis and perform careful and detailed examination when encountering patients presenting with symptoms or risk factors of ACS. In addition, they need to precisely diagnose ACS and perform optimal treatment without delay.
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Affiliation(s)
- Daisuke Usuda
- grid.411998.c0000 0001 0265 5359Department of General Medicine, Kanazawa Medical University Himi Municipal Hospital, 1130 Kurakawa, Himi-shi, Toyama-ken 935-8531 Japan
- grid.411998.c0000 0001 0265 5359Department of Infectious Diseases, Kanazawa Medical University, Uchinada-machi, Ishikawa-ken 920-0293 Japan
| | - Kohei Takanaga
- grid.411998.c0000 0001 0265 5359Department of General Medicine, Kanazawa Medical University Himi Municipal Hospital, 1130 Kurakawa, Himi-shi, Toyama-ken 935-8531 Japan
| | - Ryusho Sangen
- grid.411998.c0000 0001 0265 5359Department of General Medicine, Kanazawa Medical University Himi Municipal Hospital, 1130 Kurakawa, Himi-shi, Toyama-ken 935-8531 Japan
| | - Toshihiro Higashikawa
- grid.411998.c0000 0001 0265 5359Department of Geriatric Medicine, Kanazawa Medical University Himi Municipal Hospital, Himi-shi, Toyama-ken 935-8531 Japan
| | - Shinichi Kinami
- grid.411998.c0000 0001 0265 5359Department of General and Digestive Surgery, Kanazawa Medical University Himi Municipal Hospital, Himi-shi, Toyama-ken 935-8531 Japan
| | - Hitoshi Saito
- grid.411998.c0000 0001 0265 5359Department of General and Digestive Surgery, Kanazawa Medical University Himi Municipal Hospital, Himi-shi, Toyama-ken 935-8531 Japan
| | - Yuji Kasamaki
- grid.411998.c0000 0001 0265 5359Department of General Medicine, Kanazawa Medical University Himi Municipal Hospital, 1130 Kurakawa, Himi-shi, Toyama-ken 935-8531 Japan
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Smit M, Koopman B, Dieperink W, Hulscher JBF, Hofker HS, van Meurs M, Zijlstra JG. Intra-abdominal hypertension and abdominal compartment syndrome in patients admitted to the ICU. Ann Intensive Care 2020; 10:130. [PMID: 33001288 PMCID: PMC7530150 DOI: 10.1186/s13613-020-00746-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 09/23/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Intra-abdominal hypertension is frequently present in critically ill patients and is an independent predictor for mortality. Risk factors for intra-abdominal hypertension and abdominal compartment syndrome have been widely investigated. However, data are lacking on prevalence and outcome in high-risk patients. Our objectives in this study were to investigate prevalence and outcome of intra-abdominal hypertension and abdominal compartment syndrome in high-risk patients in a prospective, observational, single-center cohort study. RESULTS Between March 2014 and March 2016, we included 503 patients, 307 males (61%) and 196 females (39%). Patients admitted to the intensive care unit with a diagnosis of pancreatitis, elective or emergency open abdominal aorta surgery, orthotopic liver transplantation, other elective or emergency major abdominal surgery and trauma were enrolled. One hundred and sixty four (33%) patients developed intra-abdominal hypertension and 18 (3.6%) patients developed abdominal compartment syndrome. Highest prevalence of abdominal compartment syndrome occurred in pancreatitis (57%) followed by orthotopic liver transplantation (7%) and abdominal aorta surgery (5%). Length of intensive care stay increased by a factor 4 in patients with intra-abdominal hypertension and a factor 9 in abdominal compartment syndrome, compared to patients with normal intra-abdominal pressure. Rate of renal replacement therapy was higher in abdominal compartment syndrome (38.9%) and intra-abdominal hypertension (8.2%) compared to patients with normal intra-abdominal pressure (1.2%). Both intensive care mortality and 90-day mortality were significantly higher in intra-abdominal hypertension (4.8% and 15.2%) and abdominal compartment syndrome (16.7% and 38.9%) compared to normal intra-abdominal pressure (1.2% and 7.1%). Body mass index (odds ratio 1.08, 95% confidence interval 1.03-1.13), mechanical ventilation at admission (OR 3.52, 95% CI 2.08-5.96) and Apache IV score (OR 1.03, 95% CI 1.02-1.04) were independent risk factors for the development of intra-abdominal hypertension or abdominal compartment syndrome. CONCLUSIONS The prevalence of abdominal compartment syndrome was 3.6% and the prevalence of intra-abdominal hypertension was 33% in this cohort of high-risk patients. Morbidity and mortality increased when intra-abdominal hypertension or abdominal compartment syndrome was present. The patient most at risk of IAH or ACS in this high-risk cohort has a BMI > 30 kg/m2 and was admitted to the ICU after emergency abdominal surgery or with a diagnosis of pancreatitis.
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Affiliation(s)
- Marije Smit
- Department of Critical Care (BA 49), University Medical Center Groningen, University of Groningen, PO Box 30001, 9700 RB, Groningen, The Netherlands.
| | - Bart Koopman
- Department of Critical Care (BA 49), University Medical Center Groningen, University of Groningen, PO Box 30001, 9700 RB, Groningen, The Netherlands
| | - Willem Dieperink
- Department of Critical Care (BA 49), University Medical Center Groningen, University of Groningen, PO Box 30001, 9700 RB, Groningen, The Netherlands
| | - Jan B F Hulscher
- Department of Pediatric Surgery, University Medical Center Groningen, University of Groningen, PO Box 30001, 9700 RB, Groningen, The Netherlands
| | - H Sijbrand Hofker
- Department of Surgery, University Medical Center Groningen, University of Groningen, PO Box 30001, 9700 RB, Groningen, The Netherlands
| | - Matijs van Meurs
- Department of Critical Care (BA 49), University Medical Center Groningen, University of Groningen, PO Box 30001, 9700 RB, Groningen, The Netherlands
| | - Jan G Zijlstra
- Department of Critical Care (BA 49), University Medical Center Groningen, University of Groningen, PO Box 30001, 9700 RB, Groningen, The Netherlands
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Strang SG, Habes QLM, Van der Hoven B, Tuinebreijer WE, Verhofstad MHJ, Pickkers P, Van Lieshout EMM, Van Waes OJF. Intestinal fatty acid binding protein as a predictor for intra-abdominal pressure-related complications in patients admitted to the intensive care unit; a prospective cohort study (I-Fabulous study). J Crit Care 2020; 63:211-217. [PMID: 32980233 DOI: 10.1016/j.jcrc.2020.08.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/24/2020] [Accepted: 08/30/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE Critically ill patients are at risk for intra-abdominal hypertension (IAH) and related complications such as organ failure, abdominal compartment syndrome (ACS), and death. This study aimed to determine the value of urinary and serum intestinal fatty acid binding protein (I-FABP) levels as early marker for IAH-associated complications. METHODS A prospective observational study was conducted in two academic institutional mixed medical-surgical ICUs in the Netherlands. Adult patients admitted to the ICU with two or more risk factors for IAH (198) were included. Urinary and serum I-FABP and intra-abdominal pressure (IAP) were measured every six hours during 72 h. RESULTS Fifteen (8%) patients developed ACS and 74 (37%) developed new organ failure. I-FABP and IAP were positively correlated. Patients who developed ACS had higher median baseline levels of urinary I-FABP (235(P25-P75 85-1747)μg/g creat) than patients with IAH who did not develop ACS (87(P25-P75 33-246)μg/g, p = 0.037). With an odds ratio of 1.00, neither urinary nor serum I-FABP indicated increased risk for developing new organ failure or ACS. CONCLUSIONS A relevant diagnostic value of I-FABP levels for identifying individual patients at risk for intra-abdominal pressure related complications could not be demonstrated.
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Affiliation(s)
- Steven G Strang
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Quirine L M Habes
- Department of Intensive Care Medicine, Radboudumc, Nijmegen, the Netherlands
| | - Ben Van der Hoven
- Department of Intensive Care Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Wim E Tuinebreijer
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Michael H J Verhofstad
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Peter Pickkers
- Department of Intensive Care Medicine, Radboudumc, Nijmegen, the Netherlands
| | - Esther M M Van Lieshout
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - Oscar J F Van Waes
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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Montalvo-Jave EE, Espejel-Deloiza M, Chernitzky-Camaño J, Peña-Pérez CA, Rivero-Sigarroa E, Ortega-León LH. Abdominal compartment syndrome: Current concepts and management. Rev Gastroenterol Mex (Engl Ed) 2020; 85:443-451. [PMID: 32847726 DOI: 10.1016/j.rgmx.2020.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 02/05/2020] [Accepted: 03/06/2020] [Indexed: 11/24/2022]
Abstract
Abdominal compartment syndrome occurs when 2 or more anatomic compartments have a sustained intra-abdominal pressure >20mmHg, associated with organ failure. Incidence is 2% and prevalence varies from 0% to 36.4%. A literature search was conducted utilizing different databases. Articles published from 1970 to 2018 were included, in English or Spanish, to provide the concepts, classifications, and comprehensive management in the approach to abdominal compartment syndrome, for its treatment and the prevention of severe complications associated with the entity. Intravesical pressure measurement is the standard diagnostic method. Treatment is based on evacuation of the intraluminal content, identification and treatment of intra-abdominal lesions, improvement of abdominal wall compliance, and optimum administration of fluids and tissue perfusion. Laparotomy is generally followed by temporary abdominal wall closure 5 to 7 days after surgery. Reconstruction is performed 6 to 12 months after the last operation. Abdominal compartment syndrome should be diagnosed and operated on before organic damage from the illness occurs. Kidney injury can frequently progress and is a parameter for considering abdominal decompression. Having a biomarker for early damage would be ideal. Surgical treatment is successful in the majority of cases. A multidisciplinary focus is necessary for the intensive care and reconstructive needs of the patient. Thus, efforts must be made to define and implement strategies for patient quality of life optimization.
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Affiliation(s)
- E E Montalvo-Jave
- Departamento de Cirugía, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México; Clínica de Cirugía Hepato-Pancreato-Biliar, Hospital General de México «Dr. Eduardo Liceaga», Ciudad de México, México; Clínica de Gastroenterología, Hospital Médica Sur, Ciudad de México, México.
| | - M Espejel-Deloiza
- Clínica de Cirugía Hepato-Pancreato-Biliar, Hospital General de México «Dr. Eduardo Liceaga», Ciudad de México, México
| | - J Chernitzky-Camaño
- Departamento de Cirugía, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - C A Peña-Pérez
- Unidad de Terapia Intensiva, Hospital Médica Sur, Ciudad de México, México
| | - E Rivero-Sigarroa
- Departamento de Terapia Intensiva, Instituto Nacional de Ciencias Médicas y Nutrición «Salvador Zubirán», Ciudad de México, México
| | - L H Ortega-León
- Clínica de Cirugía Hepato-Pancreato-Biliar, Hospital General de México «Dr. Eduardo Liceaga», Ciudad de México, México
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