A Clinician’s Guide to Management of Intra-abdominal Hypertension and Abdominal Compartment Syndrome in Critically Ill Patients

laet, Inneke E. De; Malbrain, Manu L N G; Waele, Jan J. De

doi:10.1186/s13054-020-2782-1

Cited by 84 publications

(72 citation statements)

References 52 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The management is always patiently individualized. Along with the value of IAP, the etiology of ACS, and the impact on organ dysfunction need to be considered[ 32 ].…”

Section: Managementmentioning

confidence: 99%

“…Along with proper sedation and neuromuscular blockade, low tidal volume and a limited pressure mode may optimize ventilation and lung protection[ 32 ]. Higher positive end-expiratory pressure can be used in IAH to prevent end-expiratory lung collapse and reduce ventilation-perfusion mismatch[ 36 ].…”

Section: Managementmentioning

confidence: 99%

“…Surgical decompression needs to be followed by a clear closure plan[ 39 ]. Decompressive laparotomy can result in ischemia-reperfusion syndrome and supportive measures need to be considered along with fluid balance and improvement in wall compliance to avoid recurrent ACS[ 32 ].…”

Section: Managementmentioning

confidence: 99%

See 2 more Smart Citations

Abdominal compartment syndrome among surgical patients

León¹,

Chavez²,

Surani³

2021

WJGS

View full text Add to dashboard Cite

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.

show abstract

“…The management is always patiently individualized. Along with the value of IAP, the etiology of ACS, and the impact on organ dysfunction need to be considered[ 32 ].…”

Section: Managementmentioning

confidence: 99%

Section: Managementmentioning

confidence: 99%

See 1 more Smart Citation

Abdominal compartment syndrome among surgical patients

León¹,

Chavez²,

Surani³

2021

WJGS

View full text Add to dashboard Cite

show abstract

“…There has been promising evidence to support the role of early aggressive fluid resuscitation with Lactated Ringers in mild AP [43]; however, in subjects with predicted SAP, prolonged aggressive volume administration may be harmful [44]. Specifically, in SAP patients with systemic vascular leak syndrome, aggressive fluid resuscitation may increase thirdspacing and intra-abdominal pressure, which can lead to the development of abdominal compartment syndrome and respiratory failure [44][45][46]. Thus, after initiation of fluid therapy, endpoints such as urine output, mean arterial pressure, oxygen saturation with respiratory rate, and intra-abdominal pressure should be closely monitored early in the disease course.…”

Section: Fluid Resuscitationmentioning

confidence: 99%

“…If ACS ensues, decompressive laparotomy should be considered urgently for prevention of worsening end-organ failure. Percutaneous drainage represents an alternative decompressive modality in ACS when feasible [45]. Further studies are needed to clarify the type and timing of decompressive techniques that can lower intra-abdominal pressure and their impact on morbidity and mortality in SAP.…”

Section: Intra-abdominal Hypertensionmentioning

confidence: 99%

Management of Severe Acute Pancreatitis

Lee

Papachristou

2020

Curr Treat Options Gastro

View full text Add to dashboard Cite

Purpose of review There have been significant advancements in different aspects of management of severe acute pancreatitis (SAP). Our review of the most recent literature focuses on severity prediction, fluid resuscitation, analgesic administration, nutrition, and endoscopic intervention for SAP and its extra-pancreatic complications. Recent findings Recent studies on serum cytokines for the prediction of SAP have shown superior prognostic performance when compared with conventional laboratory tests and clinical scoring systems. In patients with established SAP and vascular leak syndrome, intravenous fluids should be administered with caution to prevent intra-abdominal hypertension and volume overload. Endoscopic retrograde cholangiopancreatography improves outcomes only in AP patients with suspected cholangitis. Early enteral tubefeeding does not appear to be superior to on-demand oral feeding. Abdominal compartment syndrome is a highly lethal complication of SAP that requires percutaneous drainage or decompressive laparotomy. Endoscopic transmural drainage followed by necrosectomy (i.e., "step-up approach") is the treatment strategy of choice in patients with symptomatic or infected walled-off pancreatic necrosis. Summary SAP is a complex clinical syndrome associated with a high mortality rate. Early prediction of SAP remains challenging due to the limited accuracy of the available prediction tools. Early fluid resuscitation, organ support, enteral nutrition, and prevention of/or prompt recognition of abdominal compartment syndrome remain cornerstones of its management. A step-up, minimally invasive drainage/debridement is the preferred approach for patients with infected pancreatic necrosis.

show abstract

Are Classic Bedside Exam Findings Required to Initiate Enteral Nutrition in Critically Ill Patients: Emphasis on Bowel Sounds and Abdominal Distension

et al. 2020

View full text Add to dashboard Cite

The general physical examination of a patient is an axiom of critical care medicine, but evidence to support this practice remains sparse. Given the lack of evidence for a comprehensive physical examination of the entire patient on admission to the intensive care unit, which most clinicians consider an essential part of care, should clinicians continue the practice of a specialized gastrointestinal system physical examination when commencing enteral nutrition in critically ill patients? In this review of literature related to gastrointestinal system examination in critically ill patients, the focus is on gastrointestinal sounds and abdominal distension. There is a summary of what these physical features represent, an evaluation of the evidence regarding use of these physical features in patients after abdominal surgery, exploration of the rationale for and against using the physical findings in routine practice, and detail regarding what is known about each feature in critically ill patients. Based on the available evidence, it is recommended that an isolated symptom, sign, or bedside test does not provide meaningful information. However, it is submitted that a comprehensive physical assessment of the gastrointestinal system still has a role when initiating or administering enteral nutrition: specifically, when multiple features are present, clinicians should consider further investigation or intervention.

show abstract

A Clinician’s Guide to Management of Intra-abdominal Hypertension and Abdominal Compartment Syndrome in Critically Ill Patients

Cited by 84 publications

References 52 publications

Abdominal compartment syndrome among surgical patients

Abdominal compartment syndrome among surgical patients

Management of Severe Acute Pancreatitis

Are Classic Bedside Exam Findings Required to Initiate Enteral Nutrition in Critically Ill Patients: Emphasis on Bowel Sounds and Abdominal Distension

Contact Info

Product

Resources

About