A Pilot Study Comparing Percutaneous Decompression With Decompressive Laparotomy for Acute Abdominal Compartment Syndrome in Thermal Injury

Latenser, B.A.; Kowal-Vern, Areta; Kimball, Douglas; Chakrin, Alan; Dujovny, Nadav

doi:10.1097/00004630-200205000-00008

Cited by 162 publications

(85 citation statements)

References 26 publications

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“…In a pilot study, Latenser et al (13) concluded it was a 'safe and effective' way to reduce intra-abdominal pressure and prevent ACS. Additionally, both a recent systematic review (14), and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome (15) recommended that percutaneous catheter drainage precede decompressive laparotomy, especially in children.…”

Section: Discussionmentioning

confidence: 99%

Ischemic bowel as a late sequela of abdominal compartment syndrome secondary to severe burn injury

2015

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Section: Discussionmentioning

confidence: 99%

Ischemic bowel as a late sequela of abdominal compartment syndrome secondary to severe burn injury

2015

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“…[164][165][166] This approach has been supported in one human study of the continuous negative extra-abdominal pressure (NEXAP) device 167 where previous animal studies have shown no reduction in IAP for IAH cases but where there has been an IAP reduction when its commencement value was normal. 168 The effects on respiratory dynamics of the NEXAP device are complicated and partially counterproductive.…”

Section: Medical Managementmentioning

confidence: 98%

“…161,162 The IAP may in some patients be diminished by abdominal paracentesis particularly in IAH associated with severe burns, 163 although in chronic ascites this can lead to a well recognized circulatory collapse. [164][165][166] This approach has been supported in one human study of the continuous negative extra-abdominal pressure (NEXAP) device 167 where previous animal studies have shown no reduction in IAP for IAH cases but where there has been an IAP reduction when its commencement value was normal. 168 The effects on respiratory dynamics of the NEXAP device are complicated and partially counterproductive.…”

mentioning

confidence: 98%

Primary Intra-Abdominal Hypertension and Abdominal Compartment Syndrome: Pathophysiology and Treatment

Ap¹,

Wun²,

Chiappa³

et al. 2015

Emerg Med Open J

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Abdominal Compartment Syndrome (ACS) is a potentially lethal condition caused by various events that produce intra-abdominal hypertension. The most common cause is blunt abdominal trauma. Increasing intra-abdominal pressure causes progressive hypoperfusion and ischemia of the intestines and other peritoneal and retroperitoneal structures. Pathophysiological effects include release of cytokines, production of oxygen free radicals, and decreased cellular formation of adenosine triphosphate. These processes may lead to translocation of bacteria from the gut and intestinal edema, predisposing patients to multiorgan dysfunction syndrome. The consequences of abdominal compartment syndrome are profound and affect many vital body systems. Respiratory, hemodynamic, cardiovascular, renal, and neurological abnormalities are signs of abdominal compartment syndrome. Medical management of critically ill patients with raised intra-abdominal pressure should be instigated early to prevent further organ dysfunction and to avoid progression to ACS. Many treatment options are available and are often part of routine daily management in the ICU (nasogastric, rectal tube, prokinetics, enema, sedation, body position). Some of the newer treatments are very promising options in specific patient populations with raised IAP. Nursing care involves vigilant monitoring for early detection, including serial measurements of intra-abdominal pressure.KEYWORDS: Intra-abdominal hypertension; Abdominal compartment syndrome; Damage control laparotomy; Laparostomy; Open abdomen. DEFINITIONS, INCIDENCE AND MEASUREMENT STRATEGIES IN INTRA-ABDOMINAL HY-PERTENSION (IAH) AND ABDOMINAL COMPARTMENT SYNDROME (ACS)The concept of the Abdominal Compartment Syndrome (ACS) has been rediscovered as a final common pathway of the physiologic sequelae of increased Intra-Abdominal Pressure In each case if the graph shifts to the right, higher IAP and lower APP values may not be associated with significant end-organ dysfunction creating a degree of "ACS-resistance." Shifts to the left would create "ACS-sensitivity" where lower values of IAP (higher APP values) may still be associated with organ dysfunction which might not occur normally. This results in difficulty for broader acceptance of critical IAP and APP levels for individual cases. ACS-sensitivity may potentially occur in patients where there is pre-existing partial end-organ failure, morbid obesity or following fluid hyper-resuscitation in patients with severe burns, haemorrhagic pancreatitis, massive blood loss, widespread intra-peritoneal sepsis and high-output intestinal fistulae. 6-8There is no strict definition of what represents abnormal IAP, but there is a general acceptance that measured pressures >12 mmHg when recorded 1-6 hours apart are considered to represent IAH, where Sugrue, et al. have shown that this represents up to 40% of cases admitted to a surgical Intensive Care Unit (ICU). 9 Although there are biases in the prospective assessment of a selective population admitted to an ICU who ...

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“…PCD appears to be most effective in patients with secondary ACS due to pancreatitis, liver cirrhosis, sepsis, and massive fluid resuscitation and in burns. Latenser et al [14] showed that PCD reduced IAP and prevented ACS in 55% of burned patients. PCD is a relatively simple technique, cost effective and less invasive then OAD.…”

Section: Evacuation Of Intra-abdominal Space Occupying Lesionsmentioning

confidence: 99%

What’s new in medical management strategies for raised intra-abdominal pressure: evacuating intra-abdominal contents, improving abdominal wall compliance, pharmacotherapy, and continuous negative extra-abdominal pressure

Keulenaer¹,

Regli²,

Laet³

et al. 2014

Anaesthesiol Intensive Ther

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In the future, medical management may play an increasingly important role in the prevention and management of intra-abdominal hypertension (IAH). A review of different databases was used (PubMed, MEDLINE and EMBASE) with the search terms 'Intra-abdominal Pressure' (IAP), 'IAH' , ' Abdominal Compartment Syndrome' (ACS), 'medical management' and 'non-surgical management' . We also reviewed all papers with the search terms 'IAH' , 'IAP' and 'ACS' over the last three years, only extracting those papers which showed a novel approach in the non-surgical management of IAH and ACS. IAH and ACS are associated with increased morbidity and mortality. Non-surgical management is an important treatment option in critically ill patients with raised IAP. There are five medical treatment options to be considered to reduce IAP: 1) improvement of abdominal wall compliance; 2) evacuation of intra-luminal contents; 3) evacuation of abdominal fluid collections; 4) optimisation of fluid administration; and 5) optimisation of systemic and regional perfusion. This paper will review the first three treatment arms of the WSACS algorithm: abdominal wall compliance; evacuation of intra-luminal contents and evacuation of abdominal fluid collections. Emerging medical treatments will be analysed and finally some alternative specific treatments will be assessed. Other treatment options with regard to optimising fluid administration and systemic and regional perfusion will be described elsewhere, and are beyond the scope of this review. Medical management of critically ill patients with raised IAP should be instigated early to prevent further organ dysfunction and to avoid progression to ACS. Many treatment options are available and are often part of routine daily management in the ICU (nasogastric, rectal tube, prokinetics, enema, sedation, body position). Some of the newer treatments are very promising options in specific patient populations with raised IAP. Future studies are warranted to confirm some of these findings.

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A Pilot Study Comparing Percutaneous Decompression With Decompressive Laparotomy for Acute Abdominal Compartment Syndrome in Thermal Injury

Cited by 162 publications

References 26 publications

Ischemic bowel as a late sequela of abdominal compartment syndrome secondary to severe burn injury

Ischemic bowel as a late sequela of abdominal compartment syndrome secondary to severe burn injury

Primary Intra-Abdominal Hypertension and Abdominal Compartment Syndrome: Pathophysiology and Treatment

What’s new in medical management strategies for raised intra-abdominal pressure: evacuating intra-abdominal contents, improving abdominal wall compliance, pharmacotherapy, and continuous negative extra-abdominal pressure

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