Abdominal Compartment Syndrome in Critically Ill Patients

Sadeghi, Mohsen Vakili; Kiani, Arda; Sheikhy, Kambiz; Taghavi, Kimia; Farrokhpour, Mohsen; Abedini, Atefeh

doi:10.3889/oamjms.2019.228

Cited by 9 publications

(7 citation statements)

References 18 publications

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“…Over the last three decades, IAP's concerns have been rediscovered, better articulated and have achieved numerous clinical significance 11 , 24 , 25 2 . The physician used the above method routinely to measure the intra-abdominal pressure of patients in the neurological ICU.…”

Section: Discussionmentioning

confidence: 99%

Intra-Abdominal Pressure Measurements in Neurocritical Patients

Shan

et al. 2021

JoVE

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Intra-abdominal pressure (IAP) is increasingly being recognized as an indispensable and significant physiological parameter in intensive care units (ICU). IAP has been measured in a variety of ways with the development of many techniques in recent years. The level of intra-abdominal pressure under normal conditions is generally equal to or less than 12 mmHg. Accordingly, abdominal hypertension (IAH) is defined as two consecutive IAP measurements higher than 12 mmHg within 4-6 h. When IAH deteriorates further with IAP higher than 20 mmHg along with organ dysfunction and/ or failure, this clinical manifestation can be diagnosed as abdominal compartment syndrome (ACS). IAH and ACS are associated with gastrointestinal ischemia, acute renal failure, and lung injury, leading to severe morbidity and mortality. Elevated IAP and IAH may affect the cerebral venous return and outflow of the cerebrospinal fluid by increasing the intrathoracic pressure (ITP), ultimately leading to increased intracranial pressure (ICP). Therefore, it is essential to monitor IAP in critically ill patients. The reproducibility and accuracy of intra-bladder pressure (IBP) measurements in previous studies need to be further improved, although the indirect measurement of IAP is now a widely used technique.To address these limitations, we recently used a set of IAP monitoring systems with advantages of convenience, continuous monitoring, digital visualization, and long-term IAP recording and data storage in critically ill patients. This IAP monitoring system can detect intra-abdominal hypertension and potentially analyze clinical status in real time. The recorded IAP data and other physiological indicators, such as intracranial pressure, can be further used for correlation analysis to guide treatment and predict a patient's possible prognosis.

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Section: Discussionmentioning

confidence: 99%

Intra-Abdominal Pressure Measurements in Neurocritical Patients

Shan

et al. 2021

JoVE

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“…ACS is a severe complication that results from an acute and sustained increase in IAP, and thus causes significant morbidity and mortality [ 8 ]. Recently, there has been an increasing focus on the clinical significance of IAP in critically ill patients, [ 9 ] which can greatly affect circulation, respiration, and abdominal organ function [ 10 – 12 ]. The ACS concept was introduced by Kron in 1984 to describe dysfunction involving the cardiovascular, pulmonary, renal, gastrointestinal, and cranial organ systems caused by severe increases in IAP [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

Comparison of Intra-Abdominal Pressure Measurements in Critically Ill Patients Using Intravesical Normal Saline at 15°C, 25°C, and 35°C

et al. 2021

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Background The incidence of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) in intensive care units is high. Dynamic monitoring of intra-abdominal pressure (IAP) is important to treat patients with these conditions. The World Society of Abdominal Compartment Syndrome revised IAP measurement and treatment guidelines in 2013. IAP is measured by instilling ≤25 mL of sterile saline into the bladder, but there is no requirement for the saline to be at a specific temperature. Many doctors presume that using cold saline will trigger bladder muscle spasms, resulting in measurement error. In the present study, we investigated the effect of body-temperature saline on IAP measurements. Material/Methods A single-center study was conducted in 12 patients with IAH over a 2-year period. IAP was measured via the bladder with instillation of sterile saline at temperatures of 35°C, 25°C, and 15°C. We analyzed the data using R software, version 4.1.0. Paired t tests were used for comparisons between groups. A Spearman rank correlation analysis was performed to compare groups. Analysis results were plotted using the R packages ggplot2, ggpubr, and BlandAltmanLeh. P <0.05 was considered statistically significant. Results There was a significant difference in IAP measurement between the 15 ° C and 35 ° C groups ( t =−2.55, P =0.027). There was no significant difference between the 25 ° C and 35 ° C groups ( t =0.73, P =0.48). Bland-Altman analysis showed that IAP was consistent in the 25°C and 35°C groups. Conclusions Although it is preferable to measure IAP with saline at body temperature (35 ° C), a temperature >25 ° C is associated with accurate results. Using saline at <15 ° C should be avoided.

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“…Abdominal compartment syndrome (ACS) or intraabdominal hypertension (IAH) can occur as a complication in many clinical scenarios such as in patient with visceral edema, shock and reperfusion, hemoperitoneum, retroperitoneal edema, acute pancreatitis, paralytic ileus, small bowel obstruction etc. and is a dangerous feature in these critically ill patients, leading to increased mortality and poorer outcomes 4 .IAH has profound effects on multiple organ system functions 5,6 . The cardiovascular effects of IAH include a decreased venous return, increased systemic vascular resistance, increased intrathoracic pressure, decreased cardiac output, and inferior vena cava compression.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Intra Abdominal Pressure Monitoring Techniques and the Effects of the Abdominal Compartment Syndrome

Shah¹,

Asaf²

2021

PJMHS

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Background: Abdominal compartment syndrome (ACS) is a life-threatening condition that develops in the setting of increasing and uncontrolled intra-abdominal hypertension (IAH), leading to cardiovascular, respiratory, neurologic and/or renal dysfunction. Aims: To establish a porcine model for the evaluation of the effects of IAH on renal blood flow (RBF) and to determine if IVC pressure and/or Camino fiberoptic direct intraabdominal pressure measurements can accurately predict IAPs that have been derived using bladder pressure measurements. Methods: Abdominal laparotomy, placement of IAP and RBF measuring devices, and fascial closure were performed on six adult feeder pigs with a mean body weight of 25 +/- 5 kg. A Transonic Doppler flow probe, a suprapubic bladder catheter, a Camino fiberoptic probe, and a triple lumen central venous catheter were placed and then baseline measurements were taken of renal blood flow, bladder pressure, direct intra-peritoneal Camino pressure and IVC pressure, respectively. Normal saline was then infused into the abdomen to simulate increasing IAP. Following a 5–10-minute stabilization period, all measurements were again taken. Results: The correlation between IVC pressure and bladder pressure was 0.98, with a mean bias of -0.5 (SD 2.0; 95% CI: -0.9, -0.2). The correlation between direct IAP readings by Camino probe and bladder pressure was 0.91, with a mean bias of -3.9 (SD 4.3; 95% CI: -4.6, -3.2). There was a strong negative correlation (-0.95) between RBF and bladder pressure. At an IAP of 20 mmHg, RBF reduced by an average of 45.4% (95% CI: 40%, 50.8%). Upon abdominal decompression, RBF returned to 66.6% (95% CI: 54.3%, 78.9%) of its baseline value. Conclusions: A porcine model is effective in accurately measuring changes in real time RBF. RBF progressively declines as IAP increases, however upon decompression, it fails to achieve complete recovery. IVC pressure measurements correlate well with, and therefore may substitute, the gold standard bladder pressure measurements as representatives of IAP. Keywords: Abdominal Compartment syndrome, renal blood flow, intrabdominal hypertension, bladder pressure

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Abdominal Compartment Syndrome in Critically Ill Patients

Cited by 9 publications

References 18 publications

Intra-Abdominal Pressure Measurements in Neurocritical Patients

Intra-Abdominal Pressure Measurements in Neurocritical Patients

Comparison of Intra-Abdominal Pressure Measurements in Critically Ill Patients Using Intravesical Normal Saline at 15°C, 25°C, and 35°C

Comparison of Intra Abdominal Pressure Monitoring Techniques and the Effects of the Abdominal Compartment Syndrome

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