Intra-abdominal hypertension: Incidence and association with organ dysfunction during early septic shock

Regueira, Tomás; Bruhn, Alejandro; Hasbún, Pablo; Aguirre, Marcia; Romero, Carlos; Llanos, O; Castro, Ricardo; Bugedo, Guillermo; Hernández, Glenn

doi:10.1016/j.jcrc.2007.12.013

Cited by 70 publications

(44 citation statements)

References 37 publications

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“…This relationship has been demonstrated for critically ill surgical patients [68], mixed medical and surgical patients [69], and in patients with septic shock [36,70], severe acute pancreatitis [71], acute respiratory failure [19], and ruptured abdominal aortic aneurysms [66].…”

Section: Abdominal Perfusion Pressurementioning

confidence: 93%

Fluid therapy and perfusional considerations during resuscitation in critically ill patients with intra-abdominal hypertension

Regli

Keulenaer²,

Laet³

et al. 2014

Anaesthesiol Intensive Ther

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Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are consistently associated with morbidity and mortality among the critically ill or injured. Thus, avoiding or potentially treating these conditions may improve patient outcomes. With the aim of improving the outcomes for patients with IAH/ACS, the World Society of the Abdominal Compartment Syndrome recently updated its clinical practice guidelines. In this article, we review the association between a positive fluid balance and outcomes among patients with IAH/ACS and how optimisation of fluid administration and systemic/regional perfusion may potentially lead to improved outcomes among this patient population. Evidence consistently associates secondary IAH with a positive fluid balance. However, despite increased research in the area of non-surgical management of patients with IAH and ACS, evidence supporting this approach is limited. Some evidence exists to support implementing goal-directed resuscitation protocols and restrictive fluid therapy protocols in shocked and recovering critically ill patients with IAH. Data from animal experiments and clinical trials has shown that the early use of vasopressors and inotropic agents is likely to be safe and may help reduce excessive fluid administration, especially in patients with IAH. Studies using furosemide and/or renal replacement therapy to achieve a negative fluid balance in patients with IAH are encouraging. The type of fluid to be administered in patients with IAH remains far from resolved. There is currently insufficient evidence to recommend the use of abdominal perfusion pressure as a resuscitation endpoint in patients with IAH. However, it is important to recognise that IAH either abolishes or increases threshold values for pulse pressure variation and stroke volume variation to predict fluid responsiveness, while the presence of IAH may also result in a false negative passive leg raising test. Correct fluid therapy and perfusional support during resuscitation form the cornerstone of medical management in patients with abdominal hypertension. Controlled studies determining whether the above medical interventions may improve outcomes among those with IAH/ACS are urgently required.

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Section: Abdominal Perfusion Pressurementioning

confidence: 93%

Fluid therapy and perfusional considerations during resuscitation in critically ill patients with intra-abdominal hypertension

Regli

Keulenaer²,

Laet³

et al. 2014

Anaesthesiol Intensive Ther

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“…The true incidence of IAH in ICU patients is not known, as no study included all consecutive patients. IAH may occur in 24−38% of patients with an ICU stay >24 hours [46, 68−73], whereas a higher incidence is reported in sub-groups of severe burns (37%) [74], in ruptured abdominal aortic aneurysm (55%) [75], in severe acute pancreatitis (78%) [76] and in severe sepsis (77%) [77]. IAH is reported to occur in 12% of patients after major elective abdominal surgery [5,78] and in 46% after emergency abdominal surgery needing intensive care [79].…”

Section: Intra-abdominal Hypertension (Iah)mentioning

confidence: 99%

Abdominal signs and symptoms in intensive care patients

Blaser

Starkopf²,

Malbrain

2015

Anaesthesiol Intensive Ther

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Abdominal problems, both as a primary reason for admission or developing as a part of multiple organ dysfunction syndrome during an ICU stay, are common in critically ill patients. The definitions, assessment, incidence and outcome of different abdominal signs, symptoms and syndromes are assessed in the current review. General abdominal signs and symptoms include abdominal pain and distension, as well as other signs assessed during the physical examination (e.g. palpation, percussion). Gastrointestinal (GI) symptoms include vomiting, high gastric residual volumes, diarrhoea, GI bleeding, paralysis of the lower GI tract, bowel dilatation and absent bowel sounds. Although around half of patients suffer from these symptoms, the reported incidences of single symptoms vary within a large range due to variable definitions and case-mix. In a few studies, the total number of coincident GI symptoms was associated with increased mortality. Although acute abdomen is a well-recognized severe syndrome in emergency medicine, its incidence in ICUs is not known. Next to subjective clinical evaluation, intra-abdominal pressure, as a reproducible numerical variable, provides useful assistance in the assessment of the abdominal compartment, whereas intra-abdominal hypertension has been shown to impair the outcome of the critically ill. In conclusion, abdominal symptoms occur in half of patients in ICUs. Clinical evaluation, albeit largely subjective, remains the main bedside tool to detect abdominal problems and to assess GI function in the critically ill. IAP is a useful additional tool in the assessment of abdominal complications in ICUs.

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“…Selon cette même étude, le SCA a une prévalence de 13 % chez les patients souffrant d'HIA [9]. Ce syndrome est associé à une aggravation du pronostic vital chez les humains hospitalisés en unité de soins intensifs [9][10][11][12].…”

Section: Prévalence Et Données Vétérinairesunclassified

Pression intra-abdominale, hypertension intra-abdominale et syndrome de compartimentation abdominale

Hoareau

2014

Revue Vétérinaire Clinique

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Intra-abdominal hypertension: Incidence and association with organ dysfunction during early septic shock

Cited by 70 publications

References 37 publications

Fluid therapy and perfusional considerations during resuscitation in critically ill patients with intra-abdominal hypertension

Fluid therapy and perfusional considerations during resuscitation in critically ill patients with intra-abdominal hypertension

Abdominal signs and symptoms in intensive care patients

Pression intra-abdominale, hypertension intra-abdominale et syndrome de compartimentation abdominale

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