Is it wise not to think about intraabdominal hypertension in the ICU?

Malbrain, Manu L N G

doi:10.1097/00075198-200404000-00010

Cited by 144 publications

(116 citation statements)

References 73 publications

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“…Some papers have demonstrated that a persistent splanchnic hypoperfusion may induce irreversible damage in organ function and death [23][24][25] . We speculate that a global mechanism of ischemia and reperfusion may explain these findings.…”

Section: Discussionmentioning

confidence: 99%

Abdominal compartment syndrome in patients with severe acute pancreatitis in early stage

Chen¹,

Li²,

Sun³

et al. 2008

WJG

122

123

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AIM:To study retrospectively the influence of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) in patients with early acute pancreatitis (AP) (during the first week after admission) on physiological functions, and the association of the presence of IAH/ACS and outcome. METHODS: Patients (n = 74) with AP recruited in this study were divided into two groups according to intra-abdominal pressure (IAP) determined by indirect measurement using the transvesical route via Foley bladder catheter during the first week after admission. Patients (n = 44) with IAP ≥ 12 mmHg were assigned in IAH group, and the remaining patients (n = 30) with IAP < 12 mmHg in normal IAP group. For analysis of the influence of IAH/ACS on organ function and outcome, the physiological parameters and the occurrence of organ dysfunction during intensive care unit (ICU) stay were recorded, as were the incidences of pancreatic infection and in-hospital mortality. RESULTS: IAH within the first week after admission was found in 44 patients (59.46%). Although the APACHE Ⅱ scores on admission and the Ranson scores within 48 h after hospitalization were elevated in IAH patients in early stage, they did not show the statistically significant differences from patients with normal IAP within a week after admission (16.18 ± 3.90 vs 15.70 ± 4.25, P = 0.616; 3.70 ± 0.93 vs 3.47 ± 0.94, P = 0.285, respectively). ACS in early AP was recorded in 20 patients (27.03%). During any 24-h period of the first week after admission, the recorded mean IAP correlated significantly with the Marshall score calculated at the same time interval in IAH group (r = 0.635, P < 0.001). Although ACS patients had obvious amelioration in physiological variables within 24 h after decompression, the incidences of pancreatitic infection, septic shock, multiple organ dysfunction syndrome (MODS) and death in the patients with ACS were significantly higher than that in other patients without ACS (pancreatitic infection: 60.0% vs 7.4%, P < 0.001; septic shock: 70.0% vs 11.1%, P < 0.001; MODS: 90.0% vs 31.5%, P < 0.001; mortality: 75.0% vs 3.7%, P < 0.001). CONCLUSION: IAH/ACS is

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Section: Discussionmentioning

confidence: 99%

Abdominal compartment syndrome in patients with severe acute pancreatitis in early stage

Chen¹,

Li²,

Sun³

et al. 2008

WJG

122

123

View full text Add to dashboard Cite

show abstract

“…IAH is defined by a sustained or repeated pathologic elevation of IAP ≥12 mmHg (Malbrain, 2004;Malbrain et al, 2006;Saggi et al, 1998). IAH is an important cause of morbidity and mortality in critically ill patients.…”

Section: Discussionmentioning

confidence: 99%

Effect of increased intra-abdominal pressure and decompressive laparotomy on aerated lung volume distribution

Zhou

Pan

et al. 2010

J. Zhejiang Univ. Sci. B

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Increased intra-abdominal pressure (IAP) is common in intensive care patients, affecting aerated lung volume distribution. The current study deals with the effect of increased IAP and decompressive laparotomy on aerated lung volume distribution. The serial whole-lung computed tomography scans of 16 patients with increased IAP were retrospectively analyzed between July 2006 and July 2008 and compared to controls. The IAP increased from (12.1±2.3) mmHg on admission to (25.2±3.6) mmHg (P<0.01) before decompressive laparotomy and decreased to (14.7±2.8) mmHg after decompressive laparotomy. Mean time from admission to decompressive laparotomy and length of intensive-care unit (ICU) stay were 26 h and 16.2 d, respectively. The percentage of normally aerated lung volume on admission was significantly lower than that of controls (P<0.01). Prior to decompressive laparotomy, the total lung volume and percentage of normally aerated lung were significantly less in patients compared to controls (P<0.01), and the absolute volume of non-aerated lung and percentage of non-aerated lung were significantly higher in patients (P<0.01). Peak inspiratory pressure, partial pressure of carbon dioxide in arterial blood, and central venous pressure were higher in patients, while the ratio of partial pressure of arterial O 2 to the fraction of inspired O 2 (PaO 2 /FIO 2 ) was decreased relative to controls prior to laparotomy. An approximately 1.8 cm greater cranial displacement of the diaphragm in patients versus controls was observed before laparotomy. The sagittal diameter of the lung at the T6 level was significantly increased compared to controls on admission (P<0.01). After laparotomy, the volume and percentage of non-aerated lung decreased significantly while the percentage of normally aerated lung volume increased significantly (P<0.01). In conclusion, increased IAP decreases total lung volume while increasing non-aerated lung volume. Decompressive laparotomy is associated with resolution of these effects on lung volumes.

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“…There is growing evidence that intra-abdominal pressure (IAP) adversely affects almost all organ systems (1) and is a cause of significant morbidity and mortality (2)(3)(4)(5). Many risk factors for the development of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) have been identified in critically ill patients (6).…”

Section: Introductionmentioning

confidence: 99%

The influence of fluid balance on intra-abdominal pressure after major abdominal surgery

Šerpytis

Ivaškevičius

2008

Medicina

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Is it wise not to think about intraabdominal hypertension in the ICU?

Abstract: The answer is that it is unwise not to measure intraabdominal pressure in the ICU or even not to think about it.

Cited by 144 publications

References 73 publications

Abdominal compartment syndrome in patients with severe acute pancreatitis in early stage

Abdominal compartment syndrome in patients with severe acute pancreatitis in early stage

Effect of increased intra-abdominal pressure and decompressive laparotomy on aerated lung volume distribution

The influence of fluid balance on intra-abdominal pressure after major abdominal surgery

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