The cardio-respiratory effects of intra-abdominal hypertension: Considerations for critical care nursing practice

Christensen, Martin; Craft, Judy

doi:10.1016/j.iccn.2017.05.003

Cited by 10 publications

(13 citation statements)

References 29 publications

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“…Some cardiac signs of raised intra-abdominal pressure are abnormal increase in pulmonary artery pressure, central venous pressure increase, cardiac output decrease, increased heart rate, variable MAP, pulmonary artery wedge pressure increase, systemic vascular resistance increase, left ventricular end-diastolic pressure decrease and right ventricular end-diastolic pressure decrease. [6] Respiratory changes are functional residual capacity decrease, volume decrease, peak airway pressure increase, mean airway pressure increase, plateau pressures increase, intrinsic PEEP increase, dead-space ventilation increase, pulmonary oedema increase and work of breathing increase. [6] With the acute decompensation and difficulty in ventilating the patient, an aggressive decompression laparotomy was deemed to be the most effective treatment option.…”

Section: Discussionmentioning

confidence: 99%

“…[6] Respiratory changes are functional residual capacity decrease, volume decrease, peak airway pressure increase, mean airway pressure increase, plateau pressures increase, intrinsic PEEP increase, dead-space ventilation increase, pulmonary oedema increase and work of breathing increase. [6] With the acute decompensation and difficulty in ventilating the patient, an aggressive decompression laparotomy was deemed to be the most effective treatment option. [7] Sonar-guided needle aspiration may have been an option, but this would have required some time to find a sonar to borrow, which may have then compromised the patient.…”

Section: Discussionmentioning

confidence: 99%

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Acute abdominal compartment syndrome in a severely burned patient: Lack of colloid fluid availability in acute resuscitation may play a role

et al. 2018

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A 27-year-old male patient presented to Mitchell's Plain Hospital on 4 December 2017 with 50% total body surface area (TBSA) burns and an inhalational injury. He was brought in by the paramedics, and no other past medical history was obtained prior to intubation for airway protection (rapid sequence intubation). Areas involved included superficial and middermal burns to his face, occiput, neck and right arm. He had mid-dermal burns to his left foot and right leg. The remainder to his back, left arm and thigh were deep dermal and full-thickness burns. His left arm had circumferential full-thickness burns, and escharotomies were performed. He had an abbreviated burn severity index of 9. His fluid requirement, according to the modified Parkland formula, was calculated as 14 L required in the first 24 hours, at a rate of 875 mL/hr for the first 8 hours, then 437.5 mL/hr for the next 16 hours. He had a full-body scrub-down, and wounds were dressed with ACTICOAT. Morphine and midazolam sedation was started as an infusion. During the resuscitative phase, he required frequent crystalloid boluses, owing to drops in urine output and mean arterial pressures (MAPs). These were associated with increased heart rates of 130-145 bpm, and serum lactate of ~3. Inotropes were not needed at this stage. Albumin was also not obtainable after-hours in the unit, and therefore not given to the patient. After an 80 mg dose of furosemide, calculated at 1 mg/kg, he passed more than 2 mL/kg urine. Furosemide is usually given half an hour after starting albumin, and in this case the rationale for giving the furosemide is not clear. At this time, he had clear air entry, with no evidence of pulmonary oedema. He was ventilating easily on lung protective settings. His acidosis improved. He did, however, receive 17 L of fluid in total in the first 24 hours, 3 L more than the calculated need. Preoperatively he had a pH of 7.24 (from 6.9) with PaCO 2 7.1 kPa, PO 2 20.5 kPa, lactate of 3.6 mmol/L (from >15 mmol/L) and standard bicarbonate of 21.5 mmol/L. His peak airway pressure at this point was

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Acute abdominal compartment syndrome in a severely burned patient: Lack of colloid fluid availability in acute resuscitation may play a role

et al. 2018

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“…Increasing the IAP level is expected among the intensive care patients according to many factors especially that affect the stability of abdominal cavity either by the pathology of the disease itself or the treatment modalities. However, the abdominal compliance is limited and is considered intra-abdominal hypertension (IAH) as 12: 20 mmHg and abdominal compartment syndrome (ACS) as more than 21mmHg (Christensen, Craft, & Nursing, 2018). In literature, IAP disturbs the organ tissue perfusion, possibly leading to severe ischemic or circulatory changes.…”

Section: Intra-abdominal Pressure (Iap) Of Enteral-fed Patientsmentioning

confidence: 99%

Effect of Abdominal Massage on Gastrointestinal Complications and Intra-Abdominal Pressure of Critical-Enteral-Feed Patients: A Randomized Control Trial

2019

JHMN

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Background: critically ill patient need a nursing practice that can enhance him to get all benefits of enteral feeding and overlapping the GI complications and maintain the intra-abdominal pressure.Objective: This work aimed to explore the effect of abdominal massage on gastrointestinal complications and intra-abdominal pressure of critical-enteral-feed patients. Methods: A randomized controlled trial was applied on 74 eligibly enteral-fed patients at Trauma and General ICUs. Of these, the trail was completed on sixty patients who distributed randomly to equal intervention and control groups. The manipulation was two times for 15mins of abdominal massage for five days. The effect was measured on enteral feeding complications (GRV, abdominal circumference and distention, vomiting) and intra-abdominal pressure as compared with control group who didn't receive the massage.Results: the GRV difference between the massage group and control group subjects was statistically significant (P<0.001) in the 3 rd , 4 th , and 5 th days indicating higher GRV among control group. The abdominal circumference between the five days was not significantly in the two groups. The difference between the two groups in relation to the distension was statistically significant (p < 0.05) in day 3, 4 and5. None of intervention patients were vomited along the study period (5days) in compared to 5% of control patients without statistical significant. Conclusions: The abdominal massage was significantly effective in lowering GRV, preventing distension and avoiding vomiting. Besides, the abdominal massage maintained the IAP without any statistical significant support. Therefore, it is recommended that this practice can be applied as a caring procedure in the daily ICU care program.

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“…[3,8] Part two: It included abdominal perfusion pressure (APP = MAP -IAP. MAP is the mean arterial pressure.)…”

Section: Tool I: Patients' Assessment Sheetmentioning

confidence: 99%

“…[2] When the pressure is sustained or elevated due to pathological causes above 12 mmHg, developed to Intra-abdominal hypertension (IAH). [3] New organ failure or dysfunction with sustained IAP greater than 20 mmHg (with or without abdominal perfusion pressure [APP] < 60 mmHg) is called abdominal compartment syndrome (ACS). [4,5] This syndrome is responsible for the increase in prevalence of death from 90% to 100% if not immediately recognized and treated.…”

Section: Introductionmentioning

confidence: 99%

Deterioration of mechanically ventilated patients in the presence of intra-abdominal hypertension

Mahran¹,

El-Hafez²,

Abbas³

2018

JNEP

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Background and objective: Elevated pressure within the cavity of the abdomen is a serious complication that can threat the life of critically ill patients. Thus, there is an intense need to highlight the outcomes of intra-abdominal hypertension (IAH) that can face critical care nurses. Objective: This work aimed to explore the deterioration of mechanical ventilated patients in the presence of IAH. Methods: Design: A non-randomized prospective study. Procedures: This trial was implemented in trauma and general intensive care in the period between December 2015 and August 2016. The pressure within the abdomen was measured for each patient, three times with 8-hr interval, at the third day of mechanical ventilator (MV). Sepsis-related organ failure assessment score was measured for all patients at first day of admission. All patients who had normal intra-abdominal pressure (IAP) or developed IAH were observed, monitored and evaluated for the clinical outcomes until discharged. Results: Of the 60 MV patients, 83.3% developed IAH. Higher mean of MV and stay period among patients with increased pressure within the abdomen (14.04 ± 10.30 and 16.30 ± 9.36) than normotensive patients (6.90 ± 2.80 and 11.000 ± 3.77) with significant difference (p = .001). Non-survivor had a significantly higher mean IAP than survivor (23.266 ± 2.37 vs. 7.91 ± 3.17) (p value < .001). Conclusions: The occurrence of IAH complicated 83.3% of mechanical ventilated clients in the study period: like longer stay and use of ventilator, and high mortality rate.

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The cardio-respiratory effects of intra-abdominal hypertension: Considerations for critical care nursing practice

Cited by 10 publications

References 29 publications

Acute abdominal compartment syndrome in a severely burned patient: Lack of colloid fluid availability in acute resuscitation may play a role

Acute abdominal compartment syndrome in a severely burned patient: Lack of colloid fluid availability in acute resuscitation may play a role

Effect of Abdominal Massage on Gastrointestinal Complications and Intra-Abdominal Pressure of Critical-Enteral-Feed Patients: A Randomized Control Trial

Deterioration of mechanically ventilated patients in the presence of intra-abdominal hypertension

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