Intra-abdominal Pressure Control Research Articles

Intensive care in severe acute bowel obstruction (clinical lecture)

Most patients with severe acute small bowel obstruction in the early postoperative period require treatment in the intensive care unit. The main principles of intensive care are identifying major vital function disorders, their rapid correction, as well as supporting the functions of the affected organs and systems. The leading pathophysiological disorders that require intensive correction during small bowel obstruction are impaired intestinal barrier function (for bacteria and toxins), hypovolemia, hypotension and microcirculation disorders, primarily in the abdominal organs, fluid and electrolyte and acid-base disorders. Such disorders, in turn, could cause repeated development of intra-abdominal hypertension with impaired perfusion of the abdominal organs. Thus, the efficiency of intensive care for dynamic acute bowel obstruction primarily depends on the speed of correction of fluid and electrolyte disorders and restoration of intestinal blood flow, normalization of gut parietal digestion rather than on the quantity of the drugs that stimulate bowel movement. The primary method of gut microcirculation restoration is the ROSE approach to fluid resuscitation. The main criteria of the intensive care efficiency should be control of intra-abdominal pressure and timely treatment of intra-abdominal hypertension.

DEVELOPMENT OF OPEN ABDOMEN DEVICE BASED ON BIODESIGN METHODOLOGY

AbstractOpen Abdomen (OA) therapy, is purposely leaving the fascial edges of the abdomen un-approximated after a laparotomy. During the OA therapy, there must be a temporary abdominal closure (TAC) device installed in the patient to achieve abdominal closure gradually without affecting its safety. However, the actual TAC devices have some gaps in terms of functionality or usability, therefore a new device is proposed. Intending to design a usable and functional technique for patients all over the world, the BioDesign Innovation Process was used. This iterative methodology focuses on healthcare needs, invention, and concept development with three main phases: Identify, Invent and Implement. At the end of these phases, the team successfully developed two new abdominal closure techniques that fill in the gaps of functionality and usability, using a simulator that realistically mimicked the physical and mechanical properties of an open abdomen. In terms of functionality, the novel techniques showed safe installation, operational security, secure grip, low invasiveness and control of intra-abdominal pressure. In terms of usability, the devices showed better results in efficiency, effectiveness and easy re-exploration than the control group.

Optimization of the choice of laparoscopic and open alloplastic surgery of postoperative ventral hernias

Background. Postoperative ventral hernias (PVH) account for 20.4-22 % of all abdominal hernias. The recurrence rate after alloplastic surgery of large and giant PVH is 10-25 %. Adequate selection of alloplastic surgery method in PVH may help to improve treatment outcomes and reduce the frequency of relapses.
 Objective. To describe the features of laparoscopic and open alloplastic surgery of PVH.
 Materials and methods. Analysis of literature sources on this topic.
 Results and discussion. According to the classification, PVH are divided into medial (subxiphoid, epigastric, umbilical, subumbilical, suprapubic) and lateral (subcostal, flank, iliac, lumbar). Autoplastic surgery (according to Sapezhko, Mayo) is used only for small-sized PVH in young and middle-aged people in the absence of diastasis recti and obesity (up to 3.5 %). In 96.5 % of cases alloplastic surgery is used (open – 81.1 %; laparoscopic – 15.4 %). There are about a dozen types of alloplastic interventions. When choosing the optimal intervention, it is necessary to take into account the width of the defect, the width of diastasis or contracture of the rectus abdominis muscles, the level of intra-abdominal pressure. When performing laparoscopic alloplastic intervention, prevention of trocar wound infection is performed using Dekasan solution (“Yuria-Pharm”) by rinsing before suturing. Alloplastic surgeries of giant PVH should be performed in combination with techniques for separating the anatomical components of the anterior abdominal wall and mandatory monitoring of intra-abdominal pressure, as intra-abdominal hypertension is a frequent complication of such procedures. Preoperative preparation and examination of patients before PVH surgery includes laboratory tests (general and biochemical blood tests, coagulation analysis), electro- and echocardiography, ultrasound or computed tomography of the required areas, spirography, consultations with related specialists, slag-free nutrition and 10-12 days of laxatives (in the outpatient settings), correction of comorbidities, maximum bowel cleansing before surgery, control of intra-abdominal pressure, prevention of infectious complications of the wound and prevention of thromboembolic complications. Contraindications to elective surgery include ineffective preoperative preparation, impaired cardiopulmonary activity, increased intra-abdominal pressure >12 mm H2O using bandage compression, reduction of breathing function <60 % of normal. To prevent postoperative wound infection during surgery at the stages of separation of the anatomical components of the anterior abdominal wall, fixation of the mesh and before drainage and suturing the wound, Decasan washing is used (400-800 ml depending on the wound surface area). Postoperative treatment includes analgesia (paracetamol – Infulgan, “Yuria-Pharm”), oxygen therapy, abdominal bandaging, monitoring of intra-abdominal pressure, stimulation of intestinal function (metoclopramide – Reosorbilact, “Yuria-Pharm”), antibacterial treatment, correction of electrolyte balance, nonsteroidal anti-inflammatory drugs. Removal of drainages from the mesh implant is performed in 3-4 days, from the subcutaneous wound – in 5-6 days.
 Conclusions. 1. The choice of PVH alloplastic surgery type should be made taking into account the size of the defects, the width of the diastasis recti and intra-abdominal pressure. 2. Optimization of the choice of treatment procedure for giant PVH can be achieved by determining the intra-abdominal pressure during surgery during contact of the rectus abdominis muscles. 3. Decasan lavage is used to prevent infection of trocar and surgical wounds.

Acute Intestinal Failure.

Acute intestinal failure (AIF), “reduction of gut function below the minimum necessary for the absorption of macronutrients and/or water and electrolytes, requiring parenteral nutrition”, is common, but very often neglected part of multiorgan dysfunction syndrome (MODS) in the critically ill patients. It is now increasingly being recognized as a cause of prolonged ICU and hospital stay and poor outcome. Multidisciplinary team approach, systematic approach to management with treatment of sepsis, early mobilization and enteral feeding with prokinetics if required, control of intra-abdominal pressure and surgical intervention, when mandated, can help treat AIF and improve patient outcomes.How to cite this article: Chandankhede SR, Kulkarni AP. Acute Intestinal Failure. Indian J Crit Care Med 2020;24(Suppl 4):S168–S174.

Using the aponeurotic hypotensive suture in surgical treatment of patients with median postoperative ventral hernias

One of the operation about the median postoperative ventral hernia is retromuscular plastic Stoppa-Rives. For large defects closure rear sheets of the sheaths of direct muscles associated with the eruption of the seams. The authors propose a new hypotensive aponeurotic suture located opposite each other of the chains of stitches oriented in the transverse direction. This seam is used in 14 patients. All patients were able to take in rear sheets of the sheaths of direct muscles under the control of intra-abdominal pressure. During the early postoperative period without complications. Patients viewed through 6-20 months. Recurrence was not detected. It is concluded that the use of this seam is safe and effective closure of the fascia when alloplasty.

Abdominal Wall Prosthetic Repair in Ventral and Incisional Hernia Treatment: Classification, Terminology and Technical Aspects (Review)

DOI: 10.17691/stm2015.7.2.19 Received August 26, 2014V.V. Parshikov, MD, DSc, Professor, Department of Hospital Surgery named after B.А. Korolev;А.А. Fedaev, PhD, Associate Professor, Department of Hospital Surgery named after B.А. KorolevNizhny Novgorod State Medical Academy, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russian federationThe review considers in detail the most important aspects of open abdominal wall prosthetic repair techniques applied in surgical treatment of ventral and incisional hernias according to contemporary foreign and domestic experience. we have presented the views of leading researchers on the use of synthetic endoprostheses. The authors have suggested a modern classification of primary ventral and incisional hernias indicating its variation from the previous classification SwR (Chevrel and Rath) and others. we have assessed and interpreted the English terms compared to those used in Russia. The review has traced the change of the term “tension-free plasty” in its historical perspective.The work has presented the main up-to-date techniques for mesh endoprostheses implantation, their advantages and drawbacks. There have been estimated the key points of prosthetic repair surgeries in median abdominal wall closure. we have considered correct names of variants of surgeries depending on mesh placement in relation to hernia orifices, anatomical layers of abdominal wall, and self-tissue displacement.we have clarified some peculiarities of operative techniques relying on intra-abdominal pressure control, and estimated the advantages and disadvantages of these techniques.The review has specified the most urgent problems of modern herniology, and presented one of promising directions of surgical technique improvement in the treatment of patients with large ventral and incisional hernias. we have shown the necessity of proper usage and understanding of the implication of terms standing for operative interventions, as well as correct use of corresponding classifications and terminology for adequate comparison of our research results with those of our colleges.Key words: incisional hernias; ventral hernias; prosthetic repair; tension-free plasty; abdominal wall reconstruction; mesh; intra-abdominal pressure.For contacts: Parshikov Vladimir Vyacheslavovich, e-mail: pv1610@mail.ruV.V. Parshikov, А.А. fedaev

Risk factors of venous thromboembolism in patients with large ventral hernias

A study of venous hemodynamics and blood coagulation system in 40 patients operated on for large ventral hernias. Tension free hernia repair under the control of intraabdominal pressure helps to reduce stasis of blood in the veins of the legs. The development of inflammatory complications accompanied by higher levels of markers of coagulation: fibrinogen, C-reactive protein and D-dimer.

Comparison between open and open-vacuum-assisted closure treatment in the adjuvant treatment of the abdominal compartment syndrome

Abdominal compartment syndrome (ACS) represents a potentially life-threatening condition in critically ill patients. The control of intra-abdominal pressure (IAP) plays a pivotal role in prevention/treatment of ACS. We compared the efficacy of two different therapies – open and open-vacuum-assisted closure (open-VAC) treatment [1] – on resolution of intra-abdominal hypertension/prevention of ACS.

Control of intra-abdominal pressure in severe acute pancreatitis with continuous hemodiafiltration using a polymethyl methacrylate membrane hemofilter and colloid fluid therapy

Control of intra-abdominal pressure in severe acute pancreatitis with continuous hemodiafiltration using a polymethyl methacrylate membrane hemofilter and colloid fluid therapy