Decompression Of Abdominal Compartment Syndrome Research Articles

Indications for Surgical and Interventional Therapy of Acute Pancreatitis

15 to 20% of patients with acute pancreatitis develop necrosis of the pancreatic parenchyma or extrapancreatic tissue. The disease is associated with a mortality rate of up to 20%. The mainstays of treatment consist of intensive medical care and surgical and interventional therapy. A systematic literature search focused on indications for surgical and interventional therapy of necrotising pancreatitis. 85 articles were analysed for this review. By using the Delphi method, the results were presented to the quality committee for pancreas diseases of the German Society for General and Visceral Surgery and to expert pancreatologists in an interactive conference using plenary voting during the visceral medicine congress 2019 in Wiesbaden. For the finalised recommendations, an agreement of 84% of participants was achieved. Documented or clinical suspicion of infected, necrotising pancreatitis are indications for surgical and interventional therapy (recommendation grade: strong; evidence grade; low). Sterile necrosis is a less common indication for intervention due to late complications or persistent severe pancreatitis. Invasive interventions should be delayed when possible until four weeks after onset of pancreatitis. Optimal treatment strategy consists of a "step-up approach" (evidence grade: high; recommendation grade: strong). The first step is catheter drainage, followed, if necessary, by minimally invasive surgical or interventional necrosectomy. If minimally invasive techniques do not result in clinical improvement, open necrosectomy is necessary. 35 to 50% of patients are successfully treated with drainage alone. Indications for emergency intervention are bowel perforation, bowel ischemia and bleeding. Surgical decompression of abdominal compartment syndrome is indicated if the patient is refractory to medical treatment and percutaneous drainage. Abscesses and symptomatic pseudocysts are indications for interventional drainage. Early cholecystectomy during index admission is recommended for patients with mild biliary pancreatitis. Cholecystectomy should be delayed after severe, biliary pancreatitis. The recommendations for surgical an interventional therapy of necrotising pancreatitis address the basis of current indications in literature. They should serve in daily practice as a reference standard for decision making in multidisciplinary teams.

THERAPEUTIC MISADVENTURE WITH A BETA BLOCKER DURING A THYROID STORM

SESSION TITLE: Critical Care and Pediatrics SESSION TYPE: Global Case Reports PRESENTED ON: 10/10/2018 01:00 PM - 02:00 PM INTRODUCTION: Thyroid storm (TS) has a high mortality rates, whether treated 20% [2] or untreated 50%-90% [1,2]. Immediate goals are to decrease synthesis, prevent release, decrease peripheral action with beta blockers, support circulation and treat the precipitating condition (3). Caution against beta blocker is warranted in patients with heart failure, although it may be beneficial when tachycardia is a significant precipitant to decompensated cardiac function (4). We present a case of thyroid storm with right heart failure and exaggerated response to propranolol leading to circulatory collapse secondary to cardiogenic shock. CASE PRESENTATION: 48-year-old female with untreated hypertension presented to emergency for progressively worsening dyspnea, cough and diarrhea with elevated white count and fever. Treatment was initiated per sepsis protocol and PE was ruled out with contrasted CT. Shortly afterward, GCS deteriorated from 14 to 6 and she was intubated for airway protection. Lab work revealed an undetectable TSH with elevated free T4 and T3. Upon revaluation, her Burch-Wartofsky Point Scale was 95, elevated from 55 on arrival. She received glucocorticoids, propylthiouracil and oral propranolol. She developed bradycardia and cardiac arrest. Post ROSC echocardiogram showed right heart failure with flattened ventricular septum and EF of 45%. A second cardiac arrest ensued despite glucagon and transcutaneous pacing attempts. She was stabilized with crystalloids, vasopressors and bicarbonate drip. Central venous and bladder pressures were 34 and 26, minutes before a third cardiac arrest that ended with an emergency bedside laparotomy for decompression of abdominal compartment syndrome. Her hospital course was further complicated by coagulopathy, blood loss and renal failure requiring dialysis. DISCUSSION: The concept of thyrocardiac disease must be kept in mind when managing a TS. In long standing hyperthyroidism, the resulting cardiomyopathy is compensated by tachycardia and increased sensitivity to catecholamines [3]. This compensation depends on excess adrenergic drive to maintains adequate cardiac output. Failure to consider this led to our therapeutic misadventure. Current management of TS includes propranolol to lessen the adrenergic effect on the heart and to inhibit peripheral conversion of T4 to T3. This patient’s experience suggested that abrupt disruption of this compensatory state with beta blockade puts the body at risk for cardiovascular collapse. CONCLUSIONS: It is imperative to for clinicians to avoid beta blockers or use short acting beta blockers with extreme caution when managing TS Reference #1: Nayak B1, Burman K. Thyrotoxicosis and thyroid storm. Endocrinol Metab Clin North Am. 2006 Dec;35(4):663-86, vii Reference #2: Richard Carroll and Glenn Matfin Endocrine and metabolic emergencies: thyroid storm Ther Adv Endocrinol Metab. 2010 Jun; 1(3): 139–145. Reference #3: Singhal, A., & Campbell, D. "Thyroid storm." 2003. www.emedicine.com/ped/topic2247.htm (16 Dec. 2004) DISCLOSURES: No relevant relationships by Emmanuel Addo-Yobo, source=Web Response No relevant relationships by Nanette Bentley, source=Web Response No relevant relationships by Diana Trofimovitch, source=Web Response No relevant relationships by Karthik Vijayan, source=Web Response No relevant relationships by Gabriel Zaietta, source=Web Response

EComment. Intra-abdominal hypertension and abdominal compartment syndrome in cardiac surgery patients

Intra-abdominal hypertension (IAH) has been defined by the World Society of the Abdominal Compartment Syndrome (WSACS) as a sustained or repeated pathological elevation of intra-abdominalŰressure (IAP) ≥12 mmHg and abdominal compartment syndrome (ACS) as IAP >20 mmHg with new organ dysfunction or failure [1]. IAH/ACS are recognized with increasing frequency in critically-ill patients. ACS is encountered in surgical and medical intensive care units and must be considered as an important factor of multi-organ failure including splanchnic, renal, liver, cardiovascular, respiratory and central nervous system dysfunction. The syndrome is also associated with considerable morbidity and mortality. WSACS recommend that IAP be measured regularly in critically-ill patients who demonstrate risk factors for the development of IAH [1]. Even if these risk factors are found in cardiac surgery patients, the prevalence of IAH in cardiac surgery has not fully been elucidated. We read with great interest the paper by Dalfino et al. [2]. They aimed at identifying the risk factors for IAH in cardiac surgery patients. In their study, IAH is strongly associated with higher baseline IAP values, higher central venous pressure, positive fluid balance, extracorporeal circulation, use of vasoactive drugs and acute kidney injury. They conclude that patients presenting risk factors must be monitored properly during the perioperative period. We agree with their conclusions and would like to add a brief comment on therapeutic interventions. Currently, the diagnosis and management of IAH/ACS is evolving tremendously, and comprehensive strategies to reduce IAP play an important role in such patients. Approaches or techniques of potential utility include sedation and analgesia, neuromuscular blockade, body positioning, nasogastric/colonic decompression, promotility agents, diuretics and continuous renal replacement therapies, fluid resuscitation strategies, and percutaneous catheter drainage [1,3]. Non-operative strategies for the management of IAH/ACS may be summarized using five therapeutic goals: (1) evacuation of intraluminal contents; (2) evacuation of intra-abdominal space-occupying lesions; (3) improvement in abdominal wall compliance; (4) optimization of fluid administration; and (5) support of systemic and regional tissue perfusion [3]. Surgical abdominal decompression should be considered in any patient who demonstrates evidence of ACS. Decompressive laparotomy should not be feared or delayed because rapid decompression after the diagnosis of ACS dramatically improves cardiac function and results in improved organ perfusion and survival. Due to the severe morbidity associated with all forms of surgical decompression, the indications, timing and technique used should be carefully evaluated [3-5]. De Wolf et al. [4] reported two patients who required surgical abdominal decompression for ACS that developed early after emergency coronary artery bypass graft surgery. Both patients had a protracted clinical course, but they survived and were discharged from the hospital. Rabbi et al. [5] described a secondary ACS that occurred during an elective coronary revascularization which resulted in an inability to wean from cardiopulmonary bypass. After decompressive laparotomy was done, the patient was successfully weaned from bypass. ACS is a potentially fatal entity of which all clinicians, and cardiovascular surgeons in particular, need to be acutely aware. We think that successful outcome depends on early recognition, early conservative treatment to reduce IAH and decompressive laparotomy if ACS develops in these complicated patients. Conflict of interest: none declared

Tissue Plasminogen Activator–Assisted Hematoma Evacuation to Relieve Abdominal Compartment Syndrome After Endovascular Repair of Ruptured Abdominal Aortic Aneurysm

To describe our experience with a novel technique to decompress abdominal compartment syndrome after endovascular aneurysm repair (EVAR) of ruptured abdominal aortic aneurysm (rAAA). From January 2003 to April 2010, 13 patients (12 men; mean age 75 years) treated for rAAA with EVAR underwent tissue plasminogen activator (tPA)-assisted decompression for intra-abdominal hypertension. All of the patients but one had intra-abdominal pressure >20 mmHg, with signs of multiple organ failure or abdominal perfusion pressure <60 mmHg. With computed tomography guidance, a drain was inserted into the retroperitoneal hematoma, and tPA solution was injected to facilitate evacuation of the coagulated hematoma and decrease the abdominal pressure. In the 13 patients, the mean intra-abdominal pressure decreased from 23.5 mmHg (range 12-35) to 16 mmHg (range 10-28.5). A mean 1520 mL (range 170-2900) of blood was evacuated. Urine production (mean 130 mL/h, range 50-270) increased in 7 patients at 24 hours after tPA-assisted decompression; among the 5 patients in which urine output did not increase, 3 underwent hemodialysis by the 30-day follow-up. One patient did not respond with clinical improvement and required laparotomy. The 30-day, 90-day, and 1-year mortality was 38% (5/13 patients); none of the deaths was related to the decompression technique. tPA-assisted decompression of abdominal compartment syndrome after EVAR can decrease the intra-abdominal pressure and could be useful in preventing multiple organ failure. It is a minimally invasive technique that can be used in selected cases but does not replace laparotomy or retroperitoneal surgical procedures as the gold standard treatments.

Surgical Decompression for Abdominal Compartment Syndrome in Severe Acute Pancreatitis

In patients with severe acute pancreatitis and abdominal compartment syndrome, establishment of the indications and optimal time for surgical decompression may avoid exacerbation of multiple-organ dysfunction syndrome. Retrospective study. Tertiary care university teaching hospital. Twenty-six consecutive patients with severe acute pancreatitis and abdominal compartment syndrome treated by surgical decompression between January 1, 2002, and December 31, 2007. Surgical decompression of the abdomen. Morbidity, mortality, and organ dysfunction before and after surgical decompression. At the time of surgical decompression, the median sequential organ failure assessment score among patients was 12 (interquartile range, 10-15), and the median intra-abdominal pressure was 31.5 (interquartile range, 27-35) mm Hg. After surgical decompression, renal or respiratory function was improved in 14 patients (54%). The overall hospital mortality was 46%, but mortality was 18% among 17 patients in whom surgical decompression was performed within the first 4 days after disease onset. Patients with severe acute pancreatitis and abdominal compartment syndrome managed by surgical decompression had severe multiple-organ dysfunction syndrome and high mortality. Surgical decompression may improve renal or respiratory function. Early surgical decompression is associated with reduced mortality in patients with severe acute pancreatitis, early multiple-organ dysfunction syndrome, and abdominal compartment syndrome.

Open abdomen treatment following endovascular repair of ruptured abdominal aortic aneurysms

Open abdomen treatment (OAT) is considered a lifesaving procedure in patients with abdominal compartment syndrome (ACS) after endovascular or open intervention for ruptured abdominal aortic aneurysms (RAAA). Standardized treatment methods and algorithms for its use are still lacking. The high, published mortality rates may reflect difficulties in detecting and treating ACS, especially in patients treated by emergency endovascular aneurysm repair (eEVAR). Presented are standardized algorithms for OAT, including a new technique using the vacuum-assisted closure (VAC) system developed during 10 years of experience with eEVAR for RAAA. We retrospectively analyzed 102 patients with RAAA treated by eEVAR from January 1998 to April 2008. Abdominal decompression was done when intravesical pressure >20 mm Hg or when abdominal perfusion pressure was <50 to 60 mm Hg and concomitant organ deterioration occurred. OAT was initially done with a subcutaneously sutured plastic bag or with a nonsutured zipper drape combined with a VAC device (VAC/ETHIZIP; KCI International Inc, Amstelveen, The Netherlands; Ethicon, Somerville, NJ). All patients were switched to VAC/ETHIZIP as soon as possible. Dressings were generally changed every 3 to 5 days. Intra-abdominal pressure was monitored until stability was observed after delayed direct abdominal closure. Overall 30-day mortality for eEVAR was 13% (13 of 102); 8% (7 of 82) for patients without ACS and 30% (6 of 20) for those with ACS. Decompression for ACS was needed in 20 patients (20%) primarily during the intervention (n = 14) or secondarily in the intensive care unit (n = 6). Six of 20 (30%) patients requiring OAT died <or=30 days (4 primary, 2 secondary). A mean of 3.6 (range, 1-12) planned second-look interventions were done per patient at an interval of 3 to 5 days. No bowel lesions were observed. Four patients required antibiotic therapy for abdominal infection, and all infections resolved. Delayed abdominal wall closure (direct closure, 11; closure with polypropylene mesh, 3; bilateral anterior rectus abdominis sheath turnover flap, 1) was achieved after a median of 6 days (range, 1-47 days). The use of standardized novel techniques and a treatment protocol and algorithm for OAT after eEVAR for RAAA were feasible and safe. It decreased the workload of the medical and nursing staff, enhanced patient comfort because the need for dressing changes was minimized, and likely contributed to lower overall mortality in RAAA patients. Delayed direct fascial closure was possible in most patients.

Surgical management of abdominal compartment syndrome; indications and techniques.

The indications for surgical decompression of abdominal compartment syndrome (ACS) are not clearly defined, but undoubtedly some patients benefit from it. In patients without recent abdominal incisions, it can be achieved with full-thickness laparostomy (either midline, or transverse subcostal) or through a subcutaneous linea alba fasciotomy. In spite of the improvement in physiological variables and significant decrease in IAP, however, the effects of surgical decompression on organ function and outcome are less clear. Because of the significant morbidity associated with surgical decompression and the management of the ensuing open abdomen, more research is needed to better define the appropriate indications and techniques for surgical intervention.

Management of Abdominal Compartment Syndrome in a Very Low Birth Weight Neonate Using Penrose Drains and Subsequent Management of Abdominal-Wall Defects

Percutaneous drainage of the peritoneal cavity has been recently evaluated for the treatment of perforated viscous in the very low birth weight (VLBW) neonate and percutaneous decompression for abdominal compartment syndrome (ACS) has been studied in older patient populations. This is the first reported case of using this technique to treat ACS in a VLBW neonate.

Surgical Decompression for Abdominal Compartment Syndrome After Emergency Cardiac Surgery

Abdominal compartment syndrome typically occurs in patients after abdominal surgical procedures or trauma. Abdominal compartment syndrome is also increasingly described in conditions not related to abdominal operations, such as fluid resuscitation or burns. We report two patients who required surgical abdominal decompression for abdominal compartment syndrome that developed early after emergency coronary artery bypass graft surgery. No intraabdominal abnormalities were found at operation. Both patients had a protracted clinical course, but they survived and were discharged from the hospital.

Open Abdomen after Severe Acute Pancreatitis.

The need for surgical decompression for abdominal compartment syndrome is becoming more frequent in patients with severe acute pancreatitis, especially in association with massive fluid resuscitation at the early stages of the disease. Decompression can be achieved with either a full-thickness laparostomy that can be performed through a vertical midline or transverse subcostal incision, or by performing a subcutaneous linea alba fasciotomy. Following a fullthickness laparostomy the open abdomen can be best managed with some form of negative abdominal pressure dressing. During dressing changes every 2-3 days, every attempt should be made to gradually close the fascial incision starting from edges, but avoiding recurrent abdominal compartment syndrome. Gradual closure is more likely to succeed in association with a negative fluid balance. Peripancreatic exploration or necrosectomy is seldom required at the initial laparostomy, unless performed for late onset abdominal compartment syndrome associated with infected peripancreatic necrosis. Primary fascial closure should always be attempted. If impossible and there is no need for subsequent abdominal re-exploration, the open wound should be covered with split-thickness skin grafting directly over the bowel loops. After a maturation period of 9-12 months definitive repair of the abdominal wall defect is performed utilizing the components separation technique, mesh repair, or a pedicular or microvascular tensor facia lata flap. Knowledge of the available decompression and reconstruction options is essential for individualized management of patients with severe acute pancreatitis and abdominal compartment syndrome. More research and comparative studies are needed to determine the most successful methods to be used.

Management of abdominal compartment syndrome during extracorporeal life support

To describe the successful use of a peritoneal dialysis catheter for emergent decompression of abdominal compartment syndrome during extracorporeal life support for septic shock. Case report. Pediatric intensive care unit at a freestanding tertiary children's hospital. Two-year-old toddler with influenza A complicated by methicillin-resistant Staphylococcus aureus pneumonia and septic shock. Placement of peritoneal dialysis catheter. Changes in hemodynamic and respiratory parameters. Improvement in extracorporeal membrane oxygenation venous drainage with subsequent survival. Although the standard therapy for abdominal compartment syndrome is decompressive laparotomy, a minimally invasive percutaneous approach may be effective and should be considered in selected patients.

The Open Abdomen in Trauma: Do Infectious Complications Affect Primary Abdominal Closure?

One of the primary goals of damage control surgery in the trauma patient is primary closure of the abdomen. We hypothesized that extra-abdominal infections, such as those complicating injuries to the thorax, diaphragm, long bones, or musculoskeletal system, would decrease the likelihood of primary abdominal closure and increase hospital resource utilization in patients requiring open abdominal management. The trauma registry of the American College of Surgeons (TRACS) was reviewed retrospectively from 1995-2002 for open abdomen technique and damage control surgery. The outcome was primary fascial closure or delayed closure. Patients who died prior to closure were excluded. We evaluated infectious complications, including ventilator-associated pneumonia (VAP), blood stream infection (BSI), and surgical site infection (SSI). Other parameters studied were multiple rib fractures, long bone fractures, chest injuries, diaphragm injuries, empyema, and transfusion requirements. Hospital charges were obtained from the hospital administrative database. Univariate, multivariate, and regression analyses were performed to identify the effects of infectious complications on primary abdominal closure, length of stay, total hospital charges, and disposition. Three hundred forty-four patients required the open abdomen technique: 67% received damage control laparotomy and 33% decompression of abdominal compartment syndrome. Two hundred seventy-six patients (80%) went on to abdominal closure of some form and constituted the primary study group. Primary abdominal closure was achieved in 180 (65%) with a mean time to closure of 3.5 days. Ventilator-associated pneumonia, BSI, and SSI were associated with lack of primary closure (p < 0.05). Increased blood transfusions also were associated with failure of primary closure (p < 0.05). Ventilator-associated pneumonia and BSI were associated with significantly greater lengths of stay in the intensive care unit (ICU) (24.2 days vs. 12.6 days and 30.5 days vs. 17.9 days; both p < 0.0001) and significantly greater total hospital charges (232,080 US dollar vs. 142,893 US dollar; 247,440 US dollar vs. 160,940 US dollar; and 264,778 US dollar vs. 170,447 US dollar; all p < 0.001). Inability to achieve primary abdominal closure was associated with infectious complications (VAP, BSI, and SSI) and large transfusion requirements. Infectious complications also significantly increased ICU utilization and hospital charges. Death was associated with BSI, femur fractures, and large transfusion requirements, whereas infectious complications did not have a significant impact on discharge disposition.

Translumbar Extraperitoneal Decompression for Abdominal Compartment Syndrome After Endovascular Treatment of a Ruptured AAA

Purpose: To report an unusual case of abdominal compartment syndrome (ACS) following endovascular repair of a ruptured abdominal aortic aneurysm (rAAA) that had been treated with a stent-graft 3 years prior. Case Report: A 68-year-old man with a 3-year-old Vanguard bifurcated aortic stent-graft experienced sudden back pain and collapse. Aneurysm rupture documented by computed tomography was due to dislocation of the left graft limb. A Talent aortomonoiliac graft was deployed, followed by a femorofemoral bypass. No endoleak was evident. A few hours later, the patient became oliguric and hemodynamically unstable. Increased intraabdominal pressure (IAP) was recorded. Abdominal decompression was performed, removing 1500 mL of blood from the retroperitoneum through an 18-cm lumbotomy; the peritoneum was opened, and another 500 mL of blood was aspirated. The IAP fell immediately, followed by diuresis a few hours later. The patient recovered and was discharged after 27 days. Conclusions: Some of the perioperative complications seen after conventional rAAA repair are also encountered after endovascular treatment. ACS requires urgent decompression, and less invasive approaches, such as translumbar extraperitoneal decompression, may be a good alternative to a midline laparotomy.

Translumbar Extraperitoneal Decompression for Abdominal Compartment Syndrome after Endovascular Treatment of a Ruptured AAA

To report an unusual case of abdominal compartment syndrome (ACS) following endovascular repair of a ruptured abdominal aortic aneurysm (rAAA) that had been treated with a stent-graft 3 years prior. A 68-year-old man with a 3-year-old Vanguard bifurcated aortic stent-graft experienced sudden back pain and collapse. Aneurysm rupture documented by computed tomography was due to dislocation of the left graft limb. A Talent aortomonoiliac graft was deployed, followed by a femorofemoral bypass. No endoleak was evident. A few hours later, the patient became oliguric and hemodynamically unstable. Increased intra-abdominal pressure (IAP) was recorded. Abdominal decompression was performed, removing 1500 mL of blood from the retroperitoneum through an 18-cm lumbotomy; the peritoneum was opened, and another 500 mL of blood was aspirated. The IAP fell immediately, followed by diuresis a few hours later. The patient recovered and was discharged after 27 days. Some of the perioperative complications seen after conventional rAAA repair are also encountered after endovascular treatment. ACS requires urgent decompression, and less invasive approaches, such as translumbar extraperitoneal decompression, may be a good alternative to a midline laparotomy.

High success with nonoperative management of blunt hepatic trauma: the liver is a sturdy organ.

Nonoperative management of liver injuries (NOMLI) is highly successful and rarely leads to adverse events. Prospective observational study. High-volume academic level I trauma center. For 26 months, 78 consecutive unselected patients with liver injuries were followed up prospectively. In the absence of hemodynamic instability or signs of hollow visceral trauma, NOMLI was offered irrespective of the magnitude of the liver injury. Main Outcome Measure Failure of NOMLI, defined as a laparotomy after an initial decision to treat the patient nonoperatively. Of the 78 patients, 23 (29%) were operated on immediately, but only 12 (15%) for bleeding from the liver. All 12 patients required packing in addition to other maneuvers (hepatorrhaphy [n = 8], resection [n = 4], and liver isolation [n = 1]). Of the remaining 55 patients selected for NOMLI, the method failed in 8 for reasons unrelated to the liver injury: 2 underwent a splenectomy, 1 underwent a nephrectomy, 1 had a small-bowel repair, 1 underwent abdominal decompression for abdominal compartment syndrome, and 3 underwent a nontherapeutic laparotomy. The success rate of NOMLI was 85% (47 of 55 patients), but the liver-specific success rate was 100%. Compared with those in whom NOMLI was successful, patients in whom it failed had a higher Injury Severity Score and underwent more blood transfusions, but they had similar liver injury grades. In total, 66 (85%) of liver injuries did not bleed significantly. No adverse events were attributed to NOMLI. Nonoperative management of liver injuries is safe and effective regardless of the grade of liver injury. Failure of NOMLI is caused by associated abdominal injuries and not the liver. Fluid and blood requirements, the degree of injury severity, and the presence of other abdominal organ injuries may help predict failure.

The importance of measurement of respiratory mechanics during surgery of the abdominal wall

Assessment of respiratory mechanics is widely used in intensive care units in mechanically ventilated patients in order to assess the state of respiratory illness, the effects of pharmacological treatment, and the progression of the respiratory syndrome. Moreover, respiratory mechanics are also involved in monitoring respiratory function and muscle performance during weaning from the ventilator. In surgery of the abdominal wall with increase of abdominal pressure (large laparocele repair, decompression of abdominal compartment syndrome) the assessment of respiratory mechanics is a useful tool giving a better understanding of pathophysiologic implications. Intrao-peratively, it is important to detect variations from baseline values in order to avoid respiratory complications of surgical procedures. Non-invasive measurement of respiratory mechanics requires certain devices: a pneumotachograph connected to the endotracheal tube for measuring respiratory flow and tidal volume and two pressure transducers, one to measure the pressure at airway opening, the other to measure esophageal pressure by connection to an esophageal balloon. These signals are sent via an analog digital converter to a personal computer to be analysed and stored by dedicated respiratory mechanics software. The end-inspiratory occlusion technique and esophageal balloon technique make complete measurement of respiratory mechanics possible.

Laparoscopic decompression of abdominal compartment syndrome after blunt hepatic trauma.

Abdominal compartment syndrome (ACS) can occur in a variety of surgical conditions, particularly those with major life-threatening hemorrhage, massive volume resuscitation, prolonged operation times, and coagulopathy. In severely traumatized patients, the incidence of ACS is reported to be as high as 14% to 15% after damage control laparotomies. Although favorable results have been achieved with nonsurgical management of adult blunt hepatic trauma, the failure rates still range from 0% to 19%. Exploratory laparotomy is considered the intervention of choice in patients with blunt hepatic trauma who fail nonsurgical treatment. Expedient abdominal decompression currently is the treatment of choice after ACS. Oliguria, tachypnea, and tachycardia developed in two blunt hepatic trauma patients with grade IV and V injuries while they were receiving nonsurgical treatment. The intra-abdominal pressures measured more than 35 and 25 cm H 2O, respectively. Two patients with grade II and III ACS received laparoscopic examination instead of laparotomy. Their ACS was decompressed effectively via laparoscopy without any adverse effects. Therefore, we suggest that laparoscopy can be used as a safe alternative for the decompression of ACS.