Development Of Intra-abdominal Hypertension Research Articles

Postoperative intra-abdominal hypertension predicts worse hospital outcomes in children after cardiac surgery: a pilot study†.

Our goal was to determine the incidence and characteristics of postoperative intra-abdominal hypertension (IAH) in paediatric patients undergoing open-heart surgery. This single-centre study included consecutive children (aged <16 years) who underwent open-heart surgery between July 2020 and February 2021. Patients who entered the study were followed until in-hospital death or hospital discharge. The study consisted of 2 parts. Part I was a prospective observational cohort study that was designed to discover the association between exposures and IAH. Postoperative intra-abdominal pressure was measured immediately after admission to the intensive care unit and every 6 h thereafter. Part II was a cross-sectional study to compare the hospital-related adverse outcomes between the IAH and the no-IAH cohorts. Postoperatively, 24.7% (38/154) of the patients exhibited IAH, whereas 3.9% (6/154) developed abdominal compartment syndrome. The majority (29/38, 76.3%) of IAH cases occurred within the first 24 h in the intensive care unit. Multivariable analysis showed that the Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery score [odds ratio (OR) = 1.86, 95% confidence interval (CI) 1.23-2.83, P = 0.004], right-sided heart lesion (OR = 5.60, 95% CI 2.34-13.43, P < 0.001), redo sternotomy (OR = 4.35, 95% CI 1.64-11.57, P = 0.003), high baseline intra-abdominal pressure (OR = 1.43, 95% CI 1.11-1.83, P = 0.005), prolonged cardiopulmonary bypass duration (OR = 1.01, 95% CI 1.00-1.01, P = 0.005) and deep hypothermic circulatory arrest (OR = 5.14, 95% CI 1.15-22.98, P = 0.032) were independent predictors of IAH occurrence. IAH was associated with greater inotropic support (P < 0.001), more gastrointestinal complications (P = 0.001), sepsis (P = 0.003), multiple organ dysfunction syndrome (P < 0.001) and prolonged intensive care unit stay (z = -4.916, P < 0.001) and hospitalization (z = -4.710, P < 0.001). The occurrence of a composite outcome (P = 0.009) was significantly increased in patients with IAH. IAH is common in children undergoing cardiac surgery and is associated with worse hospital outcomes. Several factors may be associated with the development of IAH, including basic cardiac physiology and perioperative factors. This study was registered in the Chinese Clinical Trial Registry (Trial number: ChiCTR2000034322)URL site: https://www.chictr.org.cn/hvshowproject.html?id=41363&v=1.4.

Fluid Management, Intra-Abdominal Hypertension and the Abdominal Compartment Syndrome: A Narrative Review.

Background: General pathophysiological mechanisms regarding associations between fluid administration and intra-abdominal hypertension (IAH) are evident, but specific effects of type, amount, and timing of fluids are less clear. Objectives: This review aims to summarize current knowledge on associations between fluid administration and intra-abdominal pressure (IAP) and fluid management in patients at risk of intra-abdominal hypertension and abdominal compartment syndrome (ACS). Methods: We performed a structured literature search from 1950 until May 2021 to identify evidence of associations between fluid management and intra-abdominal pressure not limited to any specific study or patient population. Findings were summarized based on the following information: general concepts of fluid management, physiology of fluid movement in patients with intra-abdominal hypertension, and data on associations between fluid administration and IAH. Results: We identified three randomized controlled trials (RCTs), 38 prospective observational studies, 29 retrospective studies, 18 case reports in adults, two observational studies and 10 case reports in children, and three animal studies that addressed associations between fluid administration and IAH. Associations between fluid resuscitation and IAH were confirmed in most studies. Fluid resuscitation contributes to the development of IAH. However, patients with IAH receive more fluids to manage the effect of IAH on other organ systems, thereby causing a vicious cycle. Timing and approach to de-resuscitation are of utmost importance, but clear indicators to guide this decision-making process are lacking. In selected cases, only surgical decompression of the abdomen can stop deterioration and prevent further morbidity and mortality. Conclusions: Current evidence confirms an association between fluid resuscitation and secondary IAH, but optimal fluid management strategies for patients with IAH remain controversial.

A modern view of the causes and mechanisms of the development of acute disseminated peritonitis

Despite the fact that the diagnosis of acute peritonitis has improved in recent years, a wide range of antibiotics is available, and minimally invasive methods of surgical treatment have been implemented, the mortality rate for this disease is high and ranges from 12.5 % to 39.2 %.&#x0D; The purpose of the work was to analyze data from literary sources regarding the classification of acute peritonitis, to summarize the causes and mechanisms of its development among the adult population.&#x0D; Analytical and bibliosemantic research methods were used in the work.&#x0D; It is known that according to the nature of penetration of microflora into the abdominal cavity, peritonitis is divided into primary, secondary and tertiary. According to the clinical course, peritonitis is divided into acute, subacute and chronic. According to the nature of the exudate in the abdominal cavity, serous, serous-purulent, fibrinous, fibrinous-purulent, purulent, hemorrhagic, fecal and purulent peritonitis are distinguished. To date, the existing classifications are constantly being improved and have both practical and academic significance.&#x0D; It has long been known that the cause of unsatisfactory results of surgical treatment of patients with acute disseminated peritonitis can be the development of intra-abdominal hypertension with subsequent development of compartment syndrome and multiple organ failure. The development of multiple organ failure is the leading cause of death in patients with acute surgical pathology. Abdominal compartment syndrome plays a big role in this, the mortality in which reaches very significant figures – 42-68 % and without treatment approaches 100 %.&#x0D; Therefore, the development of acute peritonitis is due to numerous reasons (in particular, acute destructive appendicitis, cholecystitis, perforated ulcer of the stomach or duodenum, intestinal obstruction, tumor processes, gynecological pathology, abdominal injuries, etc.), which in turn causes the absence of a generally recognized justified classification.

Intra-abdominal pressure monitoring in the management of patients with blunt injury abdomen: Prospective observational study

Background and Aim: Abdominal trauma can result in the increase of intra-abdominal pressure (IAP) for a variety of reasons including the accumulation of blood or free fluid in the peritoneal cavity, oedema of the intestinal wall, retroperitoneal hematoma or abdominal packing for haemorrhage control. The aim was to study the role of intra-abdominal pressure (IAP) monitoring in the management of patients with blunt injury abdomen. Material and Methods: Hospital based prospective observational study in 100 patients who presented to emergency medicine department later shifted to department of general surgery in Tertiary care Institute of India, over a period of 18 months. IAP was measured in emergency medicine department and ICU at presentation, that is, 0 hours, 3 hours, 6 hours, 12 hours, 24 hours, 48 hours, 72 hours and 96 hours. Parameters noted were blood pressure, pulse rate, respiratory rate, oxygen saturation (SpO2), urine output, blood urea, serum creatinine, IAP, time of presentation to hospital after injury, duration of ICU and hospital stay, need for ventilatory support, morbidity (new organsystem dysfunction) and mortality. Results: Correlation between IAP and vital parameters, renal parameters at 0, 3, 6, 24 and 72 hours were found statistically significant. Observation between IAP and vital parameters, renal parameters at 12 hours all parameters are significant except IAP has weak positive correlation with DBP and this was found statistically insignificant. Hospital stay decreased as IAP increases in surgically intervened group because IAP returned to normal after surgical decompression, but this finding was statistically significant only at 72 hours in our study. Conclusion: Before development of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS), the potential candidates should be offered surgical decompression at proper time.

Предоперационная подготовка и особенности индукции в анестезию при острой кишечной непроходимости (клиническая лекция)

В статье представлены основные направления предоперационной подготовки в случае тяжелой острой кишечной непроходимости (ОКН) и подчеркнуто, что данная подготовка должна быть ограниченной во времени и не задерживать проведение оперативного вмешательства. При тяжелой ОКН вместе с тщательной оценкой витальных функций и определением ведущих нарушений крайне важно оценить больного по шкалам и определить основные риски развития осложнений. Общая анестезия, как правило, является методом выбора при ОКН, однако для улучшения интра- и послеоперационного обезболивания она может быть дополнена и методами регионарной анестезии. При подготовке к проведению общей анестезии в первую очередь следует определять риски сложной интубации, а также регургитации и аспирации желудочного содержимого, что позволяет целенаправленно подходить к выбору техник интубации и предотвращать возникновение этих грозных осложнений. Прием Селлика уже не обязателен для использования у таких пациентов, а вместо него во время интубации может быть применена бимануальная ларингоскопия. Артериальная гипотензия является частым осложнением во время индукции в анестезию при тяжелой ГКН, и у таких больных всегда следует проводить инфузионную терапию, а также коррекцию водно-электролитных нарушений. Вместе с тем для предотвращения отека кишечника и развития интраабдоминальной гипертензии инфузионная терапия должна быть ограничена как во времени, так и в объеме. Если невозможно полностью скорректировать гиповолемию, для снижения риска возникновения существенной артериальной гипотензии во время индукции в анестезию быстрой последовательности следует с профилактической целью назначать вазопрессоры.

The Intestinal Barrier Function and Intra-Abdominal Pressure Depend on Postoperative Analgesia Technique in Children with Appendicular Peritonitis.

Introduction Peritonitis is one of the risk factors for the development of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS). The plasma citrulline and intestinal fatty acid-binding protein (I-FABP) are informative markers of intestinal barrier function. The aim of this study was to determine the correlation of the plasma citrulline and I-FABP with intra-abdominal pressure (IAP) and their relation to analgesia techniques in children suffering from appendicular peritonitis. Materials and Methods 74 children operated for appendicular peritonitis were randomized into three groups of postoperative analgesia: “Opioids” (n = 25), intravenous morphine of 10 mcg/kg/h; “Lidocaine” (n = 23), intravenous lidocaine with initial bolus of 1.5 mg/kg and then infusion of 1.5 mg/kg/h; and “EA” (n = 26), epidurally 0.25% bupivacaine with initial bolus of 1 mg/kg and then infusion of 0.4 mg/kg/year. Retrospectively patients in each group were divided into the following subgroups: “without IAH” (n = 33), “IAH” (n = 27), and “ACS” (n = 14). We detected citrulline and I-FABP in plasma on day 1 (D1) and day 3 (D3) of hospital stay. Results The patients without IAH on D1 presented significantly higher plasma citrulline (23.7 (16.0–31.3) nmol/ml) and lower I-FABP (76.9 (32.6–121.1) pg/ml) levels compared with patients in subgroup “IAH” (9.3 (7.3–11.3) nmol/ml and 226.0 (161.8–290.3) pg/ml, respectively) and subgroup “ACS” (6.9 (5.3–8.6) nmol/ml and 1011.7 (731.9–1291.5) pg/ml, respectively). The IAP had strong inverse correlation (rs = −0.74; p < 0.00001) with citrulline and positive strong correlation (rs = 0.73; p < 0.00001) with I-FABP. The citrulline in patients with IAH during three days postoperatively increased significantly in “Lidocaine” to 72% (p=0.01) and in “EA” to 138% (p=0.02), but it decreased to 13% (p=0.37) in “Opioids” group. In children with ACS, citrulline on D3 was significantly higher than that on D1 and increased in “Lidocaine” to 59% (p=0.05) and in “EA” to 134% (p=0.001), but in “Opioids” it decreased to 30% (p=0.48). The I-FABP in patients with IAH decreased to 12% in “Lidocaine” group (p=0.86) and to 75% in “EA” group (p=0.01), but it increased to 37% (p=0.57) in “Opioids” group. During observation period, I-FABP in patients with ACS decreased significantly in “Lidocaine” to 42% (p=0.05) and in “EA” to 96% (p=0.003), but it increased in “Opioids” to 63% (p=0.22). Conclusions The IAP was inversely correlated with plasma citrulline and positively correlated with I-FABP in children with appendicular peritonitis. Epidural analgesia is the most protective for intestinal wall barrier function in patients at risk of IAH and ACS.

Role of intra-abdominal pressure monitoring in the management of patients with blunt injury abdomen

Background: Blunt injury abdomen is associated with significant morbidity and mortality in spite of improved recognition, diagnosis and management. The aim was to study the role of intra-abdominal pressure (IAP) monitoring in the management of patients with blunt injury abdomen.Methods: Hospital based prospective observational study in 77 patients who presented to emergency medicine department with blunt injury abdomen for over a period of 22 months. Age ≥18 years, patients with acute blunt injury abdomen are included in study.Results: Our study population (77 patients) were a group of patients who presented with blunt injury to abdomen, out of which 66 were male (85.70%), 11 were female (14.30%). Most common age group involved in our study was 20-30 years, mean time of presentation to the hospital was 7.40 hours. SBP, DBP, SpO2 decreased significantly as IAP increases. P. R., R. R. increased significantly as IAP increases. U/O decreased significantly as IAP increases. Sr. Cr, B.U. increased significantly as IAP increases. Surgical abdominal decompression had helped in all operated patients to get statistically significant decrement of IAP during initial post-operative hours. 12 patients required ventilator support in surgically intervened group. Mean duration of hospital stay was 8.025 days. Mortality rate in our study was 3.9%.Conclusions: Before development of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS), the potential candidates should be offered surgical decompression at proper time.

SYNDROME INTESTINAL INSUFFICIENCY IN THE PATHOGENESIS OF ABDOMINAL COMPARTMENT-SYNDROME IN PATIENTS WITH ACUTE DESTRUCTIVE PANCREATITIS

The syndrome of intestinal insufficiency (SII) in patients with acute obstructive pancreatitis (ADP) leads to the formation of intra-abdominal hypertension (IAH), and then to the development of abdominal compartment syndrome (ACS) with all its inherent symptoms: acute heart, lung and kidney failure. Objective: to determine the role of SII in the development of abdominal compartment syndrome in patients with ADP. Materials and methods. Clinical studies were conducted in 71 patients with sterile pancreatic necrosis. Pathoanatomical studies of the small intestine were performed in 20 patients who died due to sterile pancreatic necrosis, of which 10 (50 %) died without SII and 10 (50 %) with SII. Results and discussion. SII developed in 57 (80 %) patients. Absolute quantitative and chronological relationships between SII and IAH and subsequent development were found in 11 (15 %) patients with ACS. SII was ahead of the formation of IAH by an average of 24 hours. IAH and, accordingly, ACS were not formed in patients without SII. The data of enterometry in the deceased with and without SII fully confirmed the results of clinical studies on the leading role of intestinal insufficiency in the development of IAH. Conclusions. SII is the initial and main link in the pathogenesis of the formation of IAH and the subsequent development of ACS in patients with ADP.

Predictive risk factors for intra-abdominal hypertension after cardiac surgery.

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was is it possible to identify predictive risk factors for the development of intra-abdominal hypertension (IAH) or abdominal compartment syndrome after cardiac surgery. Altogether 131 papers were found using the reported search, of which 7 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. A total of 755 patients were included, with the incidence of IAH between 26.9% and 83.3%. The limited evidence on IAH after cardiac surgery should be interpreted with caution. Obesity is a strong predictor of postoperative IAH, although not confined to a central pattern and body mass index is correlated with intra-abdominal pressure (IAP). Prolonged cardiopulmonary bypass and aortic cross-clamp time predisposed to IAH in 4 cohorts. IAH in cardiac surgery patients is associated with hepatic and renal impairment, and corresponding biochemical markers may be helpful in screening, although lacking specificity. In contrast to the development of IAH in other settings, the evidence for the role of fluid balance is poor. Accurate prediction of IAH remains elusive. Based on the available evidence, routine IAP measurement should be considered postoperatively in patients with obesity, particularly those with renal or hepatic impairment, prolonged cardiopulmonary bypass or operative time, requiring vasopressor support, to prevent the deleterious effects of IAH.

Intra-abdominal hypertension in obese patients undergoing coronary surgery: A prospective observational study

BackgroundCoronary artery bypass grafting surgery has an increased risk of adverse events in obese patients. This increased risk might be explained in part by an increased intra-abdominal pressure and the development of intra-abdominal hypertension. Therefore, the objective of this study was to investigate the correlation between obesity and intra-abdominal hypertension and to evaluate its possible impact after coronary artery bypass grafting. MethodsA total of 50 consecutive patients scheduled to undergo coronary artery bypass grafting at a single center were selected prospectively before undergoing elective coronary artery bypass grafting. Based on the body mass index, 25 obese (body mass index ≥ 30) patients were matched with 25 control patients. Each patient had intra-abdominal pressure taken at baseline followed by one measurment every 4 hours until 24 hours after coronary artery bypass grafting. The serum markers for liver and kidney functions were collected once a day for 7 days after coronary artery bypass grafting. ResultsObese patients had a greater (mean ± SD) peak intra-abdominal pressure (15.4 ± 1.6 mm Hg versus 10.6 ± 1.6 mm Hg; P = .011) and mean change of intra-abdominal pressure from baseline (5.1 ± 3.3 mm Hg versus 2.2 ± 2.4 mm Hg; P = .001). The mean abdominal perfusion pressure was less in the obese group (63.0 ± 8.0 mm Hg versus 70.1 ± 11 mm Hg; P = .017). The liver dysfunction, as determined by the Schindl liver function scoring system between the obese and control groups, was not statistically significant (28% vs 8%; P = .066). More patients in the obese group developed renal injury based on the calculated glomerular filtration rate (32% vs 8%; P = .034). Obesity was highly associated with developing intra-abdominal hypertension (odds ratio: 2.99; 95% confidence interval: 1.92–3.53; P < .001). ConclusionObesity is associated with the development of intra-abdominal hypertension after coronary artery bypass grafting. This effect might indirectly impair the renal and liver functions through a decrease in the abdominal perfusion pressure.

The Role of Presepsin in Patients with Acute Surgical Diseases.

AIM:The purpose of this study was to determine the level of significance of markers in the development of intra-abdominal hypertension in patients with acute surgical diseases of the abdominal cavity.METHODS:The authors surveyed 100 patients who were monitored at the Regional Clinical Hospital, Karaganda. The criterion for inclusion in the study was the informed consent of patients to participate in the study, the presence of acute surgical pathology, and the monitoring of intra-abdominal pressure over time. The exclusion criteria for patients from the study is the presence of sub and decompensation of associated diseases: trauma (hematoma of the bladder), bladder tumour and impaired integrity of the pelvic ring. The design of the study was by the legislation of the Republic of Kazakhstan, international ethical norms and normative documents of research organizations, approved by the ethics committee of the Karaganda State Medical University.RESULTS:According to the world scientific literature, there are 4 indicators that change their value in response to increases in pressure in the abdominal cavity: fibrinogen and prothrombin index (the main indicators of the coagulogram); marker of blood clots D-dimer; early marker of translocation of bacterial flora into the bloodstream sCD14 (presepsin).CONCLUSION:The authors concluded that the obtained data indicate that an increase in intra-abdominal pressure in acute surgical diseases of the abdominal cavity causes hypercoagulation and an increase in presepsin. Monitoring IAP with simultaneous measurement of the level of presepsin significantly improves the stratification of critical patients in need of emergency surgery.

Mortality predictors of patients suffering of acute pancreatitis and development of intraabdominal hypertension

Background/aim Intraabdominal hypertension (IAH) occurs frequently in patients with acute pancreatitis and adds to their morbidity and mortality. The main aim of the study was to identify the determination of the predictive factors connected to IAH that influence the evolution of acute pancreatitis. Materials and methods The prospective cohort study was conducted on 100 patients who had acute pancreatitis. According to obtained intraabdominal pressure (IAP) values, the patients were divided into two groups: one group (n = 40) with normal IAP values and the other (IAH group, n = 60) with increased IAP values. Deceased patients were specially analyzed within the IAH group in order to determine mortality predictors. Results Statistical significance of IAP (P = 0.048), lactates (P = 0.048), peak pressure (P = 0.043), abdominal perfusion pressure (P = 0.05), and mean arterial pressure (P = 0.041) was greater for deceased than for surviving patients in the IAH group. High mortality appears for patients younger than 65 years old, with lactate level higher than 3.22 mmol/L and filtration gradient (GF) lower than 67 mmHg. Conclusion Age, lactates, GF, and APACHE II score are determined as mortality predictors for patients suffering from acute pancreatitis who developed IAH. The mortality rate is higher when the level of GF is decreasing and the level of lactate increasing.

Incidence, Risk Factors, and Outcomes of Intra-Abdominal Hypertension in Critically Ill Patients-A Prospective Multicenter Study (IROI Study).

To identify the prevalence, risk factors, and outcomes of intra-abdominal hypertension in a mixed multicenter ICU population. Prospective observational study. Fifteen ICUs worldwide. Consecutive adult ICU patients with a bladder catheter. None. Four hundred ninety-one patients were included. Intra-abdominal pressure was measured a minimum of every 8 hours. Subjects with a mean intra-abdominal pressure equal to or greater than 12 mm Hg were defined as having intra-abdominal hypertension. Intra-abdominal hypertension was present in 34.0% of the patients on the day of ICU admission (159/467) and in 48.9% of the patients (240/491) during the observation period. The severity of intra-abdominal hypertension was as follows: grade I, 47.5%; grade II, 36.6%; grade III, 11.7%; and grade IV, 4.2%. The severity of intra-abdominal hypertension during the first 2 weeks of the ICU stay was identified as an independent predictor of 28- and 90-day mortality, whereas the presence of intra-abdominal hypertension on the day of ICU admission did not predict mortality. Body mass index, Acute Physiology and Chronic Health Evaluation II score greater than or equal to 18, presence of abdominal distension, absence of bowel sounds, and positive end-expiratory pressure greater than or equal to 7 cm H2O were independently associated with the development of intra-abdominal hypertension at any time during the observation period. In subjects without intra-abdominal hypertension on day 1, body mass index combined with daily positive fluid balance and positive end-expiratory pressure greater than or equal to 7 cm H2O (as documented on the day before intra-abdominal hypertension occurred) were associated with the development of intra-abdominal hypertension during the first week in the ICU. In our mixed ICU patient cohort, intra-abdominal hypertension occurred in almost half of all subjects and was twice as prevalent in mechanically ventilated patients as in spontaneously breathing patients. Presence and severity of intra-abdominal hypertension during the observation period significantly and independently increased 28- and 90-day mortality. Five admission day variables were independently associated with the presence or development of intra-abdominal hypertension. Positive fluid balance was associated with the development of intra-abdominal hypertension after day 1.

Influence of intraabdominal hypertension on morphological changes of internal organs in experiment

The development of intra-abdominal hypertension is possible with a wide range of surgical pathologies, in particular, the abdominal cavity, as well as in other nosologies and significantly aggravates the prognosis. Thus, polytrauma and major burns present up to 60% of the risk of abdominal compartment syndrome (AKS), and intestinal obstruction, peritonitis and acute destructive pancreatitis - in almost 80% of cases. The purpose of the work was to investigate the morphological changes that occur in the internal organs in an intraabdominal hypertension syndrome caused by peritonitis. The experiment was conducted on 28 guinea pigs, divided into three groups: I — the control group (n=8), the II group, in which the peritonitis was simulated by destruction of the colon in the experimental animals (n=10), III — the group of experimental animals, in which the peritonitis model was combined with a paranephrine blockade in combination with a blockage of the circular ligament of the liver (n=10). In all experimental animals, intraabdominal pressure was measured every 6 hours during the day. The results were processed using Microsoft Excel spreadsheet formulas using the Student t criterion. For morphological study section material was used (fragments of the kidneys, small intestine and peritoneum). To facilitate cutting the pieces, we carried out preliminary fixation of organs in 10% neutral formalin (at least 24 hours). From each organ, cut into 1–2 bits or ribbons, which were fixed in 10% neutral formalin solution. After posting according to the generally accepted method, bits were poured into paraffin. Paraffin sections 5–7 microns thick were stained with hematoxylin and eosin. As a result of experimental work, it has been found that combined regional blockades effectively reduce intra-abdominal pressure within six hours after use, but their effect is short-lived. In the experimental peritonitis group, with the implementation of regional blockades with lidocaine solution, the morphological changes of the kidneys and peritoneum were less pronounced. Improvement of the technique of regional blockades, in particular the continued infusion of local anesthetics, can significantly increase the effectiveness of the technique without side effects that are inherent in, in particular, peridural analgesia.

Abdominal perfusion pressure is superior from intra-abdominal pressure to detect deterioration of renal perfusion in critically Ill patients.

Intra-abdominal hypertension (IAH) is a frequent cause of acute kidney injury (AKI) among critically ill patients who have risk factors. This study aimed to determine the relation between Abdominal Perfusion Pressure (APP) and AKI showed by the Doppler-based renal resistive index (RRI). In this study, 38 patients older than 18 years old who received mechanical ventilation and had risk factors for the development of IAH were prospectively studied. All measurements and parameters were divided into two groups according to renal dysfunction (Group I: RRI <0.72 vs Group II: RRI >0.72). The mean IAPs were not significant between the groups, 11.5±6.9 mm Hg in Group I (n=35) and 13.5±5.8 in Group II (n=33), respectively. APPs were statistically higher in Group I (81.2±13.6) than Group II (66.4±9.5) (p<0.001). The AUC for the association between APP at RRI >0.72 was 0.802 (p<0.001), with the APP ≤72 mmHg having a sensitivity of the 76% (95% CI 58-89%) and a specificity of 71% (95% CI 54-85%). Our findings suggest that an APP with a threshold of ≤72 mmHg is associated with a significant increase in renal RRI, which may be predictive of worsening of renal perfusion.

Risk Factors for the Development of Intra-Abdominal Hypertension and Abdominal Compartment Syndrome after Complex Ventral Hernia Repair: A Case Series of 175 Consecutive Patients

Risk Factors for the Development of Intra-Abdominal Hypertension and Abdominal Compartment Syndrome after Complex Ventral Hernia Repair: A Case Series of 175 Consecutive Patients

Intra-abdominal hypertension triggered by portal vein thrombosis postoperatively: an ignored, but potential, cause of acute kidney failure in patients with cirrhosis

Intra-abdominal hypertension (IAH), even abdominal compartment syndrome, resulting from major stem portal venous thrombosis (MSPVT) postoperatively can lead to acute kidney failure (AKF). However, few physicians consider this clinical presentation, which is rarely reported in the literature. IAH often induces a few obvious clinical presentations, such as oliguria, anuria, and abdominal distension, etc., even in cases with normal liver function. Many doctors consider that AKF is due to hepatorenal syndrome (HRS), while postoperative development of portal vein thrombosis (PVT) may be another important factor inducing AKF, which appears to have been ignored in recent years. In fact, devascularization surgery and/or shunt placement for treatment of portal hypertension are known to easily induce PVT, especially during devascularization procedures because of the rapid accumulation of platelets. In addition, the risk of hypercoagulability increases because of the use of hemostatic agents. Also, PVT may lead to gastro-intestinal congestion and tissue edema, which can contribute to the development of IAH. Abdominal distension became very obvious because collateral circulation could not be restored in time due to MSPVT after ligamentectomy surrounding the liver. Thus, it was difficult to arrive at a diagnosis of PVT at an earlier stage by B-type ultrasound and/or measurement of D-dimer levels. To achieve an early diagnosis, it is very important to actively incorporate the methods mentioned above. However, these methods are not recommended unless the diagnosis of HRS is definitive. The effective treatment is to administer anticoagulants, such as low-molecular-weight heparin, and to discontinue hemostatic agents in time. AKF will not benefit from Terlipressin if HRS was not considered as the major cause of AKF, especially in cases of IAH. It is well known that peritoneal dialysis and/or hemodialysis should be adopted to sustain kidney function postoperatively .

The duration of intra-abdominal hypertension strongly predicts outcomes for the critically ill surgical patients: a prospective observational study.

IntroductionIntra-abdominal hypertension (IAH) is associated with morbidity and mortality in critically ill patients. The present study analyzed the clinical significance of IAH in surgical patients with severe sepsis.MethodsThis was a prospective study carried out in the surgical intensive care unit (SICU). Intra-abdominal pressure (IAP) was measured three times a day via a urinary catheter filled with 25 mL of saline. IAH was defined as an IAP ≥ 12 mmHg, and the peak IAP was recorded as the IAP for the day. Data were analyzed in terms of IAH development and the IAH duration.ResultsOf the 46 patients enrolled in the study, 42 developed IAH while in the SICU. The development of IAH aggravated the clinical outcomes; such as longer SICU stay, requirement of ventilator support, and delayed initiation of enteral feeding (EF). The IAH duration showed a significant correlation with pulmonary, renal, and cardiovascular function, and enteral feeding. The IAH duration was an independent predictor of 60-day mortality (odds ratio: 1.196; p = 0.014).ConclusionsThe duration of IAH is a more important prognostic factor than the development of IAH; thus every effort should be made to reduce the IAH duration in critically ill patients.Trial registrationNCT01784458

Mortality indicators and risk factors for intra-abdominal hypertension in severe acute pancreatitis.

This study assessed the risk factors associated with mortality and the development of intra-abdominal hypertension (IAH) in patients with severe acute pancreatitis (SAP). To identify significant risk factors, we assessed the following variables in 102 patients with SAP: age, gender, etiology, serum amylase level, white blood cell (WBC) count, serum calcium level, Acute Physiology and Chronic Health Evaluation II (APACHE-II) score, computed tomography severity index (CTSI) score, pancreatic necrosis, surgical interventions, and multiple organ dysfunction syndrome (MODS). Statistically significant differences were identified using the Student t test and the χ (2) test. Independent risk factors for survival were analyzed by Cox proportional hazards regression. The following variables were significantly related to both mortality and IAH: WBC count, serum calcium level, serum amylase level, APACHE-II score, CTSI score, pancreatic necrosis, pancreatic necrosis >50%, and MODS. However, it was found that surgical intervention had no significant association with mortality. MODS and pancreatic necrosis >50% were found to be independent risk factors for survival in patients with SAP. Mortality and IAH from SAP were significantly related to WBC count, serum calcium level, serum amylase level, APACHE-II score, CTSI score, pancreatic necrosis, and MODS. However, Surgical intervention did not result in higher mortality. Moreover, MODS and pancreatic necrosis >50% predicted a worse prognosis in SAP patients.

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Background and aims: Intraabdominal hypertension (IAH) has been increasingly recognized as a cause of significant morbidity and mortality in critically ill patients. Aims: The aim of this study was to determine the relationship between mortality and abdominal perfusion pressure (APP) in pediatric intensive care (PICU) patients who have risk for IAH. Methods: Thirty five (16 female) PICU patients who had risk for the development of IAH were included.Serial intraabdominal pressure (IAP) and mean arterial pressure (MAP) measurements were performed. Abdominal perfusion pressure was calculated using the formula (MAP-IAP). Results: Overall mortality rate was 48.6% (n=17). The mortality rate in patients with IAP mean ≥ 10 mmHg (n=27, 77.1%) was 55.5% (n=15), while 53.3% (n=16) in patients with IAP max ≥ 10 mmHg (n=30, 85.7%) and 46.6% (n=7) in patients with IAP min ≥ 10 mmHg (n=15, 42.8%). Mean APP was 57.9 ± 19.6 mmHg. Logistic regression analysis revealed that decrease in minAPP was associated with increased risk for mortality (Odds ratio for each 1 mmHg decrease in APP was 1.052 [CI 95%, 1.006–1.100], p<0.05). ROC curve analysis revealed that, in predicting mortality, area under curve for minAPP was 0.765. There was no association between mortality risk and arterial pH, lactate levels or urine output volume (All, p>0.05). Conclusions: Our findings showed that APP seems to be a useful tool in predicting mortality. Interventions to improve APP may be associated with better outcomes in critically ill PICU patients.