Increase In Intra-abdominal Pressure Research Articles

Intra-Abdominal Pressure Monitoring by Surface Bioimpedance Estimation

Intra-abdominal hypertension (IAH) is produced by an accumulation of liquids in the abdominal cavity. In such case, the intra-abdominal pressure (IAP) increases, and the abdominal wall is stretched. Previously, an inverse correlation between the abdominal wall’s thickness and the IAP was theorized. Since the abdominal wall can be modelled as a compound of parallel dielectric slabs, changes in their width have direct effect on its overall bioimpedance. Numerical analyses of the bioimpedance as a function of the compression of the abdominal wall were verified by an in-situ trial on a porcine model. In this work, we present the project of a medical grade bioimpedance spectroscopy system along with a summary of our findings.

Deep versus moderate neuromuscular block in laparoscopic bariatric surgeries: effect on surgical conditions and pulmonary complications

ABSTRACTBackground: The aim of this study was to evaluate the effect of deep and moderate neuromuscular block on surgical exposure quality, intraoperative lung mechanics, and postoperative respiratory functions, during laparoscopic bariatric surgery.Methods: Sixty adult morbid obese patients were enrolled in the study. They were randomly distributed in two equal groups: the deep block group, where rocuronium infusion was given to maintain the post-tetanic counts above 1, and the moderate block group, where increments of rocuronium were delivered to maintain the train of four 1–2. The surgeon was asked to assess intraoperative relaxation. The increase in intra-abdominal pressure and reported abdominal or diaphragmatic movements were recorded. Intraoperative lung mechanics were studied, and preoperative and postoperative pulmonary function tests were done.Results: The scores reported by the surgeons for intraoperative surgical exposure were indifferent among the two groups (5 (4–5) in the deep block group and 4 (3–5) in the moderate block group, P = 0.243). The difference in the increase in intra-abdominal pressure and reported abdominal or diaphragmatic movements was insignificant between both (P = 0.299 and 0.424). Intraoperative pulmonary mechanics and postoperative pulmonary functions were comparable (P > 0.05), and the postoperative pain score was indifferent between both groups (P > 0.05).Conclusion: During laparoscopic bariatric surgery of morbidly obese patients, the quality of abdominal relaxation and surgical exposure, intraoperative lung mechanics, and postoperative pulmonary functions were indifferent with the use of moderate or deep neuromuscular block.

Is intraabdominal pressure a predictive factor for mortality and morbidity in abdominal trauma?

Abstract The clinical signs and symptoms of an acute in increase intraabdominal pressure (IAP) are subtle, especially in the conditions of the polytraumatized patient. Thus, abdominal compartment syndrome (ACS) can brutally occur and can have a major impact on the body’s main organs and systems. The purpose of our research was to identify the influence of intraabdominal pressure, intra-abdominal hypertension, and abdominal compartment syndrome, in the evolution of polytraumatized patients. Our study analyzed the patients admitted in the IIIrd Department of General Surgery of University Emergency Hospital in Bucharest between 1st of January 2010 and 31st of December 2018. The value of intraabdominal pressure, on admission, correlated with the risk of IAH/ ACS in patients with abdominal trauma - being major causes of morbidity and mortality. IAP monitoring should become a mandatory part of the management plan for patients with abdominal trauma.

CLINICAL SIGNIFICANCE AND CORRELATION OF INTRA-ABDOMINAL PRESSURE WITH THE OUTCOME OF PERFORATION PERITONITIS

Background: A progressive increase in intra-abdominal pressure (IAP) may cause abdominal compartment syndrome (ACS) with organ dysfunction. However, it remains strangely underdiagnosed.
 Objective: To correlate Intra-abdominal pressure with the outcome in perforation peritonitis patients.
 Methods: An Observational study was done on 50 patients with perforation peritonitis and patients undergoing intervention in the form of either emergency laparotomy or drain placement. The abdominal pressures were indirectly determined by measuring urinary bladder pressure with a Foley's catheter. Pearson correlation was used to see relation between intra- abdominal pressure and outcome of peritonitis. SPSS version 16 (trial) was used for analysis.
 Results: Mean intra-abdominal pressure during time of presentation to the hospital was 26.4±3.8cm H2O. Among various morbidities following operation, surgical site infection was most common (36%) followed by wound dehiscence (30%). There was strong linear correlation between intra-abdominal pressure and factors determining morbidity such as surgical site infection, wound dehiscence, burst abdomen.
 Conclusions: There is a strong correlation of various co morbidities with increased intra-abdominal pressure in patients with perforation peritonitis which was significant statistically.
 Keywords: Intra- Abdominal Pressure, Intravescical pressure, perforation peritonitis, Abdominal Compartment Syndrome.

Intraabdominal pressure and worsening renal function during decompensations of heart failure. A preliminary report from the PIA study

BackgroundAn increase in intraabdominal pressure (IAP) during acute heart failure, seems to be directly related to worsening renal function, which leads to worse clinical outcomes. We aimed to analyze the relationship between IAP and determinants of renal function during admission for acute decompensation of heart failure (ADHF) in a conventional Internal Medicine Ward. Patients and methodsDescriptive and prospective study. Patients admitted for ADHF with an estimated glomerular filtration rate >30mL/min/1.73m2, willing to participate and who gave their informed consent were included. Ethics Committee of Aragon approved the protocol (PI 15 0227). ResultsWe hereby report the results of an interim analysis of the first 28 patients included. Patients were divided in 2 groups according to the median of IAP measured during the first 24h after admission for ADHF, namely high IAP (IAP>15mmHg) and low (IAP<15mmHg). Fourteen patients were included in each group. No differences were found in baseline clinical characteristics, comorbidities or treatment between both groups. Patients with IAP above 15mmHg, showed a significant lower baseline estimated glomerular filtration rate (70.7 vs. 44.4mL/min/1.73m2 with p=0.004], blood urea 36 vs. 83mg/dL with p=0.002]; serum creatinine 0.87 vs. 1.3mg/dL with p=0.004 and cystatin C 1.2 vs. 1.94mg/dL with p=0.002. Additionally, these patients had higher uric acid (5.7 vs. 8.0, p=0.046), lower hemoglobin concentrations (11.7 vs. 10.5g/L, p=0.04) and longer length of hospital stay (6.5 vs. 9.6 days, p=0.017). ConclusionsThe increase in IAP seems to be a frequent finding in patients admitted for ADHF. Patients share similar clinical profile irrespective of IAP, although the increase in IAP is associated with a significant baseline impairment of renal function.

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.

Analyzing the effect of laparoscopy duration time on peroperative gastroesophageal reflux

Background/aimIntraabdominal pressure (IAP) is one of the main reasons for gastroesophageal reflux (GER). This study investigates whether IAP during laparoscopic surgery leads to GER in a time-dependent manner.Materials and methodsIn a laparoscopy model, 15 mmHg IAP was created in 8 Wistar albino rats in the Trendelenburg position (TP). A 5 mm laparotomy was performed in the left lower abdominal region, and a 6 Fr catheter was placed intraabdominally. Air was insufflated into the abdominal cavity, and the pressure was kept constant at 15 mmHg. Esophageal pH alterations were measured by pH sticks for 4 h every 30 min.ResultsThe basal median esophageal pH value was 9 (8–10), the value after placing the catheter was 9 (7–10) (P = 0.47), and the median pH value after placing the subjects in TP was 9 (8–10) (P = 0.70). In our experimental model, esophageal pH values were found to decrease significantly at the 150th minute in TP and at 15 mmHg IAP (P < 0.05). Two rats died: one at the 120th minute and the other at the 240th minute (P > 0.05).ConclusionEsophageal pH values decreased and continued to remain low following IAP increase and TP in this experimental rat model. Prolonged laparoscopic procedures can particularly lead to GER that requires instant recognition and rapid and appropriate intervention.

Інвагінація кишечника у дітей. Історія та сучасний стан проблеми (огляд літератури)

Acute intestinal intussusception in children is a frequent type of acquired intestinal obstruction and ranks second among nosologies in pediatric emergency surgery after acute appendicitis. Of course, today there remains an interest in the issue of improving the efficiency of diagnosis and treatment of this pathology of children. Laparoscopy allows you to identify invaginate, assess the condition of the intestine in the area of infringement and identify (or exclude) concomitant pathology contributing to the occurrence of invagination, and the simultaneous use of pneumocompression can greatly facilitate the smoothing of invaginate. Nevertheless, the number of scientific reports and works on, possibly, the negative effect of increased pressure in the abdominal cavity on the function of individual organs and systems of newborns and young children is not enough. That is why a number of questions about the safety of the use of laparoscopic method in the treatment of intussusception in infants in combination with pneumocompression, because at this moment there is a sharp increase in intra-abdominal pressure. Answers to questions can be obtained by studying the effect of combined pressure on the state of internal organs. This became the basis for conducting an appropriate clinical experimental study. The results of the study should determine the safe limits of intra-abdominal pressure when using the method of laparoscopy in combination with pneumocompression.

Increased Intra-abdominal Pressure Induces Acute Kidney Injury in an Experimental Model of Congestive Heart Failure

Congestive heart failure (CHF) entails a complex interaction between the heart and the kidney that represents a clinical entity called cardiorenal syndrome (CRS). One of the mechanisms underlying CRS includes increased intra-abdominal pressure (IAP). We examined the effect of elevated IAP on kidney function in rats with low- and high-output CHF. Rats with compensated and decompensated CHF induced by means of aortocaval fistula, rats with myocardial infraction (MI) induced by means of left anterior descending artery ligation, and sham control rats were subjected to either 10 or 14 mm Hg IAP. Urine flow (V), Na+ excretion (UNaV), glomerular filtration rate (GFR), and renal plasma flow (RPF) were determined. The effects of pretreatment with tadalafil (10 mg/kg orally for 4 days) on the adverse renal effects of IAP were examined in decompensated CHF and MI. Basal V and GFR were significantly lower in rats with decompensated CHF compared with sham control rats. Decompensated CHF rats and MI rats subjected to 10 and 14 mm Hg IAP exhibited more significant declines in V, UNaV, GFR and RPF than compensated and sham controls. Elevated IAP also induced tubular injury, as evidenced by significantly increased absolute urinary excretion of neutrophil gelatinase-associated lipocalin. In addition, in a nonquantitative histologic analysis, elevated IAP was associated with increase in necrosis and cell shedding to the tubule lumens, especially in the decompensated CHF subgroup. Pretreatment of decompensated CHF rats and MI rats with tadalafil ameliorated the adverse renal effects of high IAP. Elevated IAP contributes to kidney dysfunction in high- and low-cardiac output CHF. IAP induces both hemodynamic alterations and renal tubular dysfunction. These deleterious effects are potentially reversible and can be ameliorated with the use of phosphodiesterase-5 inhibition.

Diastasis Recti Abdominis-diagnosis, Risk Factors, Effect on Musculoskeletal Function, Framework for Treatment and Implications for the Pelvic Floor

Background:Diastasis Recti Abdominis (DRA) can occur during pregnancy and postpartum. It is defined as an increase of the inter-recti distance (IRD) beyond normal values. The diagnosis of DRA is inconsistent within the literature and varies depending on measurement instrument and activity during measurement (rest versus active curl-up). DRA is characterized by the stretching of linea alba (LA) and contributes to a protrusion of the anterior abdominal wall due to increased laxity in the myofascial system that supports abdominal viscera. DRA has been postulated to affect lumbopelvic support and function due to laxity of the LA and altered angle of muscle insertion, but recent studies have not confirmed this. Risk factors for the development of DRA have been investigated in pregnancy to 12-months postpartum.Objective:Rehabilitation for DRA has been traditionally focused on reducing the IRD, but recent research has proposed that a sole focus on closing the DRA is suboptimal.Results:It is important alongside the rehabilitation of the abdominal wall that there is the consideration of the pelvic floor (PF). In healthy individuals, with the activation of the transversus abdominis, there is a sub-maximal co-contraction of the PF muscles. This co-contraction can be lost or altered in women with urinary incontinence. An increase in intra-abdominal pressure without simultaneous co-contraction of the PF may cause caudal displacement of the PF.Conclusion:The aim of this review is to bring the reader up to date on the evidence on DRA and to propose a rehabilitation framework for the whole abdominal wall in DRA with consideration of the impact on the PF.

In Search of a Simple and Reliable Method of Measuring Intra-abdominal Pressure in Peritoneal Dialysis Patients.

Background:Patients treated with peritoneal dialysis (PD) are at increased risk of developing mechanical complications such as dialysate leaks and hernias thought to be partially related to an increase in intra-abdominal pressure (IAP) secondary to dialysate in the abdomen. However, measurement of IAP requires specialized equipment that is not readily available in the home dialysis unit.Objectives:To develop a reliable method of measuring IAP in PD patients that could be easily used in the home dialysis unit. We hypothesized that the handheld Stryker pressure monitor would be suitable for this purpose via connection to the PD catheter.Design:Cross-sectional.Setting:Tertiary Care Hospital, Ottawa, Ontario, Canada.Patients:Patients who were having a PD catheter inserted via laparoscopic surgery at The Ottawa Hospital were recruited for the study.Measurements:With the patients at end-expiration, the IAP measured with the Stryker monitor connected to the PD catheter was compared with the insufflator pressures of 15, 10, and 5 mm Hg.Methods:Bland-Altman plots were constructed and intraclass correlation coefficients were calculated for each pressure.Results:Twelve patients participated in the study: 9 men and 3 women. They were on average 53 ± 15 years old and 81 ± 13.4 kg. Two patients had to be excluded from the analysis due to difficulties zeroing the Stryker pressure monitor at the time of surgery. There were also rapid fluctuations in the insufflator pressure recording, creating additional challenges in comparing the 2 measurements at end-expiration. The 95% limits of agreement for the Bland-Altman plots ranged from 7.9 (@15 mm Hg) to 12.2 (@10 mm Hg). The intraclass correlation coefficients for reliability of the individual measurements ranged from 0.015 (10 mm Hg) to 0.634 (15 mm Hg).Limitations:Small sample size and lack of a gold standard comparator may have affected our results.Conclusions:In our study, we used the operating room insufflator as the gold standard for measuring IAP. By Bland-Altman plots and intraclass correlation coefficients, the pressure values obtained with the Stryker pressure monitor were not a reliable estimate of insufflator IAP especially at lower pressures. Further studies are needed to identify an ideal tool for measurement of IAP to guide PD management.

Spontaneous Activity in Urethral Smooth Muscle.

The urethra is a muscular tube that extends from the bladder neck and is composed of an inner layer of smooth muscle referred to as the internal urethral sphincter and an outer layer of striated muscle which forms the external urethral sphincter. The smooth muscle layer can be separated into an inner layer of longitudinally orientated smooth muscle and an outer, relatively thinner, layer of circular muscle. Tonic contraction of both the smooth and striated muscle components of the urethra generates a urethral closure pressure which exceeds intravesical pressure in the bladder to maintain urinary continence. It is likely that contraction of urethral smooth muscle is involved in the long-term maintenance of tone, since it can achieve this at relatively low energy cost, whereas the striated muscle contributes more to the rise in urethral tone that accompanies increases in bladder pressure secondary to coughing or other sudden increases in intra-abdominal pressure. The level of urethral smooth muscle tone is regulated by several autonomic neurotransmitters, including noradrenaline, acetylcholine, ATP and nitric oxide. However, it is also clear that urethral smooth muscle is capable of generating significant tone in the absence of neural input. In this chapter we will discuss the mechanisms responsible for contraction of urethral smooth muscle, with specific focus on the role of ion channels and Ca2+ handling proteins to this process. The mechanisms underlying spontaneous activity in urethral interstitial cells(UICs), putative pacemaker cells of the urethra, will also be examined along with the modulation of these mechanisms by key excitatory and inhibitory neurotransmitters.

A novel human cadaver model to investigate a retrourethral transobturator male sling procedure.

PurposeTo develop a cadaver model for the assessment of a male transobturator male sling (retrourethral transobturator sling [RTS], AdVance™; Boston Scientific, USA) to investigate its effect on a simulated abdominal and retrograde leak point pressures (ALPP, RLPP) and the urethral pressure profile (UPP).Materials and MethodsThree fresh frozen human male cadaver specimens were obtained. A suprapubic tube was inserted into the bladder and connected to a digital manometer to measure bladder pressure. Manual suprapubic pressure was then applied to generate an increase in intraabdominal pressure and measure a simulated ALPP. Subsequent measurements of RLPP and UPP were recorded. All measurements were undertaken prior to and following insertion of a RTS.ResultsThe placement of the RTS consistently increased the simulated ALPP for all three cadaver specimens when compared to baseline measures. No leaks occurred at simulated ALPP's of 170 cm H2O for specimen 1, 160 cm H2O for specimen 2, and 170 cm H2O for specimen 3. There was minimal or no change in the RLPP's and UPP's following insertion of the RTS when compared to respective baseline.ConclusionsA model using fresh unfixed cadavers that incorporates a simulated measurement of ALPP is feasible for male stress urinary incontinence surgical intervention investigations.

The Relation between the Distance of Recto-Fascial Plication and the Intra-Abdominal Pressure Changes before and Immediately after Abdominoplasty

Background: Abdominoplasty surgery involves excisionof redundant abdominal skin flap and, in most cases, involvesrestoring weakened anterior abdominal wall muscles creatingan abdominal profile that is smoother and firmer. Diastasisrecti caused by anterior abdominal wall weakness. It happensbecause the space between left and right recti muscles hasbeen widened. Surgical correction for diastasis during theabdominoplasty can be considered as a definitive way forcorrection of diastasis by performing a plication or foldingof the linea alba, this results in a tighter abdominal wall.Aim of Work: Is to evaluate the relationship between thedistance of recto-fascial plication and intra-abdominal pressure(IAP) changes before and immediately after abdominoplasty.Patient and Methods: This study included 75 femalepatients, ageing between 24-57 years old, with mean age of43.3 years. Patients complained of abdominal redundancyafter childbirth, or post massive weight loss, with weak anteriorabdominal wall muscles. The diastasis width was measuredintraoperatively at three levels (3cm above the umbilicus, atthe umbilicus, and 3cm below the umbilicus) before performingrecto-fascia plication. Recto-fascial plication have beenperformed for all patients during their abdominoplasty procedurein two layers. Intra-abdominal pressure (IAP) variation,before and immediately after rectus sheath plication weremeasured using U-tube technique. Statistical analysis of allmeasurements were done.Results: Statistical analysis showed that the mean valueof diastasis above and at the umbilicus didn't differ significantly,however it was significantly lower below the umbilicuscompared with the other two levels. Comparing the pre andpostoperative IAP showed non-statistically significant increaseof IAP postoperative. Most importantly, statistics showed thatthere is a statistically significant positive correlation betweenthe IAP immediately after surgery and the distance of rectofascialplication especially above the umbilicus. Complicationrate in the current study was 2.6%.Conclusion: As a result of our current study, rectus diastasiswidth is significantly correlated with the IAP immediatelyafter abdominoplasty, therefore the larger the width of therectus diastasis, the more increase of IAP that would happenimmediately after abdominoplasty.

Impact of technical innovation on surgical outcome of laparoscopic major liver resection: 10 years' experience at a large-volume center.

PurposeLaparoscopic major liver resection (major LLR) remains a challenging procedure because of the technical difficulty. Several significant technical innovations have been applied in our center since 2012. They include routine application of bipolar electrocautery, initiation of temporary increase of intra-abdominal pressure during bleeding events from veins to balance the central venous pressure, and use of temporary inflow control of the Glissonean pedicle. This study evaluated the impact of these technique modifications in patients with major LLR.MethodsBetween January 2004 and February 2015, a total of 606 patients underwent LLR at Samsung Medical Center in Seoul, Korea. Major LLR was employed in 233 cases. All major LLR procedures were anatomical resections performed with a totally laparoscopic approach. We compared surgical parameters of right hepatectomy (RH), left hepatectomy (LH), and right posterior sectionectomy (RPS) before and after 2012.ResultsOpen conversion rates of RH and LH and estimated blood loss in RPS significantly decreased after 2012. The postoperative complication rate of major LLR was 12.7% and was similar before and after 2012. Bile leakage was the most common complication (3.2%).ConclusionThe modifications of surgical techniques resulted in good outcomes for laparoscopic major LLR. We recommend routine application of these techniques to improve outcomes, especially in patients requiring major liver resection.

Presión intraabdominal y empeoramiento de la función renal durante las descompensaciones de la insuficiencia cardiaca. Un informe preliminar del estudio PIA

BackgroundAn increase in intraabdominal pressure (IAP) during acute heart failure, seems to be directly related to worsening renal function, which leads to worse clinical outcomes. We aimed to analyze the relationship between IAP and determinants of renal function during admission for acute decompensation of heart failure (ADHF) in a conventional Internal Medicine Ward. Patients and methodsDescriptive and prospective study. Patients admitted for ADHF with an estimated glomerular filtration rate > 30mL/min/1.73 m2, willing to participate and who gave their informed consent were included. Ethics Committee of Aragon approved the protocol (PI 15 0227). ResultsWe hereby report the results of an interim analysis of the first 28 patients included. Patients were divided in 2groups according to the median of IAP measured during the first 24h after admission for ADHF, namely high IAP (IAP>15mmHg) and low (IAP< 15mmHg). Fourteen patients were included in each group. No differences were found in baseline clinical characteristics, comorbidities or treatment between both groups. Patients with IAP above 15mmHg, showed a significant lower baseline estimated glomerular filtration rate (70.7 vs. 44.4mL/min/1.73 m2 with p=0.004], blood urea 36 vs. 83mg/dL with p=0.002]; serum creatinine 0.87 vs. 1.3mg/dL with p=0.004 and cystatin C 1.2 vs. 1.94mg/dL with p= 0.002. Additionally, these patients had higher uric acid (5.7 vs. 8.0, p=0.046), lower hemoglobin concentrations (11.7 vs. 10.5g/L, p=0.04) and longer length of hospital stay (6.5 vs. 9.6 days, p=0.017). ConclusionsThe increase in IAP seems to be a frequent finding in patients admitted for ADHF. Patients share similar clinical profile irrespective of IAP, although the increase in IAP is associated with a significant baseline impairment of renal function.

Determination of the diagnostic value of early symptoms in the prognosis of necrotizing enterocolitis in neonates of different gestational age

Necrotizing enterocolitis in newborns - non-specific inflammation of the intestine, predominantly in preterm infants, which puts a child's life at risk when it progresses. Despite the large number of studies of foreign and domestic scientists in the study of etiology and pathogenesis, clinical, laboratory and instrumental diagnosis of NEC, this disease remains one of the leading causes of infant mortality in intensive care units. Clinical symptoms of NEC can be manifested from intolerance to nutrition and intestinal paresis to severe peritonitis and multiple organ failure, and most diagnostic methods have high specificity but insufficient sensitivity or vice versa. The detection of early symptoms and progression symptoms of the NEC allows you to choose the best treatment tactics and improve your results. Therefore, differential diagnosis on the basis of clinical, instrumental and laboratory studies plays an important role in the diagnosis and determination of the stages of the NEC. The success of NEC treatment depends not only on timely diagnosis and evidence of surgical treatment, but also on the depth and distribution of bowel damage. Currently, there are no reliable non-invasive methods for diagnosis of the spread and depth of damage to the intestinal wall under the NEC. The terms of pre-operative preparation, the scope and type of surgical treatment remain controversial.Objective. The purpose of the study is to determine the diagnostic value of early symptoms in the development and progression of necrotizing enterocolitis in newborns of different gestational age.Materials and Methods. The work is based on studying the results of treatment of 94 newborns with NECs who were on treatment in the department of intensive care and pathology of newborns "Dniepropetrovsk Specialized Clinical Medical Center of Mother and Child. prof. MFRudneva "DOR" in 2015-2018. The diagnosis was established on the basis of clinical, instrumental (ultrasound, doppler, x-ray), laboratory and bacteriological studies. Patients were divided in terms of treatment tactics into two groups: the first group consisted of patients with NEC who did not require surgical intervention (uncomplicated NEC) (n = 71), the second group included patients requiring surgery (complicated by the NEC) ( n = 23). Additionally, patients in both groups performed intra-abdominal pressure measurements.Measurement of abdominal circumference in all patients with NECs was performed at the navel level in at least three measurements taken at intervals of 4-6 hours.Initial treatment was the same for patients in both groups and included: decompression of the stomach, complete parenteral nutrition, antibiotic therapy.Results and discussion. Increased symptoms of inability to enter into the stomach (inferiority syndrome), congestive growth in the stomach, auscultation of peristaltic bowel sounds, bloating, pain and / or tightness of the stomach accompanied the deterioration of the general condition of patients and the development of complicated forms of NEC.The appearance of a venous figure on the anterior abdominal wall and its pronounced nature over time, hyperemia and edema of the anterior abdominal wall and external genital organs revealed the presence of intraperitoneal hypertension and intra-abdominal circulation disturbance as a result of reduced perfusion pressure and inflammatory changes in the peritoneum.The increase in the abdominal circumference in patients of the I group was not more than 5 mm in the previous measurement, with the progression of the HEC and the development of complicated forms of NEC, the increase in abdominal circumference was 7 mm larger than the previous results.The main diagnostic tool for detecting progression and complications of NEC was the performance of X-ray of the abdominal cavity. X-ray of the abdominal cavity was performed for all patients with a suspicion on a NEC in a straight projection in an upright position. The most common X-ray symptoms of complicated NECs were the discovery of pneumoperitoneum, free fluid in the abdominal cavity and non-peristaltic static bowel loop. Also, the data obtained indicate that patients with complicated forms of NEC disease are accompanied by a significant increase in intraabdominal pressure, mainly due to sequestration of fluid in the third space, increasing intestinal paresis and its edema. If you do not diagnose and not eliminate a significant increase in intra-abdominal pressure, this leads to a violation of capillary perfusion of the internal organs, which leads to further ischemia and the development of abdominal compartment - a syndrome.When diagnosing pneumoperitoneum, ascites on the background of NEC or with the advent of clinical symptomatology, the progression of HEC (to exclude a hidden perforation) under ultrasound control was performed for all patients under local anesthesia abdominocentesis. In the case of a positive result of abdominocentesis, drainage of the abdominal cavity was performedConclusions. Among the early clinical syndromes that characterize the progression of the NEC, it is necessary to pay attention to the growth of the syndrome of enteral insufficiency. An increase in the incidence of intra-abdominal hypertension is an early symptom of the progression of the NEC.

IMPROVEMENT OF TECHNOLOGIES OF DIAGNOSTICS AND TREATMENT OF INTRA-ABDOMINAL HYPERTENSION IN ACUTE SURGICAL PATHOLOGY OF ABDOMINAL CAVITY

Relevance. The article is devoted to the problem of diagnosis and treatment of intra-abdominal hypertension (IAH) in acute abdominal pathology. Acute surgical diseases and abdominal injuries are accompanied by an increase in intra-abdominal pressure (IAP) in 83.6% of cases, and cause an abdominal compartment syndrome (ACS) in 16.8% of the observations.&#x0D; Objective. This review seeks to improve the results of treatment of patients with acute abdominal pathology by improving the methods of diagnosis, prevention and treatment of IAH.&#x0D; Materials and methods. The results of treatment of 187 patients with acute pathology of abdominal organs, which was accompanied by high IAP, were analyzed. Among the 187 patients, 98 (52.4%) were men, 89 (47.6%) women. The patients were divided into two groups depending on the diagnostic and therapeutic tactics chosen: the comparison group (85 (45.5%) persons) and the main group (102 (54.5%) persons). The treatment of them were carried out in accordance with our harmonized diagnostic and treatment algorithm of the correction of IAH. 149 (79.7%) patients were operated: 82 patients in the main group and 67 persons in comparison group. Our own method for the long-term determination of IAP by measuring it in the bladder was used for long-term diagnostics of IAP. Advanced laparolifting system was used in the complex conservative treatment of patients with acute pancreatitis accompanied by IAH. Methods for predicting the possibility of performing laparoscopic intervention in urgent surgery and postoperative pain after laparoscopic surgery were improved.&#x0D; Results. Implementation of the improved method of measuring IAP through prolonged monitoring of BP allowed to timely select and start the necessary therapeutic tactics, aimed to overcome intra-abdominal hypertension, and to avoid the development of abdominal compartment syndrome (sensitivity of the technique was 95.2%, specificity - 85.7%). The use of our advanced diagnostic and treatment algorithm for the prevention and treatment of IAH allowed to limit the measures to the first level in 67,6% of cases, to the second level - in 22,5% and to avoid the decompression laparostomy. At the same time, the need for such intervention arose in 11.1% of patients who had conservative treatment.&#x0D; Use of the proposed laparolifting system in the complex conservative treatment of IAH of patients with acute pancreatitis allowed to normalize IAP in the vast majority of patients, preventing the occurrence of ACS by reducing the frequency of complications associated with IAH, from 52.9% to 16.7% (p = 0.03 ), as well as overall mortality - from 35.3% to 5.6% (p = 0.03). Implementation into clinical practice the method of predicting the possibility of performing laparoscopic intervention in the conditions of urgent surgery by registering the initial values ​​of IAP, allowed to expand the indications for the implementation of this type of surgery in treatment of acute surgical pathology of the abdominal cavity organs (sensitivity of the technique was 85.7%, specificity - 95.5%). Local use of stereoselective NSAIDs (original dexketoprofen) at the end of the laparoscopic intervention followed by their intramuscular administration has a higher analgesic effect in comparison with other classes of analgesic agents, which is reliably confirmed by pain assessment indicators (visual analogue scales, blood plasma cortisol and external respiration function) (p &lt;0.0001), and has a significantly higher degree of safety (p &lt;0.001). Application of the proposed diagnostic and treatment algorithm in the complex treatment of patients with acute surgical pathology of the abdominal cavity, which is accompanied by IAH, allowed to achieve the intended goal for improving the treatment results of this category of patients by reducing the incidence of systemic complications from 54.1% to 11.8% ( p &lt;0.0001), total mortality from 21.2% to 1.96% (p &lt;0.0001), and postoperative lethality from 22.4% to 2.4% (p = 0.0001).&#x0D; Conclusions. The method of measuring IAP by prolonged monitoring of BP is effective and practical (sensitivity of the technique was 95.2%, specificity - 85.7%). The use of the laparolifting system in patients with acute pancreatitis accompanied by IAH allowed to reduce the frequency of complications from 52.9% to 16.7% (p = 0.03), and the overall mortality - from 35.3% to 5.6% (p = 0,03). The introduced method of predicting the possibility of performing laparoscopic intervention in urgent surgery demonstrates high sensitivity (85.7%) and specificity (95.5%). The local use of stereoslective NSAIDs at the end of the laparoscopic intervention has a high analgesic effect and has a significantly higher safety degree (p &lt;0.001). The use of the advanced diagnostic and treatment algorithm for treatment of IAH allows to apply only the first level measures in 67,6% of cases, the second level measures in 22,5%, to avoid the implementation of decompression laparostomy and to reduce the incidence of systemic complications from 54,1% to 11,8% (p &lt;0.0001), to reduce total mortality from 21.2% to 1.96% (p &lt;0.0001) and postoperative lethality from 22.4% to 2.4% (p = 0.0001).

A Novel Non-Gas Endospray for Applying Fibrin Glue in Laparoscopic Surgery

Purpose: Fibrin glue and polyglycolic acid felt are used for tissue repair in various surgical procedures. However, using a spray device to apply fibrin sealant during laparoscopic surgery can increase the intraperitoneal pressure, which can cause complications such as air embolism. We developed a novel non-gas endospray for use in laparoscopic surgery. This study aimed to evaluate the sealing effect of this non-gas endospray in comparison with a conventional gas-spray device and to evaluate the safety of its application in the clinical setting. Materials and Methods: An ex vivo pressure test model was used to assess the sealing effect of the non-gas endospray (method 1) versus conventional gas-spray (method 2). A bottle was sealed with a rabbit skin sample that had been pierced nine times by a 19G needle. Each skin sample was sealed using either method 1 or method 2 (n = 10 for each method). The non-gas endospray was then used in two patients undergoing laparoscopic splenectomy with CO2 pneumoperitoneum. Intra-abdominal pressure was measured throughout the surgery. Results: Bursting pressures were similar in method 1 (246.9 ± 123.2 mmHg) and method 2 (265.5 ± 93.6 mmHg; P = 0.7082). During laparoscopic splenectomy, the non-gas endospray was successfully used to apply fibrin glue without any increase in intra-abdominal pressure. Conclusions: The novel non-gas endospray produced a strong sealing effect similar to that of a conventional gas-spray device and has thus far proved feasible in the clinical setting.

The Case Files

The Case Files