Intra-abdominal Hypertension In Patients Research Articles

Increased intraluminal pressure in the small intestine as an important factor in the development of intra-abdominal hypertension in patients with diffuse secondary peritonitis: An observational prospective study

Increased intraluminal pressure in the small intestine as an important factor in the development of intra-abdominal hypertension in patients with diffuse secondary peritonitis: An observational prospective study

Continuous passive paracentesis versus large-volume paracentesis in the prevention and treatment of intra-abdominal hypertension in the critically ill cirrhotic patient with ascites (COPPTRIAHL): study protocol for a randomized controlled trial

BackgroundCritically ill patients with cirrhosis and ascites are at high risk for intra-abdominal hypertension (IAH) which increases mortality. Clinical guidelines recommend maintaining intra-abdominal pressure (IAP) below 16 mmHg; nonetheless, more than three quarters of critically ill patients with cirrhosis develop IAH during their first week of ICU stay. Standard-of-care intermittent large-volume paracentesis (LVP) relieves abdominal wall tension, reduces IAP, optimizes abdominal perfusion pressure, and is associated with short-term improvement in renal and pulmonary dysfunction. However, there is no evidence of the superiority of different paracentesis strategies in the prevention and treatment of IAH in critically ill patients with cirrhosis.This trial aims to compare the outcomes of continuous passive paracentesis versus LVP in the prevention and treatment of IAH in patients with cirrhosis and ascites.MethodsAn investigator-initiated, open label, randomized controlled trial, set in a general ICU specialized in liver disease, was initiated in August 2022, with an expected duration of 36 months. Seventy patients with cirrhosis and ascites will be randomly assigned, in a 1:1 ratio, to receive one of two methods of therapeutic paracentesis. A stratified randomization method, with maximum creatinine and IAP values as strata, will homogenize patient baseline characteristics before trial group allocation, within 24 h of admission.In the control group, LVP will be performed intermittently according to clinical practice, with a maximum duration of 8 h, while, in the intervention group, continuous passive paracentesis will drain ascitic fluid for up to 7 days.The primary endpoint is serum creatinine concentration, and secondary endpoints include IAP, measured creatinine clearance, daily urine output, stage 3 acute kidney injury and multiorgan dysfunction assessed at day 7 after enrollment, as well as 28-day mortality rate and renal replacement therapy-free days, and length-of-stay. Prespecified values will be used in case of renal replacement therapy or, beforehand ICU discharge, liver transplant and death. Safety analysis will include paracentesis-related complication rate and harm. Data will be analyzed with an intention-to-treat approach.DiscussionThis is the first trial to compare the impact of different therapeutic paracentesis strategies on organ dysfunction and outcomes in the prevention and treatment of IAH in critically ill patients with cirrhosis and ascites.Trial registrationClinicalTrials.gov NCT04322201. Registered on 20 December 2019

Внутрішньочеревна гіпертензія як ускладнення гострого панкреатиту

The aim of our work was to review modern aspects of pathogenesis, diagnosis and treatment of intra-abdominal hypertension as a complication of the severe course of acute pancreatitis. Acute pancreatitis is a systemic disease, the severe course of which is associated with organ dysfunction and increased intra-abdominal pressure. The frequency of intra-abdominal hypertension in patients with severe acute pancreatitis is 60%, while 10-30% of patients in this category hospitalized in the intensive care unit have abdominal compartment syndrome. An increase in intraabdominal pressure has a negative effect on the course of acute pancreatitis. Namely, multiple organ failure occurs more often; pancreatic and peripancreatic necrosis, prolonged systemic inflammatory response syndrome, complications during the use of enteral nutrition, the need for invasive interventions, the length of hospitalization and the percentage of deaths increase. Determination of intra-abdominal pressure through the urinary bladder in patients with severe acute pancreatitis should be considered as a standard for diagnosing intraabdominal hypertension. It has been proven that the use of paracentesis with drainage of the abdominal cavity in the staged treatment of patients with a complicated course of acute pancreatitis (peripancreatic accumulation of fluid in the early period of the disease) reliably reduces intra-abdominal pressure after 72 h since the detection of fluid (17.4 ± 2.6 and 11.4 ± 1.6 mm Hg), serum amylase (774.3 ± 233.9 and 472.7 ± 168.6 Units/l), procalcitonin (1.3 ± 0.7 and 0.6 ± 0.5 ng/ml) and interleukin-6 (531.3 ± 120.9 and 417.1 ± 82.4 pg/ml). Achievements in intensive care, optimization of indications for surgical interventions, early enteral nutrition, rational use of liquid resuscitation and the growing role of minimally invasive interventions have had a positive effect on the prognosis of acute pancreatitis, overall morbidity and led to a decrease in deaths in this category of patients. However, the prevention and treatment of persistent intra-abdominal hypertension and abdominal compartment syndrome require further study and improvement.

FACTORS INCREASING INTRA-ABDOMINAL PRESSURE IN PATIENTS WITH A COMPLICATED COURSE OF ACUTE PANCREATITIS

Relevance. The frequency of development of intra-abdominal hypertension in patients with a complicated course of acute pancreatitis is 60-70% and leads to an increase in the mortality rate up to 62%. Acute peripancreatic fluid collection, occurring in 65.2-88.9% of patients with moderate and severe acute pancreatitis in the early period of the disease, is one of the causes of increased intra-abdominal pressure.
 Objective: to assess the effect of acute peripancreatic fluid collection on intra-abdominal pressure and the effectiveness of paracentesis with drainage of the abdominal cavity as a method of treatment of intra-abdominal hypertension in patients with complicated course of acute pancreatitis in the early period of the disease.
 Methods. The study included 60 patients with a complicated course of acute pancreatitis, who were divided into two groups depending on the features of the selected treatment tactics: the main group (paracentesis, drainage of the abdominal cavity was additionally performed) – 30 patients, the comparison group (conservative therapy was applied) - 30 patients. Intra-abdominal pressure indicators were compared in the studied groups and performed a comparative analysis of the dependence of its changes on the amount of exudate removed from the abdominal cavity.
 Results. When using paracentesis and drainage of the abdominal cavity in the early period in patients with a complicated course of acute pancreatitis, a significant difference was obtained between the intra-abdominal pressure indicators in the studied groups after one day (8.7±1.5 vs. 14.7±3.3 mm Hg (p<0.0001)) and after 7 days (10.5±1.3 vs. 12.7±2.5 mm Hg (p=0.0001)). In the patients of the main group, a decrease in intra-abdominal pressure was observed on the first day after paracentesis, followed by an increase after three days and stabilization after 6 days, and an average negative correlation was found between the amount of exudate removed from the abdominal cavity and changes in intra-abdominal pressure with the Pearson coefficient r = - 0.4418.
 Conclusions. The use of paracentesis, drainage of the abdominal cavity in patients with complicated course of acute pancreatitis in the early period of the disease can be considered as a safe and effective method of treatment of intra-abdominal hypertension in this category of patients.

ASSESSMENT OF INTRA-ABDOMINAL HYPERTENSION AND ITS CORRELATION TO ORGAN FAILURE IN PATIENTS ADMITTED TO SURGICAL CRITICAL CARE UNIT

Background: Intra-abdominal hypertension (IAH) is the sustained elevation in intra-abdominal pressure (IAP) ≥ 12 mmHg. It has been shown to affect various organs of the body, causing derangement and dysfunction of different organ systems. However the problem remains unappreciated and this study was done to assess the problem of IAH among the ICU patients in our own environment and also to understand the signicance of elevated IAPas a marker of organ dysfunction. Objectives Ÿ To assess prevalence of intra-abdominal hypertension in a surgical critical care unit of a tertiary care hospital Ÿ To correlate intra-abdominal hypertension with organ failure in patients admitted to surgical critical care unit. Methodology: This was an observational prospective study done among 75 patients who were admitted for a minimum period of 3 consecutive days in the surgical critical care unit of JMMC&RI, Thrissur from April 2016 to March 2017. The IAP was measured thrice daily, and SOFAscore daily for 3 consecutive days. The results were analyzed using SPSS software. Results: The prevalence of IAH in patients admitted to surgical critical care unit is 46.7% based on mean IAPand 78.7% based on maximum IAP. The mean IAPand SOFAscore were 11.40 ± 4.37 mmHg and 4.55 ± 2.72 respectively. 34.7 % of patients had organ failure. 51.4% of patients with IAH had organ failure. The mortality was 22.9% in population with IAH. The mean ICU stay and hospital stay in patients with IAH were 6.77 ± 4.98 and 13.37 ± 8.09 days respectively Conclusion:The prevalence of IAH in patients admitted to surgical critical care unit is 46.7%. There is a signicantly higher incidence of organ failure, longer ICU stay and hospital stay in patients with IAH. No signicant association was found between IAH and mortality.

INDICATIONS AND RESULTS OF PREVENTIVE MINIMALLY INVASIVE SURGICAL DECOMPRESSION IN INTRAPERITONEAL HYPERTENSION IN PATIENTS WITH STERILE PANCREATIC NECROSIS WITH CARDIAC AND PULMONARY COMORBIDITY

Resume. Intra-abdominal hypertension (IBH) in patients with sterile pancreatic necrosis (SP) leads to the formation of abdominal compartment syndrome (ACS) in 6-8 96. The most vulnerable in this regard are patients with cardiac and pulmonary comorbidity (CLC). Difficulties in predicting the development of ACS in most cases do not allow making a timely decision on surgical decompression, which leads to delayed surgical treatment and associated high mortality. Objective: to develop and conduct a clinical evaluation of a method for determining indications for preventive minimally invasive surgical decompression in IBH in patients with SP with cardiac and pulmonary comorbidity. Materials and methods. Prospective cohort studies were performed in 84 patients with sterile pancreatic necrosis with CLC, of which 40 patients were in the main group and 44 in the comparison group. Results and discussion. IBH I-II art. was formed in the main group in 32 (80 %) patients, in the comparison group in 34 (77 %). In 10 (29,4 %) patients from group for comparison, ACS developed, while in all 5 (5/22 - 22,7 %) patients with IBH of the first art., it was not possible to diagnose the syndrome in vivo. Categorically, it became possible to verify ACS only in 5 (5/12 - 41,6 %) patients with type II IBH, however, delayed surgical decompression in 60 % (3 out of 5) cases led to mortality. In the main group of patients with SP with CLC, the developed method for determining indications for preventive surgical decompression in IBH I-II art., allowed to prevent the development of ACS in 34 % (11 out of 32) patients, to reduce the number of intraoperative complications by 43 %, and the minimally invasive variant of operations reduced the number of early postoperative complications by 75 %. Conclusions. The developed method for determining indications for preventive minimally invasive surgical decompression in patients with SP with CLC allowed to reduce the mortality associated with an increase in intra-abdominal pressure by more than 2 times, and the overall mortality by 5,5 %.

Features of correction of intra-abdominal hypertension in patients with severe course of acute pancreatitis

Introduction. According to literature data, 60% of patients with severe acute pancreatitis have intra-abdominal hypertension, which leads to the development of abdominal compartment syndrome in 30% of patients and increases the mortality rate to 75%. The aim of the study was to improve the results of treatment of patients with severe acute pancreatitis by improving methods of intraabdominal hypertension correction. Materials and methods. The results of treatment of 35 patients with severe acute pancreatitis, the course of which was complicated by increased intra-abdominal pressure, were analyzed. Depending on the selected treatment tactics, the patients were divided into a comparison group (17 (48.6%) patients who were treated with traditional approaches in the diagnosis and treatment of intra-abdominal hypertension) and the main group (18 (51.7%) patients who were treated with improved staged approach). Results. The use of the proposed staged approach in the treatment of intra-abdominal hypertension in patients with a severe course of acute pancreatitis makes it possible to obtain a probable decrease in the level of intra-abdominal pressure already 24 hours after the start of treatment in comparison with the level at hospitalization (16.59±0.74 and 15.29±0.77mm Hg, p<0.05, respectively), while normal values of the indicator are reached on the sixth day of therapy (11.82±0.71 mm Hg). When analyzing the terms of the normalization of bowel function (reduction of flatulence, passing gases, independent stool), a probable difference was obtained in the studied groups, namely, in the main group the indicated clinical signs were achieved within the first week from the start of treatment in 16 (88.9%) patients, in in the comparison group – in 10 (58.8%) patients (χ2=4.1, p<0.05). Conclusions. The use of the proposed staged approach in the complex treatment of patients with severe acute pancreatitis, which is accompanied by intra-abdominal hypertension, made it possible to improve the results of treatment of this category of patients by reducing the frequency of complications from 52.9% to 16.7% (χ2=4.9, p=0.03) and total mortality from 35.3% to 5.6% (χ2=4.7, p=0.03).

Intra-abdominal pressure during and after cardiac surgery: a single-centre prospective cohort study.

While intra-abdominal hypertension (IAH) has been associated with adverse outcomes in multiple settings, the epidemiology and clinical implications of IAH in the context of cardiac surgery are less known. In this study, we aimed to describe the prevalence of IAH in patients undergoing cardiac surgery and determine its association with patient characteristics and postoperative outcomes. We conducted a single-centre prospective cohort study in which intra-abdominal pressure was measured in the operating room after general anesthesia (T1), after the surgical procedure (T2), and two hours after intensive care unit (ICU) admission (T3) in a subset of patients. Intra-abdominal hypertension was defined as intra-abdominal pressure (IAP) ≥ 12 mm Hg. Postoperative outcomes included death, acute kidney injury (AKI), and length of stay in the ICU and hospital. A total of 513 IAP measurements were obtained from 191 participants in the operating room and 131 participants in the ICU. Intra-abdominal hypertension was present in 105/191 (55%) at T1, 115/191 (60%) at T2, and 31/131 (24%) at T3. Intra-abdominal pressure was independently associated with body mass index, central venous pressure, and mean pulmonary artery pressure but was not associated with cumulative fluid balance. Intraoperative IAH was not associated with adverse outcomes including AKI. Intra-abdominal hypertension is very common during cardiac surgery but its clinical implications are uncertain.

MAIN PRINCIPLES OF ETIOPATHOGENETIC TREATMENT OF NEWBORNS WITH GASTROSCHISIS

Introduction. The paper focuses on the challenging issue of treatment of newborns with gastroschisis (GS) and a high level of intraabdominal hypertension in case of severe viscero-abdominal disproportion. The aim of the paper is to present the current state of the problem at the regional level based on our own clinical experience in observation and treatment of newborns with GS. Material and methods. The study is based on the analysis of examination and treatment of 29 newbornswith GS. The distribution of boys and girls was nearly the same: 16 (55.17%) boys and 13 (44.83%) girls. The number of premature babies was 23 (79.31%). The complex of diagnostic procedures included clinical laboratory examination, radiologic investigation (using contrast agents when required), ultrasound investigation and Doppler sonography, intraabdominal pressure measurement, histologic study of surgical specimens.Results. Prenatal information on the congenital anterior abdominal wall defect was obtained with the help of prenatal ultrasound. In most cases, fetal GS is diagnosed before 20 weeks of pregnancy. Prenatal ultrasound was performed in 13 (44.83%) pregnant women out of the researched group. Two false test results were obtained.Radiologic investigation of a child with GS is necessary to detect intestinal obstruction, necrosis or bowel perforation. Among patients under our study, two cases of ileal atresia were registered. The analysis of intraabdominal pressure indices in patients with GS showed a high level of intraabdominal hypertension in approximately 70% of cases. It proves that patients with GS have a high level of surgical and anesthetic risk. The main therapy measures include the following steps: appropriate preoperative preparation, anesthetic management, and the choice of appropriate perioperative techniques taking into account the level of intraabdominal hypertension and viscero-abdominal disproportion.Depending on the child's condition, type of GS and level of intraabdominal hypertension, there were twosurgical options:1. Primary radical surgery.2. Staged surgical treatment.Analyzing the results of the study, it may be noted that 8 newborns in total died after the surgery, which is 27.59%(it used to be 56-60% till 2005). The main causes of death were respiratory failure, neonatal sepsis and unfavorable premorbid conditions (very low gestational age, severe comorbidity, multiple congenital malformations).Conclusions. 1. Successful treatment of newborns with GS depends on the early diagnosis of the pathology, which must be prenatal, and elimination of contradictions in treatment tactics. 2. Before suturing the abdominal wall defect in newborns with GS, it is necessary to measure intraabdominal pressure, since intraabdominal hypertension leads to a significant deterioration in the mechanical properties of the lungs, hemodynamic abnormalities,oliguria, intestinal ischemia, decrease in organ perfusion, which must be taken into account when carrying out preoperative preparation and aesthetic management. 3. The level of intraabdominal hypertension in patients with GS,which is high in 68.96% of cases, must be an indication for choosing the method of surgical correction of the defect i.e.the refusal of radical plasty of the abdominal wall and the resort to staged intervention or other surgical techniquesthat involve an increase in the abdominal cavity volume. 4. The reduction in mortality in newborns with GS to 27.59%is possible due to the introduction of etiopathogenetic approaches to early diagnosis, preoperative management, anesthetic management and surgical correction of this pathology into the practice of neonatal surgery.

Management of intra-abdominal hypertension during ECMO: Total water-assisted colonoscopy as a step-up minimally invasive treatment, and a literature review.

Background and study aims During extracorporeal membrane oxygenation (ECMO), intra-abdominal hypertension (IAH) can impair ECMO venous drainage, reducing its ability to provide an adequate oxygenated blood flow. When medical therapy is ineffective in managing IAH, guidelines recommend a decompressive laparotomy (DL), though the procedure is associated with several complications and poor outcomes. Patients and methods This was a case series of IAH in patients affected with acute respiratory distress syndrome (ARDS) on veno-venous (V-V) ECMO, in whom we performed total water-assisted colonoscopy (t-WAC) to treat IAH. Results In three patients who underwent t-WAC, we report a real-time intra-procedural reduction of IAH, normalization of ECMO blood flow, and a reduction of vasopressors and lactates. t-WAC was performed in the context of evident abdominal compartment syndrome with multiorgan failure, and in one case was performed because of IAH and ECMO impairment. One patient was discharged alive, while the other two died of multiorgan failure, although the cause of death was apparently not secondary to IAH. Conclusions During ECMO, in select cases,T-WAC may represent a first-line non-invasive approach.

Role of Intra-Abdominal Pressure as a Prognostic Marker and Its Correlation with APACHE II and SOFA Scores in Patients of Acute Pancreatitis

Intra-abdominal hypertension (IAH) is a known but neglected complication in acute pancreatitis. The present study was conducted to establish the role of intra-abdominal pressure (IAP) as a prognostic marker in patients with acute pancreatitis and also to correlate IAP with APACHE II and SOFA scores. A prospective observational single-center cohort study was conducted on adult patients diagnosed with acute pancreatitis. Intra-abdominal pressure was measured through a transurethral Foley’s bladder catheter. APACHE II and SOFA scores were calculated at the time of admission (day 1). APACHE II score was reevaluated on day 3 and 5. SOFA score was reevaluated everyday till day 5. APACHE II score, SOFA score, and IAP at admission were significantly higher among non survivors when compared to survivors. There was significant correlation of IAP with APACHE II and SOFA scores. APACHE II and SOFA scores at cut-off values of 12 and 6 predicted IAP of > 12 (mm of Hg) with reasonable sensitivity and specificity. IAP could be used as a reliable negative prognostic marker in acute pancreatitis. APACHE II and SOFA scores could be used to predict intra-abdominal hypertension in patients of acute pancreatitis.

Severe Intraabdominal Hypertension in Critically Ill COVID-19 Patients With Acute Kidney Injury

Severe Intraabdominal Hypertension in Critically Ill COVID-19 Patients With Acute Kidney Injury

Computed Tomography Findings in Intraabdominal Hypertension in Patients with Acute Pancreatitis.

Purpose Intraabdominal hypertension (IAH) in acute pancreatitis (AP) may reduce tissue perfusion and impair organ function and has been shown to portend poor prognosis. We investigated the computed tomography (CT) findings in patients with AP with IAH. Methods This retrospective study comprised of consecutive patients with AP from June 2016 to June 2018 in whom intraabdominal pressure (IAP) was measured. The patients who underwent a contrast-enhanced CT within 7 days of IAP measurement were included. Using a cutoff of 12 mm Hg for IAP, the patients were divided into IAH and non-IAH groups. Measures of severity and clinical outcome were evaluated. CT parameters were compared between the groups. Results The IAH group comprised of 41 patients, while there were 20 patients in the non-IAH group. The IAH group was characterized by severe disease, increased incidence of organ failure, increased requirement for drainage and surgery, prolonged hospital and intensive care unit stay. The mortality was not significantly different between the two groups. On univariate analysis, the CT features that were found to be significantly different between the two groups were the presence of collection ( p = 0.036), the maximum dimension of collection ( p = 0.004), volume of collection ( p = 0.019), biliary dilatation ( p = 0.011), and the presence of moderate-to-severe pleural effusion ( p = 0.009). On multivariate analysis, all these parameters except biliary dilatation were found to be statistically significant. Conclusion CT findings in patients with AP may suggest IAH. This can be used as an additional marker for severity of AP.

Intra-abdominal Hypertension and Abdominal Compartment Syndrome in patients undergoing emergency laparotomy

Objective: The objectives of the Prospective observational study were to identify the frequency of abdominal compartment syndrome and intraabdominal hypertension in patients undergoing emergency laparotomy for trauma and peritonitis and to determine the impact of raised intraabdominal pressure on the overall morbidity and mortality.
 Materials and Methods: The study was conducted in the department of surgery Benazir Bhutto Hospital Rawalpindi. From June 2013 to May 2014 a total of 50 patients undergoing emergency laparotomy were included. IAP was measured preoperatively then postoperatively at 0, 6, 24 hours, and the findings were recorded on a specially designed preform. The patients having higher IAP were further evaluated up to 72 hours. All vitals, urine output, oxygen saturation, serum urea, creatinine were noted. The main outcomes were duration of hospital stay, the occurrence of burst abdomen, and mortality.
 Results: At the preoperative level the incidence of IAH was 86%. The mortality association with IAH at 6 hours postoperatively was quite significant (P<0.029). The incidence of postoperative ACS was 5% among the total patients and it was 15.6% in trauma patients. No significant association was found between IAP and occurrence of burst abdomen at any level (P values 0.4, 0.26, 0.53, 0.58 at intervals preoperatively, 0, 6, 24 hours postoperative respectively. 
 Conclusion: Intraabdominal pressure is an important factor that predicts the mortality of patients undergoing emergency laparotomy. It should be carefully monitored and managed accordingly to avoid the detrimental effects on virtually all organ systems. Abdominal decompression in significantly elevated intraabdominal pressure reverts the physiological derangement of Intrabdominal hypertension.

Abdominal compartment syndrome in severe acute pancreatitis (review of literature)

The study was performed for analysis of current understanding of intra-abdominal hypertension and abdominal compartment syndrome in patients with severe acute pancreatitis.The English and Russian articles about intra-abdominal hypertension and abdominal compartment syndrome in patients with severe acute pancreatitis were analyzed. The articles were found in «Russian Science Citation Index» and «PubMed».There is a pathogenetic relationship between increased intra-abdominal pressure and the development of severe acute pancreatitis.For today, it was shown that intra-abdominal hypertension in patients with severe acute pancreatitis is associated with significantly higher APACHE-II and MODS score, prevalence of pancreatic and peripancreatic tissue lesions, early infection of pancreatic necrosis and higher mortality.The article considers various variants of decompressive interventions such as decompressive laparotomy, fasciotomy and percutaneous catheter drainage. For today, there are no randomized studies devoted to researching effectiveness of different decompressive interventions.The study showed that it is necessary to regularly monitor intra-abdominal pressure in patients with severe acute pancreatitis. Patients with intra-abdominal hypertension require emergency medical management to reduce intra-abdominal pressure. Inefficiency of the medical management and development of abdominal compartment syndrome are indications for surgery. The effectiveness of different decompressive interventions requires further studies.

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.

Analysis of Intra-Abdominal Pressure in Obstructive and Perforative Lesions of Gastro-Intestinal Tract

Introduction: Abdominal Compartment syndrome is an emerging problem in surgical patients with significant mortality reaching up to 100% in untreated patients. Intra abdominal hypertension (IAH) and abdominal compartment syndrome is common finding in traumatic and critically ill surgical patients. There are sporadic case reports in literature of intra abdominal hypertension & abdominal compartment syndrome in general surgical patients, particularly in obstructive and perforative diseases of gastrointestinal tract (GIT). This study was done to know the pattern of intraabdominal pressure (IAP) and effect of intra abdominal hypertension (IAH) in obstructive and perforative lesions of gastrointestinal tract.
 Materials and Method: A total number of 145 cases were included between November 2016 to October 2017. These patients were from the department of Suregery, Nepalgunj Medical College, who underwent Surgery due to the Intestinal Obstruction or perforation.
 Result: There were total 145cases. The incidence of IAH in patients with intestinal obstruction and perforation peritonitis at presentation was 68.27%. 65 (66.32%) out of 98patients with perforation peritonitis had IAH and 34 (72.34%) with intestinal obstruction among 47 had IAH before surgery. There were 2.12% patients with abdominal compartment syndrome (ACS) in obstruction and 3.06% in perforation; ACS was highest amongst traumatic perforation population accounting for 13.33% of traumatic cases. There was statistically significant derangement (p-value<0.05) of organ function with raised IAP which showed marked improvement following surgery. Four patients died, all these patients had ACS at the time of presentation.
 Conclusion: IAH is a significant entity in obstructive and perforative lesions of GIT. ACS can occur in obstructive and perforative lesions of GIT with significant mortality.

Percutaneous resonance stimulation in complex correction of intraabdominal hypertension and dynamic intestinal obstruction in patients with severe acute pancreatitis

Aim. To evaluate an effectiveness of non-invasive stimulation of gastrointestinal peristaltic activity in complex correction of motor-evacuation disorders and intra-abdominal hypertension in patients with severe acute pancreatitis.Material and methods. There were 85 patients with severe acute pancreatitis. Patients were divided into two groups: group 1 (n = 43) – percutaneous resonance stimulation; group 2 (n = 42) – routine treatment of acute pancreatitis with intraperitoneal hypertension syndrome and dynamic intestinal obstruction according to normative documents. Intra-abdominal pressure was measured in 1, 3, 5, 7 days after disease onset. Abdominal perfusion pressure and filtration gradient were additionally calculated. Moreover, outcomes were assessed after 1, 3, 5, and 7 days according to visual-analogue scale.Results. There were faster regression of intraperitoneal hypertension followed by normalization of abdominal pressure after 7 days in group 1 compared with group 2 (p ≤ 0.05). Data of visual-analogue scale confirmed patients’ good tolerability of resonance stimulation including absent local discomfort during electrodes deployment and better state of health compared with group 2 (p ≤ 0.05). Infectious complications rate was 20.9% in group 1, 38.1% – in group 2. Sepsis developed in 3 (7%) patients of group 1 and in 7 (16.6%) patients of group 2. Overall mortality was 7% and 14.3% in both groups, respectively. Сonclusion. Percutaneous resonance stimulation is able to improve outcomes in patients with severe acute pancreatitis.

Early continuous veno-venous hemofiltration may prevent development of intra-abdominal hypertension in patients with severe acute pancreatitis

Early continuous veno-venous hemofiltration may prevent development of intra-abdominal hypertension in patients with severe acute pancreatitis

ABDOMINAL COMPARTMENT SYNDROME IN BURN PATIENTS

Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are consistently associated with morbidity and mortality among the critically ill or injured. Thus, avoiding or potentially treating these conditions may improve patient outcomes. Despite a large number of special publications devoted to this problem, very little attention is paid to the ACS in patients with severe burn injuries. Severe burns have been shown to be a risk factor for developing IAH. Fluid resuscitation practices used in burns management further predispose patients to increase intra-abdominal pressure. The incidence of intraabdominal hypertension in patients with severe thermal injury is, according to different authors, 57.8–82.6 %. The mortality associated with IAH in severe burns is very high once organ dysfunction occurs. The purpose of this work is to collect and analyze the problem of abdominal hypertension in burn patients, as well as to draw conclusions on the prevention of this condition and improve the results of treatment of patients with severe burn injury. Intra-abdominal hypertension is a frequent complication in severe burn patients requiring massive fluid resuscitation. Development of ACS in burn patients is associated with high mortality. Prevention, early detection and proper management may avoid this usually fatal complication. Fluid resuscitation volume is directly responsible for the development of ACS in severe burned patients. Thus, optimal fluid resuscitation can be the best prevention of IAH and ACS.