Intra-abdominal Pressure Monitoring Research Articles

Prospective study of midline abdominal incisional hernia repair by component separation technique augmented with prosthetic mesh

Background: In our tertiary care hospital, we receive a large number of acute abdomen cases. Raised intra-abdominal pressure (IAP) makes laparostomy mandatory initially and abdominal wall approximation cannot be completed due to compromised state in most cases. Large incisional hernias were seen on complete healing and this study was done to see the feasibility of component separation technique (CST) with mesh augmentation.Methods: 30 patients were subjected to CST with mesh augmentation. Preoperative defect size mapping, Pre- and post-operative monitoring of IAP were done. Pain scoring by visual analogue scale (VAS), early and late complications was noted. Patients were followed up for 60 months.Results: CST with mesh augmentation was found to be feasible with 96.77% success rate as no recurrence was noted in follow up. Preoperative average Basal metabolic index was 26.09. Size of defect varied from 17-20×9-16 cm2 (length X width). Seroma seen in 50% of patients was managed without any intervention. Skin necrosis in 6.6% and wound dehiscence in 3.33%, managed with minimal debridement & local wound care respectively. Respiratory compromise and hematoma were not seen and no patient required any active ICU care. Average length of hospital stay was 5.22 days. Close monitoring of IAP in immediate post-operative period was found to be significant.Conclusion: Physical acceptance of stable abdominal wall gives a psychological boost to patients with early recovery in form of ambulation and early return to work.

Instrumental Diagnostics and Treatment of Acute Adhesive Bowel Obstruction

Despite advances in medicine, acute adhesive bowel obstruction (AABO) continues to be one of the most difficult problems of emergency abdominal surgery. The study was based on the results of treatment of 150 patients with AABO from 2016 to 2018. Age of patients was from 16 to 96, Ме = 55 (38–70), men were 55 (36.6%), and women were 95 (63.3%). In the first 12 hours from the onset of the disease received 70 (46.7%) patients, from 12 to 24 hours – 30 (20%), in 50 cases (33.3%) patients were admitted a day or more after the onset of the disease. Patients had complex examination with clinical, laboratory, and radiological tests. According to the indications, CT scan and laparoscopy were performed. All patients had intra-abdominal pressure monitoring. Based on data obtained from information of ultrasound picture, the “enteral index” was offered by authors. It reflected the degree of structural and functional disorders in the small intestine. For more visual representation of the prevalence of the adhesive process, the authors during the US examination divided the anterior abdominal wall into 4 sectors (S). Early postoperative AABO were diagnosed at 9 (6%) patients. Sixty-three (42%) patients were operated. With a diffuse adhesive process, adhesiolysis was performed by laparotomy, with a local laparoscopy. Laparotomy was performed at 16 patients. Laparoscopy was performed at 47 cases, of which 43 (91.5%) patients had successful results of adhesiolysis. The new therapeutic and diagnostic algorithm allowed to reduce the duration of the diagnostic stage for adhesive bowel obstruction with strangulation up to 3 h (2.75–3.25), and it determined the indications for surgery in a timely manner. The rate of postoperative complications was 14.3%, postoperative mortality was 7.9%, and “good” long-term treatment results were obtained in 64.9% of patients

Intra-abdominal hypertension in early post-kidney transplantation period is associated with impaired graft function.

Moderate hyperhydration is often achieved in the early post-kidney transplantation period. Whether this strategy could lead to the development of intra-abdominal hypertension (IAH) has never been assessed so far. We aimed to study the incidence of IAH after kidney transplantation and its association with graft function recovery. We conducted a prospective monocentric study among patients undergoing kidney transplantation at the University Hospital of Reims between May 2017 and April 2019. Intravesical pressure (IVP) was monitored every 8 h from Day 0 to 3. A total of 107 patients were enrolled. Among 55 patients included in the analysis, 74.5% developed IAH. Body mass index >25 kg/m2 was associated with IAH development {odds ratio [OR] 10.4 [95% confidence interval (CI) 2.0-52.9]; P = 0.005}. A previous history of peritoneal dialysis was protective [OR 0.06 (95% CI 0.01-0.3); P = 0.001]. IAH Grades III and IV occurred in 30.9% of patients and correlated with higher Day 3 creatininaemia (419.6 ± 258.5 versus 232.5 ± 189.4 μmol/L; P = 0.02), higher delayed graft function incidence (41.2 versus 7.9%; P = 0.04), lower Kirchner index measured using scintigraphy (0.47 ± 0.09 versus 0.64 ± 0.09; P = 0.0005) and decreased Day 30 estimated glomerular filtration rate (35.8 ± 18.8 versus 52.5 ± 21.3, P = 0.05). IAH patients had higher fluid balance (P = 0.02). Evolution of IVP correlated with weight gain (P < 0.01) and central venous pressure (P < 0.001). IAH is frequent after kidney transplantation and IAH Grades III and IV are independently associated with impaired graft function. These results question current haemodynamic objectives and raise for the first time interest in intra-abdominal pressure monitoring in these patients. ClinicalTrials.gov identifier: NCT03478176.

P1714INTRA-ABDOMINAL PRESSURE IS ASSOCIATED WITH HIGHER RENAL RESISTIVE INDEX AFTER RENAL TRANSPLANTATION

Abstract Background and Aims The renal arterial resistive index (RRI) reflects renal hemodynamics non-invasively using Doppler arterial waveforms. RRI is defined by factors such as age, sex, weight, height or mean arterial pressure. Intra-abdominal hypertension (IAH) is a common complication among post-surgical patients that can affect renal blood flow. We aimed to determine the relationship between intra-abdominal pressure (IAP) and RRI in a sample of incident kidney transplant patients (KTs). Method Single-center prospective cohort of deceased-donor KTs. Anesthesia, surgical technique and immunosuppression induction therapy was the same in all cases. IAP monitoring was performed according to WSACS guidelines using the urinary bladder technique (UnoMeter Abdo-Pressure kit). IAP values were registered every 8h during the first 72h after surgery or until reoperation. Mean IAP values during the first 24h (24h-IAP) were used in this analysis. Doppler ultrasonography was performed 24h after surgery. RRI was calculated using the following formula: (peak systolic velocity – end-diastolic velocity)/peak systolic velocity. The study was approved by the local ethics committee and written informed consent was obtained in all cases. Results 137 patients were enrolled. Table 1 summarizes relevant patient and hemodynamic variables. Stepwise multivariate linear regression analysis was used to examine independent predictors of RRI in this sample, including all variables in Table 1. Age (β=0.005, std.error=0.001, P&amp;lt;0.001), dialysis vintage (β=0.001, std.error&amp;lt;0.001, P=0.02) and 24h-IAP (β=0.005, std.error=0.003, P=0.041) were independent predictors of RRI. Conclusion Increased IAP in the first 24h after surgery is common in KTs and is correlated with higher RRI, which is associated with increased risk of graft loss and death.

P1717OUTCOMES OF INCREASED INTRA-ABDOMINAL PRESSURE AFTER KIDNEY TRANSPLANTATION

Abstract Background and Aims Increased intra-abdominal pressure (IAP) is commonly found among post-surgical patients and can induce organ dysfunction. However, its prevalence and impact after kidney transplantation have not been adequately described. We aimed to study the prevalence of increased IAP after kidney transplantation and its consequences on transplant outcomes. Method IAP was prospectively measured in 121 kidney transplant recipients every 8h during the first 72h after surgery using the urinary bladder technique (UnoMeter Abdo-Pressure kit). Mean IAP values during the first 24h (24h-IAP) were used in this analysis. Grading of intra-abdominal hypertension was defined according to WSACS guidelines. Patients were followed for at least 12 months or until graft failure or death. The study was approved by the local ethics committee and informed consent was obtained in all cases. Results 24h-IAP was 12.6±3.5 mmHg. 84.2% of subjects presented with intra-abdominal hypertension during the first 72h after kidney transplantation. Body mass index (OR: 1.35, 95% CI 1.12-1.63; P=0.002), male sex (OR: 3.34, 95% CI 1.1-10.3; P=0.032) and hemodialysis as renal replacement therapy before transplantation (OR: 4.35, 95% CI 1.32-14.4; P=0.016) were independent determinants of intra-abdominal hypertension. IAP was an independent risk factor for delayed graft function (*model adjusted for recipient age, sex, history of previous kidney transplants, recipient comorbidities, donor terminal serum creatinine and comorbidities, number of HLA mismatches &amp;gt;4, cold ischemia time and donation after cardiac death status), graft failure and death (**model adjusted for all variables included in the previous model plus delayed graft failure) (Figure). Conclusion Increased IAP was highly common after transplant surgery and was associated with higher rates of delayed graft function, graft failure and death. Routine IAP monitoring should be considered after transplantation to facilitate early identification of complications and initiation of the appropriate treatment to stop its effects.

Role of Static and Dynamic Intra-abdominal Pressure Monitoring in Acute Pancreatitis: A Prospective Study on Its Impact.

This study was aimed to determine the relationship between static and dynamic intra-abdominal pressure (IAP) with the mortality and outcome of acute pancreatitis. From July 2017 to December 2018, 150 patients admitted at the Institute of Gastrosciences and Liver and diagnosed as acute pancreatitis were included in the study. Intra-abdominal pressure was measured for the first few days, and mean value of day 1 (static IAP) and highest value on day 2 and day 3 (dynamic IAP) were calculated and categorized into intra-abdominal hypertension and abdominal compartment syndrome. A statistical relationship was observed between static and dynamic IAP with the severity and mortality of acute pancreatitis. Both static and dynamic IAPs tended to be higher in nonsurvivors (83.33% and 88.88%, respectively) compared with survivors (51.51% and 63.63%, respectively). Higher IAP had more severe disease. However, IAP did not correlate with the evidence of sepsis or serum procalcitonin levels. Determination of static IAP is an easy, useful, and inexpensive method to determine and predict the mortality of acute pancreatitis. Prevention and/or early detection of intra-abdominal hypertension helps in reducing the mortality in acute pancreatitis.

Clinical effect of intra-abdominal pressure monitoring on jejunal nutrition in critically ill patients

Objective To investigate the clinical effect of intra-abdominal pressure monitoring on jejunal nutrition in critically ill patients. Methods From March 2017 to September 2018, 124 critically ill patients who needed early jejunal nutrition in ICU of our hospital were selected and randomly divided into observation group (63 cases) and control group (61 cases) according to the digital table.The observation group adjusted enteral nutrition according to IAP monitoring, while the control group was routinely observed and guided enteral nutrition.Intra-abdominal pressure was compared between the two groups.The changes of blood lactic acid, endotoxin and APACHE Ⅱ score were compared between the two groups. Results After treatment for 7 days and 14 days, the intra-abdominal pressure of the observation group[(14.28±2.36)mmHg, (12.08±1.78)mmHg] were lower than those of the control group [(16.05±2.55)mmHg and (15.21±2.11)mmHg] (t=4.013, 8.939, all P<0.05). After treatment for 14 days, the blood lactic acid, endotoxin, APACHE Ⅱ score in the observation group were (2.19±0.73)mmol/L, (0.71±0.21)U/L and (10.02±1.54), which were lower than those in the control group [(3.98±0.95)mmol/L, (0.92±0.23)U/L and (13.06±1.72)] (t=11.788, 5.313, 10.376, all P<0.05). The incidences of abdominal distension (9.52%) and gastric retention (7.94%) in the observation group were significantly lower than those in the control group (28.57%, 27.87%) (χ2=7.930, 8.437, all P<0.05). Conclusion Early jejunal nutrition under the monitoring of intra-abdominal pressure in critically ill patients can help to reduce intra-abdominal hypertension, promote the rehabilitation of patients, reduce the incidence of complications of jejunal nutrition and improve patients’ tolerance, which is worthy of clinical promotion. Key words: Enteral nutrition; Pressure; Abdominal cavity; Lactic acid; Endotoxins; APACHE Ⅱ score

Bench Validation of a Handcrafted Prototype Catheter for Intra-gastric Pressure Monitoring.

Abdominal compartment syndrome is a sustained intra-abdominal pressure (IAP) >20mm Hg associated with new organ dysfunction. In order to prevent its development and related complications, IAP monitoring should be performed in patients with risk factors. Although techniques for its monitoring have been developed, they are of high cost and not always available in low- and lower-middle-income countries. Therefore, we aim to develop and validate in a bench model a handcrafted catheter to be used as an alternative method to measure the intra-gastric pressure (IGP) as a surrogate of the IAP. We used an acrylic water container as a model of the abdomen and four handcrafted catheters made of a 16 Fr Levin tube with a globe finger tied with silk in the distal end, inflated with 1cm of air. They were placed on the bottom of the container where the water pressure was directly measured as a gold standard. The agreement between the two measures was assessed with the Bland-Altman method. We performed 120 simultaneous measures. The mean pressure difference was 0.218 (95% CI 0.074 to 0.363). The handcrafted prototype catheter and the direct measure were highly correlated. The new catheter is a reliable and reproducible tool for pressure monitoring. However, before it can be used in the clinical setting for IAP monitoring, validation in human models in a real clinical setting needs to be performed.

Intra-abdominal Pressure Changes During Hip Arthroscopy: A Prospective Multicenter Study

To evaluate intra-abdominal pressure changes during hip arthroscopy and define its relationship with other patient related variables. A prospective multicenter study evaluating intra-abdominal pressure (IAP) in patients undergoing arthroscopic treatment of femoroacetabular impingement was performed. The IAP was measured indirectly by a bladder catheter (AbViser Autovalve Intra-abdominal pressure monitor) and documented every 30 minutes during the entire procedure. The following risk factors were analyzed: traction time, duration surgery, previous abdominal surgery, capsule repair, psoas tenotomy, and surgical approach. One hundred and five patients with symptomatic femoroacetabular impingement that underwent hip arthroscopy met the inclusion criteria. There were significant differences in the IAP between the preoperative measurement of IAP and the IAP at different time points during surgery (P<.01). The IAP increased continuously from the commencement of surgery (considered as time point from portal establishment) until the first 60 minutes. After first 60 minutes of surgery, the IAP did not increase significantly. There were no significant associations between increased IAP and the risk factors analyzed. IAP increases significantly during the first 60 minutes of hip arthroscopy; it then stabilizes for the duration of surgery before decreasing just after the completion of surgery. The highest recorded IAP was not associated with additional complications. No symptomatic intra-abdominal hypertension was documented. Finally, patient- and procedure-specific risk factors did not predict changes in IAP. Systemic monitoring of IAP during the hip arthroscopy procedure can easily and effectively be done, allowing the surgeon to early detect any significant change. Level IV, therapeutic case series.

Abdominal Compartment Syndrome After Abdominal Aortic Aneurysm Repair: Subgroups, Risk Factors and Outcome

Introduction - Abdominal compartment syndrome (ACS) remains a lethal complication after abdominal aortic aneurysm (AAA) repair. The aim of this population-based cohort study was to investigate factors associated with outcome. Methods - Since 2008, postoperative ACS and decompression laparotomy after AAA repair are registered prospectively in the National vascular registry. The case records of all patients registered for ACS 2008-2015 were reviewed. The main pathophysiological mechanism seen at laparotomy was defined and the duration of intra-abdominal hypertension (IAH) prior to decompression was registered. Results - In all 119 patients from 24 vascular centres were included in the study. Among 82 repairs for ruptured AAA (rAAA), there were 44 Open surgical repairs (OSR) and 38 endovascular aortic repair (EVAR), and among 37 repairs for intact AAA (iAAA), there were 30 OSR and 7 EVAR. Mortality did not differ between EVAR and OSR for rAAA but was higher after EVAR for iAAA at one-year (6/7 [85.7%] versus 9/30 [30.0%], p=.011). Patients treated with EVAR for rAAA reached peak intra-abdominal pressure (IAP) values, and had DL earlier, than those treated with OSR (Both p<.001). Decompressive laparotomy (DL) was performed within twenty-four hours in 55 (48.2%) patients, between twenty-four and forty-eight hours in 30 (26.3%) and after forty-eight hours in 29 (25.4%). There were three main findings at DL: bowel ischemia in 27 (23.5%), postoperative bleeding in 34 (29.6%) and general oedema/fluid overload in 54 (47.0%). Mortality did not differ depending on findings at DL, figure 1, or timing of DL. Ninety-day non-survivors (60/119, 50.4%) were older (p<.001), had larger aneurysms (p=.045), received more intraoperative blood transfusions (p=.001) and were more often treated with suprarenal clamping/balloon occlusion (p<.001), compared to those who survived 90 days or longer after surgery. In multivariable regression analysis, only age was a predictor for one-year mortality (p=.026). Duration of intra-abdominal pressure ≥15 and ≥20 mmHg prior to DL were independent predictors for the need of renal replacement therapy (RRT) (p=.041 and p=.031). Open abdomen treatment was performed in 106 patients of whom 98 (92.5%) received negative pressure wound therapy (NPWT), which in a majority also was combined with mesh-mediated traction. Among 85 patients with NPWT who survived until the abdomen was closed, 81 (95.3%) achieved primary delayed fascial closure. Conclusion - Mortality in ACS did not differ depending on the cause of ACS or on whether DL was performed early, intermediate or late. The duration of IAH prior to DL affected the need for RRT, suggesting the value of close monitoring and early treatment of IAH to prevent renal failure. ACS after EVAR for rAAA developed early after surgery, and in this clinical scenario monitoring of IAP may be life-saving.

RESOLUTION OF AKI AFTER LARGE VOLUME PARACENTESIS AND CORRECTION OF INTRA-ABDOMINAL HYPERTENSION

SESSION TITLE: Wednesday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM INTRODUCTION: Intra-abdominal pressure (IAP) is the pressure within the abdominal cavity. Elevated IAP can lead to Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS). This is caused by a wide variety of causes including ascites. This entity can cause low abdominal perfusion pressures (AAP) and result in end organ damage. We present a case of AKI caused by tense ascites, which resolved after drainage CASE PRESENTATION: A 52-year-old man was transferred to our ICU for the management of hyponatremia and AKI. He presented initially with confusion, weakness, and fall. He has a history of systolic heart failure and alcohol abuse. On presentation, he was significantly volume overloaded with ascites, pitting lower extremity edema and significant electrolyte abnormalities including severe hyponatremia, hypokalemia and an AKI with creatinine of 1.35mg/dL (baseline = 0.6). Urine electrolytes were consistent with pre-renal AKI and his echo showed a normal LV function, RV and RA dilation with no signs of pulmonary hypertension. He was initially treated with hypertonic saline infusion. He was found to have liver cirrhosis on abdominal ultrasound. Given his tense abdomen, a paracentesis was performed in conjunction with IAP monitoring via an arterial line monitoring system. After zeroing the pressure at the insertion of the paracentesis catheter, an initial IAP of 22 mmHg was obtained. IAPs were documented at end expiration following each liter of ascites fluid removed (figure 1). A total of 8.75L were removed and a final IAP of 6mmHg was recorded. Mean arterial pressure prior to paracentesis was 73mmHg and AAP was 51mmHg. Over the following 24 hours, patient’s urinary output increased dramatically to over 4L without diuretics and his creatinine normalized (figure 2). Over the course of the hospital stay, the patient’s electrolyte abnormalities, volume overload, weakness and confusion resolved and he was discharged without complication DISCUSSION: We demonstrate a case of a patient who developed AKI and electrolyte derangements from tense ascites causing IAH that resolved after fluid removal. We illustrate that there may be a linear decrease in IAP with ascites volume removal. The most likely cause the the dramatic increase in UOP following the paracentesis is restoration of renal blood flow with normalization of IAP. CONCLUSIONS: IAH and ACS can be dramatic consequences of elevated IAP and clinicians should be aware of more subtle presentations of organ damage that are due to IAH Reference #1: Papavramidis, Theodossis S et al. “Abdominal compliance, linearity between abdominal pressure and ascitic fluid volume” Journal of emergencies, trauma, and shock vol. 4,2 (2011): 194-7. Reference #2: Caldwell CB, Ricotta JJ. Changes in visceral blood flow with elevated intraabdominal pressure.J Surg Res. 1987;43(1):14. Reference #3: Caldwell CB, Ricotta JJ.Changes in visceral blood flow with elevated intraabdominal pressure. J Surg Res. 1987 Jul;43(1):14-20. DISCLOSURES: No relevant relationships by Amit Chopra, source=Web Response No relevant relationships by Kurt Hu, source=Web Response No relevant relationships by Ali Wazir, source=Web Response No relevant relationships by Robert Wilcott, source=Web Response

Intra-abdominal pressure during endoscopic full-thickness resection comparing manual and automatic control insufflation: a block-randomized porcine study.

An automatic carbon dioxide (CO2) insufflating system (SPACE) was developed to stabilize intra-lumenal pressure (ILP) during endoscopic interventions. This study investigated whether SPACE could improve the control and monitoring of extra-lumenal intra-abdominal pressure (IAP) after establishing a perforation during endoscopic full-thickness resection (EFTR) of the gastric wall in porcine models. After first establishing the optimal preset pressure for gastric EFTR in four pigs, we compared IAP dynamics during EFTR between manual insufflation and SPACE using a block-randomized study (n = 10). IAP was percutaneously monitored and plotted on a timeline graph every 5s. The maximal IAP and the area under the IAP curve exceeding 10mmHg (AUC≥10mmHg) were compared between groups, with the agreement between IAP and endolumenally monitored ILP also analyzed for animals in the SPACE group. In the first study, 8mmHg was identified as the most preferable preset pressure after establishment of the perforation. In the randomized study, the mean maximal IAP in the SPACE group was significantly lower than that in the manual insufflation group (11.0 ± 2.0mmHg vs. 17.0 ± 3.5mmHg; P = 0.03). The mean AUC≥10mmHg was also significantly smaller in the SPACE group. Bland-Altman analysis demonstrated agreement between IAP and ILP within a range of ± 1.0mmHg. SPACE could be used to control and safely monitor IAP during gastric EFTR by measuring ILP during perforation of the gastric wall.

Diagnosis and Choice of a Method of Treatment of Intraabdominal Hypertension and Abdominal Compartment Syndrome

BACKGROUND: Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) remain a complex problem of abdominal surgery. To date, the pathophysiological mechanisms, methods for determining intra-abdominal pressure (IAP) the frequency of its measurement, and the methods of conservative and surgical more and more researchers consider surgical decompression as a treatment.&#x0D; AIMS: Аnalysis of the results of the implementation of monitoring of intra-abdominal pressure and its impact on the outcomes of treatment of patients with severe acute pancreatitis and acute colon obstruction.&#x0D; MATERIALS AND METHODS: A study of 397 patients with emergency abdominal pathology including 197 with acute obstructive obstruction of the colon (AOOC), 200 severe acute pancreatitis (SAP) was performed. Patients (n=201) were included in the I (main) group, which was carried out using IAP as the main criterion for assessing the patient`s condition and when choosing a method of treatment, in II ― without taking then into account and monitoring. Measurement of IAP, blood lactate was determined primarily, then alternatively 4 to 6 hours. The survey included the study of biochemical indicators, endoscopic methods, visualization (ultrasound scanning, CT of the abdominal cavity organs).&#x0D; RESULTS: In the I group of IAH patients, I and II degrees were in 73.13%, in the II group in 79.5% IAH III and IV degrees, respectively, in 26.87% and 21.5% (p0.05). Measurement of IAP was carried out according to the I.L. Kron method, repeated measurement depending on the degree of IAH after 46 hours, simultaneously, as a predictor of internal ischemia, determined the level of lactate in blood and perfusion abdominal pressure. An algorithm for early diagnosis is suggested excess intraabdominal pressure. For I and II, the degree of IAH was treated with aggressive conservative therapy, with failure of intensive therapy III of IAH degree surgical treatment, with IV degree IAH emergency decompressive laparotomy. In the I group, the mortality was significantly lower than in the II group: IAH at III, with AOOC 27.7% and 50%, respectively (p0.05), at SAP 37.5% and 80% (p0.01), respectively, at IV degree IAH for AOOC 75% and 90% (p0.05), with SAP 75% and 88,8% (p0.05) respectively.&#x0D; CONCLUSIONS: The results of treatment of patients with IAH can be improved by its early diagnosis, intensive, aggressive therapy of IAH IIII degrees. At IAH I, II degrees conservative treatment is shown, persistent aggressive conservative treatment should be performed at IAH III degree, if it is unsuccessful and IV degree of IAH, an emergency decompressive laparotomy should be performed.

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.

How to deal with severe acute pancreatitis in the critically ill.

To review recent literature on the management of patients with severe acute pancreatitis (SAP) admitted to an ICU. SAP is a devastating disease associated with a high morbidity and mortality. Recent evidence advocates adequate risk assessment and severity prediction (including intra-abdominal pressure monitoring), tailored fluid administration favoring balanced crystalloids, withholding prophylactic antibiotic therapy, and early detection and treatment of extra-pancreatic and fungal infections. Urgent (within 24-48 h after diagnosis) endoscopic retrograde cholangiopancreatography is indicated when persistent biliary obstruction or cholangitis are present. Corticosteroid therapy (mainly dexamethasone) can reduce the need for surgical interventions, length of hospital stay, and mortality. Peritoneal lavage may significantly lower morbidity and mortality. Hemofiltration may offer substantial benefit but more studies are needed to prove its efficacy. Enteral feeding using a polymeric formula and provided early through a nasogastric tube is recommended but has no survival benefit compared with parenteral nutrition. Probiotics could be beneficial, however no clear recommendations can be made. Management of SAP is multimodal with emphasis on monitoring, adequate fluid resuscitation, avoiding prophylactic use of antibiotics, cause-directed procedures or treatment, and organ support. There is a role for early enteral nutrition including probiotics.

The value of combined hemodynamic, respiratory and intra-abdominal pressure monitoring in predicting acute kidney injury after major intraabdominal surgeries

Background: The incidence of postoperative acute kidney injury (AKI) is predominantly determined by renal hemodynamics. Beside arterial blood pressure, the role of factors causing a deterioration of venous congestion (intraabdominal pressure, central venous pressure, mechanical ventilation) has emerged. The value of combined hemodynamic, respiratory and intra-abdominal pressure (IAP) monitoring in predicting postoperative acute kidney injury has received only limited exploration to date.Methods: Data were collected for adult patients admitted after major abdominal surgery at nine Hungarian ICUs. Hemodynamic parameters were compared in AKI vs. no-AKI patients at the time of admission and 48 h thereafter. Regarding ventilatory support, we tested mean airway pressures (Pmean). Effective renal perfusion pressure (RPP) was calculated as MAP−(IAP + CVP + Pmean). The Mann–Whitney U and the chi-square tests were carried out for statistical analysis with forward stepwise logistic regression for AKI as a dependent outcome.Results: A total of 84 patients (34 ventilated) were enrolled in our multicenter observational study. The median values of MAP were above 70 mmHg, IAP not higher than 12 mmHg and CVP not higher than 8 mmHg at all time-points. When we combined those parameters, even those belonging to the ‘normal’ range with Pmean, we found significant differences between no-AKI and AKI groups only at 12 h after ICU admission (median and IQR: 57 (42–64) vs. 40 (36–52); p < .05). Below it’s median (40.7 mmHg) on admission, AKI developed in all patients. If above 40.7 mmHg on admission, they were protected against AKI, but only if it did not decrease within the first 12 h.Conclusions: Calculated effective RPP with the novel formula MAP−(IAP + CVP + Pmean) may predict the onset of AKI in the surgical ICU with a great sensitivity and specificity. Maintaining effective RPP appears important not only at ICU admission but during the next 12 h, as well. Additional, larger studies are needed to explore therapeutic interventions targeting this parameter.

Intra-Abdominal Hypertension Is More Common Than Previously Thought: A Prospective Study in a Mixed Medical-Surgical ICU.

To determine the prevalence of intra-abdominal hypertension in mixed medical-surgical critically ill patients using modern definitions and measurement techniques. Secondarily to determine variables associated with intra-abdominal hypertension and ICU mortality. A prospective observational study. Single institution trauma, medical and surgical ICU in Canada. Consecutive adult patients admitted to the ICU (n = 285). Intra-abdominal pressure measurements twice a day during admission to the ICU. In 285 patients who met inclusion criteria, 30% were diagnosed with intra-abdominal hypertension at admission and a further 15% developed intra-abdominal hypertension during admission. The prevalence of abdominal compartment syndrome was 3%. Obesity, sepsis, mechanical ventilation, and 24-hour fluid balance (> 3 L) were all independent predictors for intra-abdominal hypertension. Intra-abdominal hypertension occurred in 28% of nonventilated patients. Admission type (medical vs surgical vs trauma) was not a significant predictor of intra-abdominal hypertension. Overall ICU mortality was 20% and was significantly higher for patients with intra-abdominal hypertension (30%) compared with patients without intra-abdominal hypertension (11%). Intra-abdominal hypertension of any grade was an independent predictor of mortality (odds ratio, 3.33; 95% CI, 1.46-7.57). Intra-abdominal hypertension is common in both surgical and nonsurgical patients in the intensive care setting and was found to be independently associated with mortality. Despite prior reports to the contrary, intra-abdominal hypertension develops in nonventilated patients and in patients who do not have intra-abdominal hypertension at admission. Intra-abdominal pressure monitoring is inexpensive, provides valuable clinical information, and there may be a role for its routine measurement in the ICU. Future work should evaluate the impact of early interventions for patients with intra-abdominal hypertension.

Effect of abdominal negative-pressure wound therapy on the measurement of intra-abdominal pressure

BackgroundIn critically ill surgical patients undergoing abdominal negative-pressure wound therapy (NPWT), it remains uncertain whether or not intra-abdominal pressure (IAP) measurements should be obtained when NPWT is activated. We aimed to determine agreement between IAP measured with and without NPWT. MethodsIn this analytic cross-sectional study, critically ill surgical adults (≥18 y) requiring abdominal NPWT for temporary abdominal closure after a damage control laparotomy were selected. Patients with urinary tract injuries or with pelvic packing were excluded. Paired IAP measures were performed in the same patient, with and without NPWT; two different operators performed the measures unaware of the other's result. Bland-Altman methods assessed the agreement between the two measures. Subgroup analyses (trauma and nontrauma) were performed. ResultsThere were 198 IAP measures (99 pairs) in 38 patients. Mean IAP with and without NPWT were 8.33 (standard deviation 4.01) and 8.65 (standard deviation 4.04), respectively. Mean IAP difference was −0.323 (95% confidence interval −0.748 to 0.101), and reference range for difference was −4.579 to 3.932 (P = 0.864). From 112 IAP measures (56 pairs) in 21 trauma patients, mean IAP difference was −0.268 (95% confidence interval −0.867 to 0.331), and reference range for the difference was −4.740 to 4.204 (P = 0.427). ConclusionsThere was no statistically significant disagreement in IAP measures. IAP could be measured with or without NPWT. In critically ill surgical patients with abdominal NPWT for temporary abdominal closure, monitoring and management of IAP either with or without NPWT is recommended.

Correlation between different methods of intra-abdominal pressure monitoring in varying intra-abdominal hypertension models

Grant from Extremadura Regional Government through the Plan Regional de Investigacion de Extremadura (PRI09A161 to Minimally Invasive Surgery Center Jesus Uson).

Correlation between different methods of intraabdominal pressure monitoring in varying intraabdominal hypertension models

Correlation between different methods of intraabdominal pressure monitoring in varying intraabdominal hypertension models