Intra-abdominal Pressure Monitoring Research Articles

Intra-abdominal hypertension and abdominal compartment syndrome in acute pancreatitis, hepato-pancreato-biliary operations and liver transplantation.

Intra-abdominal hypertension, even preceding the onset of abdominal compartment syndrome, is still recognized as an adverse prognostic factor. Unfortunately, most of the current supporting evidence within the critical care environment remains observational in nature. In acute pancreatitis, an active role for intra-abdominal hypertension early in the disease process follows a strong intuitive basis, and it is corroborated by preliminary evidence from animal models. Additional studies are needed to better characterize the optimal fluid resuscitation strategy, as well as the importance of intra-abdominal hypertension as an early therapeutic target. All critically ill patients with acute pancreatitis should be considered for routine intra-abdominal pressure monitoring. The prevalence and clinical relevance of intra-abdominal hypertension after elective major abdominal operations are underestimated in the literature. Hepato-pancreato-biliary surgery and liver transplantation represent high-risk surgical subspecialties, and routine intra-abdominal hypertension risk assessment to indicate postoperative intra-abdominal pressure monitoring can be recommended. Conservative management of intra-abdominal hypertension should be promptly initiated upon diagnosis. Although abdominal catheter drainage and decompressive laparotomy may be required in refractory cases based on expert clinical judgment, precise indications and timing are still unclear. Implementation of institutional protocols based on the Abdominal Compartment Society reference standards is crucial to optimize both clinical management and research in this evolving area.

The value of intra-abdominal pressure monitoring through transvesical route in the choice and outcome of management of congenital abdominal wall defects

Introduction Gastroschisis and omphalocele are most common congenital abdominal wall defects (AWDs). Surgical management aims to reduce the evisceration safely, close the defect with a cosmetically acceptable outcome under guidance of intraoperative monitoring of intra-abdominal pressure (IAP). Intravesical pressure monitoring technique recommended by (WSACS) is the most reliable technique for IAP measurement in neonates. Aim The aim of this study is to assess the value of IAP monitoring via vesical pressure measurement in the choice and outcome of management of congenital AWDs. Patients and methods This is a prospective study of 25 cases that suffered congenital anterior AWDs (gastroschisis and omphalocele) admitted to Mansoura University Children Hospital during the period from October 2013 to October 2015. They were all operated upon guided by IVP monitoring during and after repair. Results In our study, 14 (56%) cases presented with gastroschisis and 11 (44%) presented with exomphalos with a median age of 24 h. Males (56%) were slightly more than females (44%). Congenital anomalies were reported in 16 cases (64%). Primary fascial closure was successful in 15 (60%) cases, whereas Silo repair was done in six (24%) cases and skin closure in only four (16%) cases. During the attempts of closure the mean abdominal perfusion pressure was 40.24 ± 5.59, the mean peak inspiratory pressure was 24 ±6.11 and the mean IAP was 22.60± 6.89. Two cases developed intra-abdominal hypertension after abdominal closure (8%) and only one of them needed decompressive laparotomy (4%). Postoperative complications were reported in 15 (60%) cases and mortality occurred in eight (32%) cases. Conclusion Increased IAP secondary to forceful closure of the abdominal defect is associated with the occurrence of complications. IVP monitoring is feasible during closure of AWDs and a threshold of 20cm H2O is appropriate to decide between primary and staged approach. Keywords : congenital abdominal wall defect, intravesical pressure, intra-abdominal hypertension

Perioperative intra-abdominal pressure monitoring in emergency laparotomy

Background: The aim of present study is to evaluate the perioperative monitoring of intra-abdominal pressure and abdominal compartment syndrome and its association with the postoperative morbidity in terms of kidney function and pulmonary atelectasis and mortality of the patients undergoing emergency laparotomy.Methods: A prospective study was done in 100 patients undergoing laparotomy. The study was conducted in the department of general surgery, Government Kilpauk medical college and hospital for the period of six months from January 2015 to June 2015. The study group of 100 patients was divided into 2 groups, each group containing 50 patients. The first group containing 50 patients having increased intra-abdominal pressure undergoing emergency laparotomy and second group containing 50 patients undergoing elective laparotomy. The post-operative morbidity in terms of kidney function by means of urea, creatinine and urine output and pulmonary atelectasis with the help of chest x-ray and mortality analyzed compared in between the two groups.Results: By comparing the two groups, the group undergoing emergency laparotomy with increased intra-abdominal pressure had increase in the incidence of postoperative morbidity and mortality than the elective laparotomy group without elevated intra-abdominal pressure.Conclusions: Thus, the perioperative monitoring of intra-abdominal pressure is highly useful in diagnosing intra-abdominal hypertension and abdominal compartment syndrome and thereby helps in minimizing the post-operative morbidity and mortality in emergency laparotomy patients.

Bi-manual proximal external aortic compression after major abdominal-pelvic trauma and during ambulance transfer: A simulation study

BackgroundApplying manual pressure after hemorrhage is intuitive, cost-free, and logistically-simple. When direct abdominal-pelvic compression fails, clinicians can attempt indirect proximal-external-aortic-compression (PEAC), while expediting transfer and definitive rescue. This study quantifies the sustainability of simulated bi-manual PEAC both immediately on scene and during subsequent ambulance transfer. The goal is to understand when bi-manual PEAC might be clinically-useful, and when to prioritize compression-devices or endovascular-occlusion. MethodsWe developed a simulated central vessel compression model utilizing a digital scale and Malbrain intra-abdominal pressure monitor inside a cardiopulmonary resuscitation mannequin. Twenty prehospital health care professionals (HCPs) performed simulated bimanual PEAC i) while stationary and ii) inside an 80km/h ambulance on a closed driving-track. Participants compressed at “the maximal effort they could maintain for 20min”. Results were measured in mmHg applied-pressure and kilograms compressive-weight. The Borg scale of perceived-exertion was used to assess sustainability, with <16 regarded as acceptable. ResultsWhile stationary all participants could maintain 20min of compressive pressure/weight: within five-percent of their starting effort, and with a Borg-score <16. Participants applied 88–300mmHg compression pressure; (mean 180mmHg), 14–55kg compression-weight (mean 33kg), and 37–66% of their bodyweight (mean 43%). In contrast, participants could not apply consistent or sustained compression in a moving ambulance: Borg Score exceeded 16 in all cases. ConclusionsSurvival following major abdominal-pelvic hemorrhage requires expedited operative/interventional rescue. Firstly, however, we must temporize pre-hospital exsanguination both on scene and during transfer. Despite limitations, our work suggests PEAC is feasible while waiting for, but not during, ambulance-transfer. Accordingly, we propose a chain-of-survival that cautions against over-reliance on manual PEAC, while supporting pre-hospital devices, endovascular occlusion, and expeditious but safe hospital-transfer.

Optimization of indirect pressure in order to temporize life-threatening haemorrhage: A simulation study

BackgroundMinimizing haemorrhage using direct pressure is intuitive and widely taught. In contrast, this study examines the use of indirect-pressure, specifically external aortic compression (EAC). Indirect pressure has great potential for temporizing bleeds not amenable to direct tamponade i.e. abdominal-pelvic, junctional, and multi-site trauma. However, it is currently unclear how to optimize this technique. MethodsWe designed a model of central vessel compression using the Malbrain intra-abdominal pressure monitor and digital weigh scale. Forty participants performed simulated external aortic compression on the ground, on a stretcher mattress, and with and without a backboard. ResultsThe greater the rescuer’s bodyweight the greater was their mean compression (Pearson’s correlation 0.93). Using one-hand, a mean of 28% participant bodyweight (95% CI, 26–30%) could be transmitted at sustainable effort, waist-height, and on a stretcher. A second compressing hand increased the percentage of rescuer bodyweight transmission 10–22% regardless of other factors (i.e. presence/absence or a backboard; rescuer position) (p<0.001). Adding a backboard increased transmission of rescuer bodyweight 7–15% (p<0.001). Lowering the patient from waist-height backboard to the floor increased transmission of rescuer bodyweight 4–9% (p<0.001). Kneeling on the model was the most efficient method and transmitted 11% more weight compared to two-handed maximal compression (p<0.001). ConclusionsEfficacy is maximized with larger-weight rescuers who use both hands, position themselves atop victims, and compress on hard surfaces/backboards. Knee compression is most effective and least fatiguing, thus assisting rescuers of lower weight and lesser strength, where no hard surfaces exist (i.e. no available backboard or trauma on soft ground), or when lengthy compression is required (i.e. remote locations). Our work quantifies methods to optimize indirect pressure as a temporizing measure following life-threatening haemorrhage not amenable to direct compression, and while expediting compression devices or definitive treatment.

Intra-abdominal Pressure Monitoring in Open Abdomen Management with Dynamic Abdominal Closure.

The importance of elevated intra-abdominal pressure (IAP) and abdominal compartment syndrome (ACS) have been recognized in critical care for its potential damaging effects. But, quantification of IAP values may be useful as a clinical tool for determining efficacy of coughing and straining for functional recovery of OA patients. We would like to evaluate IAP generated in an OA patient and the effect of negative pressure therapy (NPT) and dynamic abdominal closure systems (ABRA) on the IAP values at rest and during coughing and straining and compare those with IAP measurements of closed abdomen after standard open elective colorectal surgery (non-OA). Eight OA and eight non-OA patients were included in this study. OA patient with NPT and ABRA (OA + NA), OA patient without NPT and ABRA completely unbraced (OA-NA) (NA stands for NPT and ABRA), and non-OA patients underwent IAP measurements at rest, during coughing, and during straining via transurethral catheter. There was no difference in the mean of IAP measurement at rest in OA-NA (6.1mmHg), OA + NA (6.5mmHg), and non-OA (6.0mmHg) patients. During coughing, IAP of OA-NA, OA + NA, and non-OA patients were 11.5, 19.1, and 22.0mmHg and during straining, IAP of OA-NA, OA + NA, and non-OA patients were 11.5, 17.5, and 23.5mmHg, respectively. Application of NPT in conjunction with ABRA did not increase IAP at rest but provided significant IAP increase in OA + NA patients, when compared to OA-NA patients during coughing and straining. NPT in conjunction with ABRA offers the advantage of increase of IAP during coughing and straining.

Influence of Ventilation Parameters on Intraabdominal Pressure.

Intraabdominal pressure monitoring is not routinely performed because the procedure assumes some invasiveness and, like other invasive procedures, it needs to have a clear indication to be performed. The causes of IAH are various. Mechanically ventilated patients have numerous parameters set in order to be optimally ventilated and it is important to identify the ones with the biggest interference in abdominal pressure. Although it was stated that mechanical ventilation is a potential factor of high intraabdominal pressure the set parameters which may lead to this diagnostic are not clearly named. To evaluate the relation between intraabdominal pressure and ventilator parameters in patients with mechanical ventilation and to determine the correlation between intraabdominal pressure and body mass index. This is an observational study which enrolled 16 invasive ventilated patients from which we obtained 61 record sheets. The following parameters were recorded twice daily: ventilator parameters, intraabdominal pressure, SpO2, Partial Oxygen pressure of arterial blood. We calculated the Body Mass Index (BMI) for each patient and the volume tidal/body weight ratio for every recorded data point. We observed a significant correlation between intraabdominal pressure (IAP) and the value of PEEP (p=0.0006). A significant statistical correlation was noted regarding the tidal volumes used for patient ventilation. The mean tidal volume was 5.18 ml/kg. Another significant correlation was noted between IAP and tidal volume per kilogram (p=0.0022). A positive correlation was found between BMI and IAP (p=0.0049), and another one related to the age of the enrolled patients. (p=0.0045). The use of positive end-expiratory pressures and high tidal volumes during mechanical ventilation may lead to the elevation of intraabdominal pressure, a possible way of reducing this risk would be using low values of PEEP and also low volumes for the setting of ventilation parameters. There is a close positive correlation between the intraabdominal pressure levels and body mass index.

Prevention of compartment syndrome after abdominal surgeries

The article presents the basic concepts and definitions of compartment syndrome, some mechanisms of its development, methods of treatment and prevention. Abdominal compartment syndrome is diagnosed in 20% of patients with therapeutic and 30% of patients with surgical pathology. Mortality in its development amid the treatment reaches 42-68%, and without treatment - 100%. The high risk of abdominal compartment syndrome development is characteristic for patients with generalized peritonitis. The trigger mechanism of syndrome development becomes increased intra-abdominal pressure, which leads to the multiple organ failure development. Currently, there are different approaches to the abdominal compartment syndrome prevention. There is no doubt that it is better to prevent this syndrome than cure, as well as any other pathological condition. It is necessary to bear in mind the probability of its formation and routinely measure intra-abdominal pressure in high-risk patients. Treatment tactics choice and timely detection of intra-abdominal hypertension are crucial in prevention of the abdominal compartment syndrome development in patients with abdominal surgical pathology. In general, it is recommended to perform preventive measures in respect of abdominal compartment syndrome in two directions. As the first one, the decision on the type of wound suturing is considered. Tissue perfusion optimization is considered as another preventive direction. Currently, there is no single approach in the abdominal compartment syndrome prevention in patients with generalized peritonitis, and further studies in this area are highly relevant. Since this pathology leads to impairment of almost all vital body functions and is associated with extremely high mortality, its early diagnosis by the intra-abdominal pressure monitoring, which allows to perform timely actions that prevent an adverse outcome, is of particular importance.

Study of the occurrence of intra-abdominal hypertension and abdominal compartment syndrome in patients of blunt abdominal trauma and its correlation with the clinical outcome in the above patients.

BackgroundIntra-abdominal pressure (IAP) measurements have been identified as essential for diagnosis and management of both intra-abdominal hypertension (IAH) and Abdominal compartment syndrome (ACS). It has gained prominent status in ICUs worldwide. We aimed to evaluate the utility of measurement of rise in bladder pressure to assess IAP levels in blunt abdominal trauma (BAT) patients.Patients and methodsThirty patients of BAT with solid organ injuries were included in this study. Intra-abdominal pressure was measured through a Foleys bladder catheter throughout their stay. Bladder pressure was compared with clinical parameters like mean arterial pressures(MAP), respiratory rate(RR), serum creatinine(SC) and abdominal girth(AG) and also with outcome in terms of intervention whether operative(OI) or non-operative(NOI).ResultsBladder pressure showed significant correlation with MAP (R = −0.418; P = 0.022), AG (R = 0.755; P = 0.000), SC (R = 0.689; P = 0.000) and RR (R = 0.537; P = 0.002). Bladder pressure (R = 0.851; P = 0.000), SC (R = 0.625; P = 0.000), MAP (R = −0.350; P = 0.058) and maximum AG difference (R = 0.634; P = 0.000) showed significant correlation with intervention. In total, 17 patients (56 %) required intervention, 9 patients (30 %) underwent NOI (pigtailing or aspiration) while 8 (27 %) needed OI. More than 3 derailed parameters were associated with 100 % intervention (Mean 3.47, SD-1.23). High APACHE III score on admission (>40) was associated with increased intervention (p = 0.001). Intervention correlates well with Grade of injury (p = 0.000) and not with number of organs injured (p = 0.061). Blood transfusion of 2 or more units of blood was associated with increased intervention (p = 0.000).ConclusionIncreased bladder pressure and other clinical parameters (MAP, SC, RR and change in AG) correlates well with intervention. Elevated bladder pressure correlates well with other clinical parameters in patients with BAT. Bladder pressure, SC, MAP, RR and AG difference can be used to determine the group of patients that can be managed conservatively and those that would benefit with minimal intervention or exploration. During Non-operative management (NOM) of patients with BAT and multiple solid organ injuries, IAP monitoring may be a simple and objective guideline to suggest further intervention whether NOI or OI. Although routine bladder pressure measurements will result in unnecessary monitoring of large number of patients it is hoped that patients with IAH can be detected early and subsequent ACS with morbid abdominal exploration can be prevented. However the criterion for non-operative failure and the point of decompression needs further refinement to prevent an increase of nontherapeutic operations.

Clinical value of intra-abdominal pressure monitoring and prognosis in severe acute pancreatitis patients with intra-abdominal hypertension

Clinical value of intra-abdominal pressure monitoring and prognosis in severe acute pancreatitis patients with intra-abdominal hypertension

The impact of relevant factors in mechanical ventilation on intra-abdominal pressure in patients with ALI/ARDS

Objective To investigate the impact of relevant factors in mechanical ventilation on intra- abdominal pressure in patients with ALI/ARDS by continuous monitoring of intra-abdominal pressure. Methods A total of 116 ALI/ARDS patients treated with mechanical ventilation in ICU were enrolled in this study. Intra-abdominal pressure (IAP) was recorded continuously. Meanwhile ventilator parameters, arterial blood gas analysis, hemodynamic variables, and as well as the levels of IL-4, IL-8 and TNF-α in blood and bronchial alveolar lavage fluid (BALF) were determined and recorded. The detection of risk factors for intra-abdomen hypertension (IAH) were carried out using multivariate stepwise logistic regression. ROC curve analysis used to estimate the diagnostic performance of these parameters for IAH. Results The oxygenation index (PaO2/FiO2) in patients with IAH after 2 hours' mechanical ventilation was significantly lower than that in patients with normal intra-abdomen pressure (IAP) (P <0.01) ; PEEP and RR in mechanical ventilation were higher in IAH group (P <0.01 or P=0.001) ; Mean artery pressure (MAP) , ejection time percent (ET) , stroke volume (SV) , cardiac index (CI) were lower in IAH group than those in normal IAP group (P <0.01) ; the levels of IL-4, IL-8 and TNF-α in blood and bronchial alveolar lavage fluid were higher in IAH group than those in normal IAP group (P <0.01) ; IAH patients have a higher mortality on 28 d (Log rank test, P=0.023). Poor oxygenation index (PaO2/FiO2) after 2 hours' ventilation, high PEEP setting, low MAP, ET, SV, CI and elevated IL-4 in the BALF were resulted in increasing risk of IAH for ARDS patients under mechanical ventilation support. Conclusions The monitoring of intra-abdominal pressure should be emphasized for ALI/ARDS patients when mechanical ventilation was employed. PaO2/FiO2, SV and IL-4 in BALF might be the independent risk factors of IAH. Key words: Mechanical ventilation; Acute lung injury/acute respiratory distress syndrome; Intra- abdominal pressure (IAP); Intra-abdominal hypertension (IAH); Logistic regression

Intra-abdominal hypertension; prevalence, incidence and outcomes in a low resource setting; a prospective observational study.

BackgroundIntra-abdominal hypertension (IAH) is defined as a sustained elevation in intra-abdominal pressure (IAP) greater than or equal to 12 mmHg. IAH has been shown to cause organ derangements and dysfunction in the body. Objective screening of IAH is neither done early enough nor at all thus leading to significant morbidity and mortality among surgical patients. The epidemiology and outcome of IAH among surgical patients has not been documented in Uganda. The aim of this study was to determine the prevalence, incidence and outcome of intra-abdominal hypertension among patients undergoing emergency laparotomy.MethodologyProspective observational study, conducted from January to April 2015 among patients undergoing emergency laparotomy. Inclusion criteria was; age >7 yrs, scheduled for emergency laparotomy, able to lie supine. Exclusion Criteria: pregnant, failed urethral catheterization, known cardiac, renal and respiratory disorders. Consecutive sampling was used. IAP, blood pressure, heart rate, respiratory rate, Sp02, Serum creatinine, Serum urea, and Urine output were measured preoperatively and postoperatively at 0, 6, 24 and 48 h. IAH was defined as IAP > 12 mmHg on three consecutive readings 3 min apart.ResultsIn total 192 patients were enrolled. Mean age ± SD was 14.25 (±3.16) yrs in the paediatrics and 34.4(±13.72) yrs in the adults with male preponderance 65 and 80.7 % respectively. The prevalence of IAH was 25 % paediatrics and 17.4 % adults and the cumulative incidence after surgery was 20 % paediatrics and 21 % adults. In paediatrics, IAH was associated with mortality at 0 h postoperatively, RRR = 1:24, 95 % CI (1.371–560.178), p-value 0.048. In adults, the statistically significant outcomes associated with IAH were respiratory system dysfunction RRR1:2.783, p-value 0.023, 95 % CI (1.148–6.744) preoperatively and mortality RRR 1:2.933, p-value 0.034, 95 % CI (1.017–8.464) at 6 h, RRR 1:3.769, p-value 0.033, 95 % CI (1.113–12.760) at 24 h postoperatively.ConclusionThe prevalence and incidence of IAH in the paediatrics and adults group in our study population were high. IAH was associated with mortality in both adult and paediatrics groups and respiratory system dysfunction in adult group. This calls for objective monitoring of intraabdominal pressure in patients undergoing emergency laparotomy with the aim of reducing associated mortality.

Use of double-layer autologous dermal flap in the treatment of recurrent and/or infected incisional hernias: presentation of the surgical technique and the results of 1-year follow-up-a prospective, consecutive cohort study.

The difficulties of treating recurrent and/or infected incisional hernias are well known in surgical practice. Several surgical techniques and various types of grafts are available for surgeons. This study presents a new surgical technique option together with the results of the 1-year follow-up. The primary aim of the study is to present the surgical technique of the procedure suitable for the treatment of recurrent and/or infected incisional hernias. The secondary aim is to determine the recurrence rate and analyse the surgical complications. The tertiary aim is to present the quality of life test results performed 3, 6 and 12months after the surgery. The authors evaluated the results of 36 recurrent and/or infected incisional hernia surgeries (11 men, average age 60.6years; 25 women, average age 58.9years) performed with their own surgical method in the framework of a tightly controlled, prospective, interventional and observational consecutive cohort study conducted between 1 January 2011 and 31 December 2013 at a university surgical department. The study evaluates the results of the 1-year follow-up period. All 36 patients had at least one recurrence of abdominal wall hernia; 12 of them also had concurrent infection of the synthetic graft and a complicating fistula. The mean BMI was 31.82kg/m(2) (25.2-43.5kg/m(2)). The average size of the abdominal wall defect was 145.9cm(2) (59-275cm(2)). The abdominal wall reconstruction was performed using an autologous, double-layer dermal flap. The grafts, which had been inserted during previous surgeries, were removed completely. The autologous dermal tissue was prepared using the flap harvested during dermolipectomy. The reconstruction was achieved using a tension-free technique. The essence of the abdominal wall reconstruction is the completion of the abdominal wall defect by a double-layer autologous dermal flap. The original abdominal wall defect was not closed by direct sutures. The quality of the prepared dermal flap was histologically evaluated. IAPMS (intra-abdominal pressure monitoring set) was applied to verify intra-abdominal pressure in the post-operative period. The result of the surgeries was assessed using a quality of life questionnaire. No recurrence of the abdominal wall hernia was registered during the 1-year follow-up period. Abdominal bulking was observed in case of three patients (8.3%). Wound infection occurred in one patient (2.77%) and skin dehiscence in two patients (5.55%). Haematoma was registered in case of one patient (2.77%) on the fifth post-operative day. Seroma formation occurred in case of eight patients (22.22%), which required percutaneous tapping. A fistula formation was observed in one patient (2.77%) 45days after the surgery. The intra-abdominal pressure remained moderately elevated during the early post-operative period (9.65-5.76mmHg on post-operative days 1 and 5). Reoperation was performed in one case due to haematoma. No fatality occurred. The 1-year recurrence rate in case of the abdominal wall reconstruction using double-layer autologous dermal flap is favourable. Being compliant with the surgical technique developed, the procedure is safe to perform. The number of surgical site infections and fistula formations is low. Based on the questionnaires evaluated, all patients would choose this method instead of the previous reconstruction(s). The method is cost-effective. Based on the results, this procedure is feasible for the treatment of recurrent and/or infected abdominal wall, incisional ventral hernias in obese "high risk" patients.

A 6th Vital Sign--Potential Use of Nasogastric Tube for Intra-abdominal Pressure Monitoring Method to Detect Feeding Intolerance in Very Low Birth-Weight Preterm Infants (

While various feeding strategies designed to optimize growth have been investigated and used in the clinical setting, the problem of not being able to recognize the warning signs of feeding intolerance early enough to prevent serious gastrointestinal complication commonly associated with very low birth-weight (VLBW) preterm infant remains. Currently, early stages of feeding intolerance are most often identified though nurse assessments. Additional methods to predict feeding intolerance in this population are needed. Currently, intra-abdominal pressure monitoring has been an effective method to predict intolerance to enteral nutrition in the adult and pediatric populations. There is supportive evidence for the use of noninvasive methods, such as nasogastric tubes, to effectively monitor IAP. While this may not be the gold standard method of using Foley catheters for measurement, it could provide predictive levels that are indicative of progression toward bowel inflammation. This review shows the potential for using noninvasive nasogastric tubes for monitoring intra-abdominal pressure and may provide direction for evaluating intra-abdominal pressures in VLBW preterm infants as a reliable method for early identification of feeding intolerance. The use of nasogastric tubes to monitor intra-abdominal pressure may provide an effective noninvasive tool to identify VLBW preterm infants progressing toward feeding intolerance and would add to assessment data. Development and testing of a reliable nasogastric tube monitoring device in the VLBW preterm infant population and identify predictive levels that indicate progression toward feeding intolerance is needed. Once IAP predictive levels are identified, provider interventions could be developed.

Intra-abdominal pressure monitoring in postoperative period in patients with diffuse peritonitis

Epidemiology, etiology, pathologic and morphologic changes associated with increased intra-abdominal pressure are described. The most common ways of its measuring and monitoring are presented. Intra-abdominal pressure is increased by more than 15 mm Hg in patients with diffuse peritonitis. Increased intra-abdominal pressure is associated with the disease severity: the higher the intra-abdominal pressure, the more severe is the disease. If intra-abdominal pressure is increased over 20 mm Hg, treatment strategy depends on the signs of organ failure. In the absence of organ failure, intra-abdominal pressure should be monitored every 4 hours as long as the patient is in critical condition. Intra-abdominal pressure monitoring in case of peritonitis must be attributed to the mandatory manipulation, as pressure changes precede the clinical manifestations of intra-abdominal complications. Measurement of intra-abdominal pressure allows to detect the early signs of multiple organ failure, which is essential for the correction of systemic complications in pancreatogenic peritonitis. In this case, monitoring of intra-abdominal pressure in diffuse postoperative peritonitis should be considered only as a screening test for assessing of the organ dysfunction severity, as the development of multiple organ dysfunction syndrome involves complex pathophysiological mechanisms. Predictions that are more accurate can be made using such integrated indicators as APACHE II (Acute Physiology And Chronic Health Evaluation scale, which is used for assessing various acute and chronic diseases), SAPS (Simplified Acute Physiology Score - a simplified scale for acute functional changes assessment), SOFA (Sepsis-related Organ Failure Assessments Score - scale for dynamic assessment of organ failure in sepsis), MPI (Mannheim Peritonitis Index) scales.

Surgical management of traumatic retroperitoneal hemor-rhage

To present the algorithm of management of victims using modern technologies including CT, laparoscopy, angiography, intraabdominal pressure monitoring, etc. Treatment of 395 victims with traumatic retroperitoneal hemorrhage was analyzed. It was shown that the use of developed algorithm decreases mortality rate from 10.5 to 4.5% and postoperative complications incidence from 23 to 14.1% in reviewed patients.

Noninvasive monitoring of intra-abdominal pressure by measuring abdominal wall tension.

Noninvasive monitoring of intra-abdominal pressure (IAP) by measuring abdominal wall tension (AWT) was effective and feasible in previous postmortem and animal studies. This study aimed to investigate the feasibility of the AWT method for noninvasively monitoring IAP in the intensive care unit (ICU). In this prospective study, we observed patients with detained urethral catheters in the ICU of Shanghai Tenth People's Hospital between April 2011 and March 2013. The correlation between AWT and urinary bladder pressure (UBP) was analyzed by linear regression analysis. The effects of respiratory and body position on AWT were evaluated using the paired samples t test, whereas the effects of gender and body mass index (BMI) on baseline AWT (IAP<12 mmHg) were assessed using one-way analysis of variance. A total of 51 patients were studied. A significant linear correlation was observed between AWT and UBP (R=0.986, P<0.01); the regression equation was Y=-1.369+9.57X (P<0.01). There were significant differences among the different respiratory phases and body positions (P<0.01). However, gender and BMI had no significant effects on baseline AWT (P=0.457 and 0.313, respectively). There was a significant linear correlation between AWT and UBP and respiratory phase, whereas body position had significant effects on AWT but gender and BMI did not. Therefore, AWT could serve as a simple, rapid, accurate, and important method to monitor IAP in critically ill patients.

Board #250 - Program Innovation Training Residents to Measure Intra-Abdominal Pressure Using Simulation

Objectives Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) have been associated with patient morbidity and mortality, reported to occur in 20% to 40% of critically ill patients.1 This high-incidence rate and high risk make monitoring of intra-abdominal pressure (IAP) through pressure measurements an important element in care of at-risk patients.2 In most hospitals, nursing personnel are responsible for IAP measurements, often reporting these to a resident. Nursing personnel are generally educated on IAP measurements by vendors of the measuring device. Conversely, residents have historically had very little instruction on measurement of IAP, yet are called upon to substantiate these measurements and to form clinical action plans based upon the measurements. This disconnect was approached through an innovative educational session using simulation. To provide residents more experience in measurement skills, a safe simulated environment was chosen. Objectives of the simulation were to: 1) teach residents the correct method for measuring IAP, 2) help residents identify common pitfalls in abdominal pressure measurements, 3) Identify the factors that may give false readings, 4) improve resident communication skills. Description A scenario using high-fidelity simulation was developed to teach residents how to correctly measure IAP and identify common pitfalls often leading to inaccurate readings. The scenario centered around a critically ill patient with pancreatitis. The patient (a high-fidelity simulator) was sitting upright, under mechanical ventilation, and was reported to be fighting the ventilator. An indirect measurement of IAP was determined using an bladder pressure monitoring device. A designated RN from the intensive care unit served as a confederate in all of the scenarios. Residents were individually introduced to a scenario involving a reported elevated IAP, and were expected to assess the patient and address the reported elevated IAP. Four major pitfalls were included in the scenario: 1) patient positioning, 2) lack of paralyzing agent, 3) transducer not leveled, 4) an aberrant clamp on the bladder catheter. Following the simulation, residents were individually debriefed and were provided feedback by experienced physicians who observed the scenario. Conclusion Overall, the training session was successful as assessed by both learners and faculty. It was simple to run, consistent throughout and efficient, allowing for multiple residents to complete training in limited time. The outcomes from the training gave a dependable baseline, making this an ideal method to use in observing resident skills in intra-abdominal pressure measurement, including diagnosis, trouble shooting, and interpretation of IAP readings. Residents were provided learning through hands-on application in the scenario and immediate feedback regarding their individual performance. Additional key findings of the simulation training: 1) debriefing the residents individually to provide formative feedback was a key factor in the learning process, 2) the less experienced residents struggled more in the simulation where as more senior residents were more likely to make an appropriate evaluation and diagnosis, 3) having a consistent nurse confederate was felt to be helpful in creating more realism and helping to steer the residents toward the correct measurement and diagnosis.

Early screening to identify patients at risk of developing intra-abdominal hypertension and abdominal compartment syndrome.

To develop a screening tool to identify patients at risk of developing intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) within 24 h of a patient's admission to intensive care unit (ICU). Prospective, observational study of 403 consecutively enrolled patients with an indwelling catheter, admitted to a mixed medical-surgical ICU in a tertiary referral, university hospital. Intra-abdominal pressure was measured at least twice daily and IAH and ACS defined as per consensus definitions. Thirty-nine per cent of patients developed IAH and 2% developed ACS. Abdominal distension, hemoperitoneum/pneumoperitoneum/intra-peritoneal fluid collection, obesity, intravenous fluid received > 2.3 l, abbreviated Sequential Organ Failure Assessment score > 4 points and lactate > 1.4 mmol/l were identified as independent predictors of IAH upon admission to ICU. The presence of three or more of these risk factors at admission identified patients that would develop IAH with a sensitivity of 75% and a specificity of 76%, the development of grades II, III and IV IAH with a sensitivity of 91% and a specificity of 62%. Patients that developed IAH required a significantly longer duration of mechanical ventilation and ICU care. Patients that developed grades II-IV IAH had a significantly higher rate of ICU mortality. IAH is a common clinical entity in the intensive care setting that is associated with morbidity and mortality. A screening tool, based on data readily available within a patient's first 24 h in ICU, was developed and effectively identified patients that required intra-abdominal pressure monitoring.

Application of intra-abdominal pressure monitoring in patients with severe acute pancreatitis

Objective To explore the clinical value of monitoring intra-abdominal pressure （ IAP） in the monitoring and treatment of patients with severe acute pancreatitis .Methods The changes of IAP in 82 patients with severe acute pancreatitis in the intensive care unit were dynamically monitored , and the effects of the increased IAP on respiratory , hemodynamic , kidney function and so on were analyzed , and the early intervention was carried out .Results No differences were found in the changes of heart rate , blood pressure , peripheral blood oxygen saturation , respiratory before and after the first measurements of IAP in 82 patients（P>0.05）.The CVR, HR, oxygenation index, MAP and IAP in 54 patients with increased IAP were respectively （17 ±177;5） cmH2O, （132 ±177;18） beats/min, （240 ±177;60）, （45 ±177;12） mmHg and （22 ±177;8） mmHg before the intervention, and were （13 ±177;4） cmH2O, （118 ±177;12） beats/min, （320 ±177;80）, （65 ±177;8） mmHg and （12 ±177; 6） mmHg after the intervention, and the differences were statistically significant （ t =4.59, 5.58, 5.88, 10.19, 7.35, respectively;P<0.01）.Conclusions The increased IAP correlates closely with the condition and prognosis of patients with severe acute pancreatitis .The routine IAP monitoring for patients with severe acute pancreatitis is helpful to the evaluation of condition and prognosis , and is also helpful to take timely and effective treatment and nursing , and can prevent the occurrence and development of abdominal compartment syndrome and assist the judgment of operation time for severe acute pancreatitis . Key words: Severe acute pancreatitis; Heart rate; Blood pressure; Blood oxygen saturation; Intra-abdominal pressure monitoring