Treatment Of Intra-abdominal Hypertension Research Articles

Abdominal compartment syndrome in critically ill patients.

Intra-abdominal hypertension can have severe consequences, including abdominal compartment syndrome, which can contribute to multi-organ failure. An increase in intra-abdominal hypertension is influenced by factors such as diminished abdominal wall compliance, increased intraluminal content, and certain systemic conditions. Regular measurement of intra-abdominal pressure is essential, and particular attention must be paid to patient positioning. Nonsurgical treatments, such as decompression of intraluminal content using a nasogastric tube, percutaneous drainage, and fluid balance optimization, play crucial roles. Additionally, point-of-care ultrasonography aids in the diagnosis and treatment of intra-abdominal hypertension. Emphasizing the importance of regular measurements, timely decompressive laparotomy is a definitive, but complex, treatment option. Balancing the urgency of surgical intervention against potential postoperative complications is challenging.

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.

Awareness and diagnosis for intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) in neonatal (NICU) and pediatric intensive care units (PICU) – a follow-up multicenter survey

BackgroundConstantly elevated intra-abdominal pressure (IAH) can lead to abdominal compartment syndrome (ACS), which is associated with organ dysfunction and even multiorgan failure. Our 2010 survey revealed an inconsistent acceptance of definitions and guidelines among pediatric intensivists regarding the diagnosis and treatment of IAH and ACS in Germany. This is the first survey to assess the impact of the updated guidelines on neonatal/pediatric intensive care units (NICU/PICU) in German-speaking countries after WSACS published those in 2013.MethodsWe conducted a follow-up survey and sent 473 questionnaires to all 328 German-speaking pediatric hospitals. We compared our findings regarding awareness, diagnostics and therapy of IAH and ACS with the results of our 2010 survey.ResultsThe response rate was 48% (n = 156). The majority of respondents was from Germany (86%) and working in PICUs with mostly neonatal patients (53%).The number of participants who stated that IAH and ACS play a role in their clinical practice rose from 44% in 2010 to 56% in 2016. Similar to the 2010 investigations, only a few neonatal/pediatric intensivists knew the correct WSACS definition of an IAH (4% vs 6%). Different from the previous study, the number of participants who correctly defined an ACS increased from 18 to 58% (p < 0,001). The number of respondents measuring intra-abdominal pressure (IAP) increased from 20 to 43% (p < 0,001). Decompressive laparotomies (DLs) were performed more frequently than in 2010 (36% vs. 19%, p < 0,001), and the reported survival rate was higher when a DL was used (85% ± 17% vs. 40 ± 34%).ConclusionsOur follow-up survey of neonatal/pediatric intensivists showed an improvement in the awareness and knowledge of valid definitions of ACS. Moreover, there has been an increase in the number of physicians measuring IAP in patients. However, a significant number has still never diagnosed IAH/ACS, and more than half of the respondents have never measured IAP. This reinforces the suspicion that IAH and ACS are only slowly coming into the focus of neonatal/pediatric intensivists in German-speaking pediatric hospitals. The goal should be to raise awareness of IAH and ACS through education and training and to establish diagnostic algorithms, especially for pediatric patients.The increased survival rate after conducting a prompt DL consolidates the impression that the probability of survival can be increased by timely surgical decompression in the case of full-blown ACS.

Physicians' Knowledge of Abdominal Compartment Syndrome and Intra-Abdominal Hypertension in Saudi Arabia: An Online Cross-Sectional Survey Study.

To determine physicians' knowledge of abdominal compartment syndrome and intra-abdominal hypertension in Saudi Arabia. A cross-sectional online survey study was conducted on physicians in Saudi Arabia between March and August 2022. A previously developed questionnaire was adapted and used in this study. The survey instrument investigated the knowledge and management of intra-abdominal hypertension and abdominal compartment syndrome among physicians. Logistic regression was used to identify predictors of being knowledgeable about abdominal compartment syndrome and intra-abdominal hypertension. A total of 266 physicians participated in this study. Around one-fifth (21.8%) the study participants were ICU physicians and 25.0% reported that they practice internal medicine. Intra-abdominal hypertension (IAH) and the impact of increased intra-abdominal pressure (IAP) on organ function were terms that the majority of research participants (70.3%) reportedthey were familiar with. A similar percentage (73.7%) reported that they are familiar with abdominal compartment syndrome (ACS). Around 43.0% of the study participants reported that they do not know how to measure IAP. The most frequently reported (13.5%) intervention in the treatment of IAH and ACS was the use of inotropes or vasopressors. The study participants showed a weak level of knowledge of ACS and IAH with a median score of 3.00 (IQR: 5.00-2.00), which represents 27.3% of the maximum attainable score. Physicians working at hospitals with 20-50 ICU beds were 41.0% (odds ratio: 0.59 (CI: 0.37-0.96)) less likely to be knowledgeable about intra-abdominal hypertension and abdominal compartment syndrome (p≤0.05). Physicians demonstrated a low level of IAP and ACS knowledge. To increase the safety of medical practices and enhance clinical outcomes for patients, awareness should be raised about the proper diagnosis and managementof IAP and ACS. Future research should focus on developing effective educational strategies to improve physicians' understanding of IAP and ACS.

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&lt;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&lt;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).

INTRABDOMINAL PRESSURE AND ITS CORRECTION IN ACUTE SURGICAL PATHOLOGY

The aim: Improving the results of treatment of patients with acute surgical pathology of the abdominal cavity by correcting intra-abdominal hypertension (IAH). Materials and methods: The results of examination and treatment of 187 patients with acute surgical pathology, which was accompanied by elevation of IAP. To compare the results, depending on the chosen diagnostic and treatment tactics, patients were divided into two groups: comparison and main. The comparison group (85 people (45,5%) included patients who have been treated with traditional approaches in diagnosis and treatment according to existing treatment protocols. The main group (102 people (54,5%) included patients in whose treatment we additionally used our proposed step-by-step approach in the treatment of IAH. Results: Systemic complications occurred in 12 patients of the main group (11,8%) and in 46 patients of the comparison group (54,1%), while in the second group the frequency of systemic complications was significantly higher (χ2 = 38,6, CI 29,3-53,6, p &lt;0,0001). 20 patients (10,7%) died (2 patients of the main group (1,96%) and 18 patients of the comparison group (21,2%) (χ2 = 17,85, CI 10,4-29,18, p &lt;0,0001). Conclusions: Use in the complex treatment of patients with acute surgical pathology of the abdominal cavity, accompanied by IAH, the proposed step-by-step approach has improved treatment outcomes by reducing the incidence of systemic complications from 54,1% to 11,8%, total mortality from 21,2% to 1,96% and postoperative mortality - from 22,4% to 2,4%.

Diagnostics and treatment of intra-abdominal hypertension for patients suffering from abdominal sepsis

Diagnostics and treatment of intra-abdominal hypertension for patients suffering from abdominal sepsis

Incidence of Intra-Abdominal Hypertension and Abdominal Compartment Syndrome: A Systematic Review

To determine the contemporary prevalence of intra-abdominal hypertension (IAH) and abdominal compartment syndrome in critically ill patients. Medline, Embase, and Central databases. Studies reporting on the prevalence of IAH in consecutively admitted critically ill patients using the World Society of Abdominal Compartment Syndrome (WSACS) consensus guidelines for intra-abdominal pressure (IAP) measurement. Duplicate independent review and data abstraction. The search identified 2428 titles with 6 eligible studies (n = 1965). Reported prevalence ranged from 30% to 49%. Despite abiding by the WSACS guidelines for IAP measurement, studies varied in their definition of IAH, frequency and duration of IAP measurement, and reporting of outcomes. Three of 6 studies reported that IAH, especially at higher grades, was an independent predictor of mortality. Intra-abdominal hypertension is a common finding in critically ill patients and may be associated with increased mortality, especially at higher grades. Further prospective research is required to examine the effect of screening and treatment of IAH on patient outcomes.

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.

Surveillance, Prevention and Treatment of Intra-abdominal Hypertension and Abdominal Compartment Syndrome

Surveillance, Prevention and Treatment of Intra-abdominal Hypertension and Abdominal Compartment Syndrome

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

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

Application value of initiative content reduction surgery in the prevention and treatment of postoperative intra-abdominal hypertension of obese patients with giant ventral hernia

Objective To investigate the clinical effect of initiative content reduction surgery in the herniorraphy on the prevention and treatment of postoperative intra-abdominal hypertension of obese patients with giant ventral hernia. Methods The retrospective cross-sectional study was adopted. The clinical data of 62 obese patients with giant ventral hernias who were admitted to the Chao-Yang Hospital of Capital Medical University from January 2011 to December 2015 were collected. The initiative content reduction surgery was adopted during the herniorraphy of ventral hemia. Observation indices: (1) surgery situations: operation time, length of resected intestines, volume of intraoperative blood loss. (2) Postoperative recovery situations: change between preoperative and postoperative urethral bladder pressure, organ function of heart, lung, liver and kidney, time of gastro-intestinal function recovery, time of drainage tube removal and duration of postoperative hospital stay. (3) Postoperative complications: incisional infection and intestinal fistula. (4) Follow-up situations. Follow-up using outpatient examination at 1 week, 1 month, 3 months and 6 months after surgery and using telephone interview at postoperative year 1 was conducted up to June 2016. The follow-up included hernia recurrence and chronic infection. Measurement data with normal distribution were represented as ±s. Measurement data with skewed distribution were represented as M (range) and analyzed by rank-sum test. Results (1) Surgery situations: all the 62 patients received successful herniorraphy of giant ventral hemia combined with initiative content reduction surgery. Operation time, length of resected intestines and volume of intraoperative blood loss were (115±22)minutes, (207±64)cm and (52±35)mL. (2) Postoperative recovery situations: the preoperative urethral bladder pressure was 18 cmH2O (range, 15-22 cmH2O, 1 cmH2O=0.098 kPa) and postoperative urethral bladder pressure was 8 cmH2O (range, 6-11 cmH2O), with a significantly statistical difference between before and after surgery (Z=-9.662, P<0.05). There was no abnormal function of heart, lung, liver and kidney after operation. The time of gastrointestinal function recovery, time of drainage tube removal and duration of postoperative hospital stay were 3.8 days (range, 3.0-6.0)days, (3.8±1.1)days and (14.5±1.9)days. (3) Postoperative complications: of 62 patients, 4 were complicated with incisional infection and improved after symptomatic treatment. There was no intestinal fistula. (4) Follow-up situations: all the 62 patients were followed up for (36±19)months. During the follow-up, 3 patients had incisional hernia recurrence and then were followed up without reoperation. No chronic infection occurred. Conclusion Initiative content reduction surgery is effective and feasible in the prevention and treatment of intraoperative intra-abdominal hypertension of obese patients with giant ventral hernia. Key words: Giant ventral hernia; Herniorraphy; Abdominal hypertension; Initiative content reduction; Obesity

Taohe Chengqi decoction combined with octreotide for prevention and treatment of intra-abdominal hypertension in rats with severe acute pancreatitis

Taohe Chengqi decoction combined with octreotide for prevention and treatment of intra-abdominal hypertension in rats with severe acute pancreatitis

PS-135 Consensus Definitions, Limiting Values And Recommendations On Intra-abdominal Hypertension Therapy (iah) And Abdominal Compartment Syndrome (acs) In Childhood Published By The Wsacs-paediatric Guidelines-committee

Background and aim Hitherto, neither evidence-based definitions nor age-related recommendations existed on the diagnosis and treatment of Intra-Abdominal Hypertension (IAH) and Abdominal Compartment Syndrome (ACS) in childhood. Following their 7th World Congress 2011 in Orlando (Florida), the World Society of the Abdominal compartment ayndrome (www. WSACS.org) instructed a paediatric expert committee to develop appropriate guidelines. Methods Based on a systematic database search relevant literature was identified related to neonatal and paediatric IAH/ACS. Using a modified Delphi methodology according to the GRADE model (A to D), all papers were checked with respect to their validity and evidence. Afterwards, paediatric consensus definitions and recommendations were framed. Results Results were published in intensive care medicine together with the revised 2013 consensus guidelines for adults (ICM 2013; 39(7):1190–206). Besides general definitions, risk factors and critical IAP thresholds (IAP: intra-abdominal pressure) recommendations were formulated concerning a standardised IAH and ACS monitoring as well as a rational therapeutic management (including medical, interventional and surgical therapy options). While in adults an IAP of 12 mmHg is regarded as dangerous, an IAP of at the latest 10 mmHg must be looked upon as IAH in children. The additional appearance of a new or aggravated organ dysfunction marks the transition into an ACS, whose diagnosis should result in the quickest possible abdominal decompression. If a decompressing laparotomy does not suffice for a durable IAP diminution itself, a prophylactic open-abdomen concept must be considered (syn.: laparostomy). The concept of abdominal perfusion pressure (APD = MAP -IAP) can facilitate the assessment of the pathogenetic influence of IAH in daily clinical practice. Discussion In the context of former surveys, paediatric intensivists often justified their widespread uncertainty and restraint with respect to regular IAP measurements and timely introduction of invasive therapy options (if indicated) with the lack of age-related guidelines and definitions. This first publication of paediatric IAP limiting values and management recommendations therefore represents an essential treatment progress and a therapeutic decision support, which should submit a significant reduction in morbidity and mortality of IAH and ACS in children and adolescents. Conclusion Since the evidence of the underlying literature has to be classified on average as low, well-designed multicenter studies are urgently needed to enable a critical reevaluation of these consensus results.

Effect of intra-abdominal volume increment on heart for the treatment of intra-abdominal hypertension after hemorrhagic shock resuscitation in minipigs

Objective To observe the effect of intra-abdominal volume increment (IAVI) on heart functions with intra-abdominal hypertension (IAH).Methods The models of hemorrhagic shock and incomplete blockage of portal vein in 8 healthy adult minipigs were successfully established and randomly divided into two groups:the IAVI treatment group (n =4 ) and the sham-operated group ( n =4). Heart rate,mean aortic pressure (MAP),fractional shortening (FS),ejection fraction (EF) and wet-to-dry ratio of heart were detected and hematoxylin-eosin staining was done. Results As compared with before shock,the heart rate at 2 h after IAH was increased ( 154 beats/min vs 123 beats/min,P ＜0.05 ),and MAP [110.0mm Hg(1 mmHg=0.133kPa) vs.127.5 mm Hg,P＜0.05],FS (29.8％ vs.40.4％,P ＜0.05) and EF (55.5％ vs.72.0％,P ＜0.05) were decreased.At 2 h after IAH,in the IAVI treatment group 8 h and 12 h after surgery,the heart rate (124 beats/min vs.156 beats/min; 120 beats/min vs.156 beats/min) was decreased as compared with sham-operated group.As compared with 2 h after IAH,in the IAVI treatment group 22 h after surgery,EF (66.9％ vs.55.5％,P ＜0.05) was increased.Conclusion Intra-abdominal volume increment can achieve a notable improvement of heart rate and EF in this model. Key words: Hemorrhagic shock; Resuscitation; Intra-abdominal hypertension; Intra-abdominal volume increment; Heart function; Minipig

Total management of the open abdomen

The management of complex abdominal problems with the 'open abdomen' (OA) technique has become a routine procedure in surgery. The number of cases treated with an OA has increased dramatically because of the popularisation of damage control for life-threatening conditions, recognition and treatment of intra-abdominal hypertension and abdominal compartment syndrome and new evidence regarding the management of severe intra-abdominal sepsis. Although OA has saved numerous lives and has addressed many problems related to the primary pathology, this technique is also associated with serious complications. New knowledge about the pathophysiology of the OA and the development of new technologies for temporary abdominal wall closure (e.g. ABThera™ Open Abdomen Negative Pressure Therapy; KCI USA Inc., San Antonio, TX) has helped improve the management and outcomes of these patients. This review will merge expert physician opinion with scientific evidence regarding the total management of the OA.

Advanced Age May Limit the Survival Benefit of Open Abdominal Decompression

Open abdominal decompression (OAD) and temporary abdominal closure (TAC) are widely performed for the treatment of intra-abdominal hypertension and/or abdominal compartment syndrome. During 2005 to 2009, 405 consecutive patients required OAD/TAC (trauma 68%, surgery 24%, medicine 5%, burn 3%). Overall patient survival to hospital discharge was 65 per cent regardless of age and was significantly decreased among patients older than 70 years of age (P < 0.0001). Survival by decade of life exceeded 50 per cent through the eighth decade but decreased to 19 per cent for the ninth decade (older than 80 years of age). Survival varied significantly by service (trauma 72%, surgical 56%, burns 55%, medical 33%) (P < 0.0001). Successful definitive fascial closure rates (range, 75 to 100%) were equivalent among all age groups (P = 0.78). Survival after OAD/TAC varies by decade of life and mechanism of injury/illness. Age alone should not negate the use of OAD/TAC. Reasonable survival rates may be expected for patients younger than 80 years of age.

Elective Inguinal Hernia Repair in a Patient with Fontan Circulation Complicated by Intraperitoneal Hemorrhage: Surgical and Anesthesiological Considerations

Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are associated with significant morbidity and mortality. Nonoperative medical management strategies play an important role in the current treatment of IAH and ACS. There are five medical treatment options to be considered to reduce elevated intra-abdominal pressure (IAP): 1) improvement of abdominal wall compliance; 2) evacuation of intraluminal contents; 3) evacuation of abdominal fluid collections; 4) optimization of systemic and regional perfusion; and 5) correction of positive fluid balance. Nonsurgical management is an important treatment option in critically ill patients with raised IAP.

Evolving Concepts in the Monitoring and Treatment of Intra-abdominal Hypertension and the Abdominal Compartment Syndrome

Evolving Concepts in the Monitoring and Treatment of Intra-abdominal Hypertension and the Abdominal Compartment Syndrome