Дане керівництво перекладено ГО «M-Gate» під редакцією ГО «Асоціації анестезіологів України». Всі права належать Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. Список скорочень: ВАІТ-відділення анестезіології та інтенсивної терапії ГКН-гостра кишкова недостатність ІМТ-індекс маси тіла КН-кишкова недостатність КШФ-кишково-шкірні фістули ПНЖК-поліненасичені жирні кислоти ПХ-парентеральне харчування СТГ-середньоланцюгові тригліцериди ХКН-хронічна кишкова недостатність ХПАПХ-хвороба печінки, асоційована з парентеральним харчуванням ШКТ-шлунково-кишковий тракт

Background There is a lack of population‐based studies on acute mesenteric ischemia (AMI). We have therefore performed a nationwide epidemiological study in Estonia, addressing incidence, demographics, interventions and mortality of AMI. Methods A retrospective population‐based review was conducted of all adult cases of AMI accrued from the digital Estonian Health Insurance Fund and Causes of Death Registry for 2016–2020 based on international classification of diseases (ICD‐10) diagnostic codes and procedure codes (NOMESCO). Results Overall, 577 cases of AMI were identified—an annual incidence of 8.7 per 100,000. The median age was 79 (range 32–104) and 57% were female. Predominating comorbidities included hypertensive disease (81%), atherosclerosis (67%), and atrial fibrillation (52%). The majority of cases (60%) were caused by superior mesenteric artery occlusion (thrombosis 54%, embolism 12%, and unclear 34%). Inferior mesenteric artery occlusion occurred in 7%, non‐occlusive mesenteric ischemia in 7%, venous thrombosis in 4%, whereas the type remained unclear in 21% of cases. 40% of patients received intervention (revascularization and/or intestinal resection) and 13% active non‐operative treatment. In 21% an exploratory laparotomy or laparoscopy revealed unsalvageable bowel prompting end‐of‐life care, which was the only management in a further 25% of cases. Conclusions The population‐based annual incidence of AMI in Estonia was 8.7 per 100,000 during the study period. The overall hospital mortality and 1 year mortality were 64% and 74%, respectively. In the 53% of patients who received active treatment hospital mortality was 32% and 1 year all‐cause mortality was 51%. Trial registration ClinicalTrials.gov Identifier NCT04867499.

Background: Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are increasingly recognized as aetiologies of organ failure and mortality among a wide variety of patient populations. Since the first global survey in 2007, several surveys have been conducted. However, it remains unclear to what extent healthcare professionals in clinical practice are aware of the widely accepted definitions and recommendations proposed in the World Society of the Abdominal Compartment Syndrome (WSACS) guidelines and whether these recommendations are being applied clinically. Methods:We conducted an international cross-sectional survey to determine the impact of the 2013 WSACS IAH/ACS Consensus Definitions and Clinical Management Guidelines on IAH/ACS clinical awareness and management. We also aimed to compare the results to the findings of the global survey conducted in 2007. Results:The survey had 559 respondents with most respondents being physicians from Europe, and who worked in mixed intensive care units (87.3%; n = 448). The majority of respondents (73.2%) were aware of WSACS (the Abdominal Compartment Society), with a greater percentage being aware of the WSACS guidelines compared to the 2007 survey (60.2% vs. 28.4%). A considerable proportion of respondents (18%) never measure intra-abdominal pressure (IAP), with the most common reason for not measuring IAP being reliance on physical examination (39%; n = 38). Analysis of the 11 questions related to knowledge and clinical practice of IAH, ACS and WSACS consensus definitions showed an improvement from the first survey (42.7% of questions answered correctly in comparison to 48.0% in this survey, P = 0.0001). The responses to how physicians managed IAH and ACS were different to the previous survey, with diuretics being used "usually" or "frequently" (49.2%), more than inotropes (38.6%), decompressive laparotomy (37.0%), paracentesis (36.5%), and fluids/blood products (24.2%). Most respondents would perform/request a decompressive laparotomy in cases of ACS. Polycompartment syndrome was something considered by 39% (n = 218) in their daily practice. Almost two thirds of respondents (63.5%; n = 355) thought that gastrointestinal injury should be added to the Sequential Organ Failure Assessment (SOFA) score. Conclusions:This survey shows an improvement in general awareness and knowledge regarding IAP, IAH and ACS, although the level of understanding and awareness