Abdominal Compartment Hypertension and Abdominal Compartment Syndrome

Maluso, Patrick; Olson, Jody C.; Sarani, Babak

doi:10.1016/j.ccc.2015.12.001

Cited by 62 publications

(53 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Sedation has been used adjunctively to reduce intraabdominal pressure and thus facilitate abdominal closure. 24 Targeting a deep level of sedation could also prevent agitation-related damage to the abdominal wound. Some clinicians proposed that targeting a lighter level of sedation and even providing no sedation or mechanical ventilation may be effective for management of patients with an open abdomen.…”

Section: Discussionmentioning

confidence: 99%

Effect of Neuromuscular Blocking Agents on Sedation Requirements in Trauma Patients with an Open Abdomen

2019

View full text Add to dashboard Cite

The appropriate level of sedation in patients with an open abdomen following damage control laparotomy (DCL) is debated. Chemical paralysis with neuromuscular blocking agents (NMBAs) has been used to decrease time to abdominal closure. We sought to evaluate the effect of NMBA use on sedation requirements in patients with an open abdomen and to determine the effect of sedation on patient outcomes. A retrospective cohort study was conducted at an American College of Surgeons’ verified level 1 trauma center. Adult trauma patients who underwent DCL between 2009 and 2015 were included. Patients with an intensive care unit length of stay of less than 48 hours and those who died before abdominal closure were excluded. The NMBA+ group received continuous NMBA within 24 hours of DCL; the NMBA− group did not. The primary outcome was cumulative sedation dose during the 7 days following DCL. Secondary outcomes included Richmond Agitation‐Sedation Scale (RASS) score, mechanical ventilation‐free days, and delirium‐coma‐free days. Delirium‐coma‐free days were analyzed with linear regression. A total of 222 patients were included (NMBA+ 125; NMBA− 97). Demographics were similar between groups including age, Injury Severity Score, and mechanism of injury. The median time to closure in the overall cohort was 2 days (interquartile range [IQR] 1–2 days). Propofol and fentanyl were the primary sedatives used. The NMBA+ group received higher cumulative doses of propofol (NMBA+ 5405 mg, IQR 3103–10,573 mg; NMBA− 3601 mg, IQR 1605–6887 mg; p=0.007), but not of fentanyl. Time to abdominal closure, but not NMBA use, was associated with a higher cumulative propofol dose on multivariate analysis. The NMBA+ group had significantly lower RASS scores on the first 3 days following DCL. Mechanical ventilation‐free days (NMBA+ 20 days vs NMBA− 18 days, p=0.960) and delirium‐coma‐free days (NMBA+ 18 days vs NMBA− 18 days, p=0.610) were similar between the groups. On linear regression, cumulative propofol dose was associated with fewer delirium‐coma‐free days (β‐coefficient −0.007, 95% confidence interval −0.015 to −0.003). In trauma patients managed with DCL, higher cumulative sedative doses were administered in patients who received adjunctive NMBA, although NMBA therapy was not associated with a higher cumulative propofol dose on multivariate analysis. Consideration must be given to the potential effect of sedation on delirium and awakening following DCL.

show abstract

Section: Discussionmentioning

confidence: 99%

Effect of Neuromuscular Blocking Agents on Sedation Requirements in Trauma Patients with an Open Abdomen

2019

View full text Add to dashboard Cite

show abstract

“…Patients with high-grade aortic insufficiency, impaired transthoracic or abdominal echogenicity, clinical signs of active exhalation, clinical or ultrasonographic evidence of pulmonary edema due to heart failure [ 18 ], pregnancy or abdominal compartment syndrome [ 19 ] were excluded from the study. The presence of an abdominal compartment syndrome was assessed by clinical examination looking for abdominal pain or specific risk factors proposed by Maluso et al [ 19 ]. When available, an intra-abdominal pressure above 25 mmHg led to the exclusion of the patient.…”

Section: Methodsmentioning

confidence: 99%

Respiratory changes of the inferior vena cava diameter predict fluid responsiveness in spontaneously breathing patients with cardiac arrhythmias

Bortolotti

Colling

Colas

et al. 2018

Ann. Intensive Care

View full text Add to dashboard Cite

BackgroundWhether the respiratory changes of the inferior vena cava diameter during a deep standardized inspiration can reliably predict fluid responsiveness in spontaneously breathing patients with cardiac arrhythmia is unknown.MethodsThis prospective two-center study included nonventilated arrhythmic patients with infection-induced acute circulatory failure. Hemodynamic status was assessed at baseline and after a volume expansion of 500 mL 4% gelatin. The inferior vena cava diameters were measured with transthoracic echocardiography using the bi-dimensional mode on a subcostal long-axis view. Standardized respiratory cycles consisted of a deep inspiration with concomitant control of buccal pressures and passive exhalation. The collapsibility index of the inferior vena cava was calculated as [(expiratory–inspiratory)/expiratory] diameters.ResultsAmong the 55 patients included in the study, 29 (53%) were responders to volume expansion. The areas under the ROC curve for the collapsibility index and inspiratory diameter of the inferior vena cava were both of 0.93 [95% CI 0.86; 1]. A collapsibility index ≥ 39% predicted fluid responsiveness with a sensitivity of 93% and a specificity of 88%. An inspiratory diameter < 11 mm predicted fluid responsiveness with a sensitivity of 83% and a specificity of 88%. A correlation between the inspiratory effort and the inferior vena cava collapsibility was found in responders but was absent in nonresponder patients.ConclusionsIn spontaneously breathing patients with cardiac arrhythmias, the collapsibility index and inspiratory diameter of the inferior vena cava assessed during a deep inspiration may be noninvasive bedside tools to predict fluid responsiveness in acute circulatory failure related to infection. These results, obtained in a small and selected population, need to be confirmed in a larger-scale study before considering any clinical application.Electronic supplementary materialThe online version of this article (10.1186/s13613-018-0427-1) contains supplementary material, which is available to authorized users.

show abstract

“…Abdominal compartment syndrome refers to that intra-abdominal pressure rises sharply due to various reasons, resulting in circulatory, respiratory and renal dysfunction, manifested as an obvious abdominal bulge, tension, hypoxia, increased airway resistance, and oliguria or anuria [29]. This syndrome is common in severe abdominal trauma, such as hepatic trauma.…”

Section: Discussionmentioning

confidence: 99%

Accident-related Hepatic Trauma in a Medical Clinical Center in Eastern China: A Cross-sectional Study

Shen

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: The treatment of hepatic injury can be complicated. Medical clinical hospitals are often the first line hospitals for the diagnosis and treatment of hepatic trauma in China. This paper aimed to summarize the experience in the diagnosis and treatment of hepatic trauma in one medical clinical center in China. Methods: This retrospective study included patients with hepatic trauma admitted between January 2002 and December 2019 at the Xishan People’s Hospital of Wuxi. The outcomes were cure rate and death within 14 days post-discharge. Results: Among the 318 patients with hepatic trauma, 146 patients underwent surgical treatment, and 172 received conservative treatment; three patients were transferred to other hospitals for further treatment; 283 patients were cured, and 35 died. Severe hepatic trauma occurred in 74 patients, with a mortality rate of 31.1%, or 7.2% of all patients. American Association for the Surgery of Trauma (AAST) grading >III (OR=3.51, 95%CI: 1.32-9.37, P=0.012) and multiple organ injury (OR=7.51, 95%CI: 2.51-22.46, P<0.001) were independently associated with death. Among patients with AAST grading >III, surgery was an independent protective factor for death (OR=0.08, 95%CI: 0.01-0.45, P=0.004). Among patients with ASST >III and who underwent surgery, age (OR=5.29, 95%CI: 1.37-20.33, P=0.015) and PHP (OR=5.54, 95%CI: 1.43-21.487, P=0.013) were independently associated with death.Conclusions: AAST grading >III and multiple organ injury were independently associated with death. Among patients with AAST grading >III, surgery was an independent protective factor for death. Among patients with ASST >III and who underwent surgery, age and PHP were independently associated with death.

show abstract

Abdominal Compartment Hypertension and Abdominal Compartment Syndrome

Cited by 62 publications

References 26 publications

Effect of Neuromuscular Blocking Agents on Sedation Requirements in Trauma Patients with an Open Abdomen

Effect of Neuromuscular Blocking Agents on Sedation Requirements in Trauma Patients with an Open Abdomen

Respiratory changes of the inferior vena cava diameter predict fluid responsiveness in spontaneously breathing patients with cardiac arrhythmias

Accident-related Hepatic Trauma in a Medical Clinical Center in Eastern China: A Cross-sectional Study

Contact Info

Product

Resources

About