Abdominal Compartment Syndrome as a Complication of Fluid Resuscitation

Harrell, Bradley R.; Miller, Sarah

doi:10.1016/j.cnur.2017.01.010

Cited by 9 publications

(5 citation statements)

References 22 publications

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“…Sublingual microscopy images of capillary perfusion obtained from a septic pig with 40% hemorrhage without inspiratory resistance (left panel) and with inspiratory resistance (right panel). emergency medicine, involves replacing lost circulating blood volume with various types of fluids (e.g., crystalloids, colloids) (6), although this may have detrimental effects of exacerbating coagulopathy by diluting clotting factors (51), causing pulmonary edema (36a), abdominal compartment syndrome (32), and increasing blood pressure to levels that can dislodge clots (73). However, it is seldom recognized that elevations in venous return, cardiac filling and output, and subsequently arterial pressure caused by reduced ITP with each inspiration represents a resuscitation effect.…”

Section: Translation To Medical Care In Human Pathophysiologymentioning

confidence: 99%

Mechanisms of inspiration that modulate cardiovascular control: the other side of breathing

Convertino

2019

Journal of Applied Physiology

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The objective of this minireview is to describe the physiology and potential clinical benefits derived from inspiration. Recent animal and clinical studies demonstrate that one of the body’s natural mechanisms associated with inspiration is to harness the respiratory pump to enhance circulation to vital organs. There is evidence that large reductions in intrathoracic pressure (>20 cmH2O) caused by some inspiration maneuvers (e.g., Mueller maneuver) or pathophysiology (e.g., heart failure, chronic obstructive lung disease) can result in adverse hemodynamic effects. However, the respiratory pump can improve cardiovascular functions when a “sweet spot” for generation of negative intrathoracic pressure during inspiration can be maintained at or less than 10 cmH2O below normal inspiration. These beneficial physiological effects include greater cardiac filling and output, lower intracranial pressure, cardiac baroreflex resetting, greater cerebral blood flow oscillatory patterns, increased vascular pressure gradients, and promoting sustained feedback between sympathetic nerve activity and arterial pressure. In addition to promoting gas exchange, data obtained from numerous animal and human experiments have provided new insights into “the other side of breathing”: the modulation of circulation by reduced intrathoracic pressure generated during inspiration. The translation of these physiological relationships form the basis for the development and application of technologies designed to optimize the intrathoracic pump for treatment of clinical conditions associated with hypovolemia including cardiac arrest, orthostatic hypotension, hemorrhagic shock, and traumatic brain injury. Harnessing these fundamental mechanisms that control cardiopulmonary physiology provides opportunities to use inspiration as a potential tool to help treat significant and often life-threatening circulatory disorders.

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Section: Translation To Medical Care In Human Pathophysiologymentioning

confidence: 99%

Mechanisms of inspiration that modulate cardiovascular control: the other side of breathing

Convertino

2019

Journal of Applied Physiology

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“…However, current evidence does not allow clinicians to accurately identify specific fluid management strategies for patients with IAH. IAH often occurs in patients with sepsis, trauma, burns, and severe acute pancreatitis [122][123][124]. These conditions are united by an accompanying inflammatory response that often progresses to shock and requires ongoing intravenous fluid therapy.…”

Section: Discussionmentioning

confidence: 99%

Fluid Management, Intra-Abdominal Hypertension and the Abdominal Compartment Syndrome: A Narrative Review

Jacobs

Wise

Myatchin

et al. 2022

Life

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Background: General pathophysiological mechanisms regarding associations between fluid administration and intra-abdominal hypertension (IAH) are evident, but specific effects of type, amount, and timing of fluids are less clear. Objectives: This review aims to summarize current knowledge on associations between fluid administration and intra-abdominal pressure (IAP) and fluid management in patients at risk of intra-abdominal hypertension and abdominal compartment syndrome (ACS). Methods: We performed a structured literature search from 1950 until May 2021 to identify evidence of associations between fluid management and intra-abdominal pressure not limited to any specific study or patient population. Findings were summarized based on the following information: general concepts of fluid management, physiology of fluid movement in patients with intra-abdominal hypertension, and data on associations between fluid administration and IAH. Results: We identified three randomized controlled trials (RCTs), 38 prospective observational studies, 29 retrospective studies, 18 case reports in adults, two observational studies and 10 case reports in children, and three animal studies that addressed associations between fluid administration and IAH. Associations between fluid resuscitation and IAH were confirmed in most studies. Fluid resuscitation contributes to the development of IAH. However, patients with IAH receive more fluids to manage the effect of IAH on other organ systems, thereby causing a vicious cycle. Timing and approach to de-resuscitation are of utmost importance, but clear indicators to guide this decision-making process are lacking. In selected cases, only surgical decompression of the abdomen can stop deterioration and prevent further morbidity and mortality. Conclusions: Current evidence confirms an association between fluid resuscitation and secondary IAH, but optimal fluid management strategies for patients with IAH remain controversial.

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“…Furthermore, several studies have reported significant relationships between BIA-determined imbalances in body fluid and clinical outcomes in patients with, for example, chronic renal failure, chronic liver disease, and chronic obstructive pulmonary disease [26][27][28]. Extracellular fluid retention may play an important role in the progression and deterioration of diseases, indicating that pathophysiologic alterations in body fluid composition are associated with poor clinical outcomes [29][30][31].…”

Section: Discussionmentioning

confidence: 99%

Extracellular Water to Total Body Water Ratio in Septic Shock Patients Receiving Protocol-Driven Resuscitation Bundle Therapy

Chae

Shin

Hong

et al. 2021

JCM

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(1) Bio-electrical impedance analysis (BIA) is a rapid, simple, and noninvasive tool for evaluating the metabolic status and for assessing volume status in critically ill patients. Little is known, however, the prognostic value of body composition analysis in septic shock patients. This study assessed the association between parameters by body composition analysis and mortality in patients with septic shock in the emergency department (ED). (2) Data were prospectively collected on adult patients with septic shock who underwent protocol-driven resuscitation bundle therapy between December 2019 and January 2021. The primary outcome was 30-day mortality. (3) The study included 261 patients, the average ratio of extracellular water (ECW) to total body water (TBW) was significantly higher in non-survivors than in survivors (0.414 vs. 0.401, p < 0.001). Multivariate analysis showed that ECW/TBW ≥ 0.41 (odds ratio (OR), 4.62; 95% confidence interval (CI), 2.31–9.26, p < 0.001), altered mental status (OR, 2.88; 95% CI, 1.28–6.46, p = 0.010), and lactate level (OR, 1.24; 95% CI, 1.12–1.37, p < 0.001) were significantly associated with 30-day mortality in patients with septic shock. (4) ECW/TBW ≥ 0.41 may be associated with 30-day mortality in patients with septic shock receiving protocol-driven resuscitation bundle therapy in the ED.

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Abdominal Compartment Syndrome as a Complication of Fluid Resuscitation

Cited by 9 publications

References 22 publications

Mechanisms of inspiration that modulate cardiovascular control: the other side of breathing

Mechanisms of inspiration that modulate cardiovascular control: the other side of breathing

Fluid Management, Intra-Abdominal Hypertension and the Abdominal Compartment Syndrome: A Narrative Review

Extracellular Water to Total Body Water Ratio in Septic Shock Patients Receiving Protocol-Driven Resuscitation Bundle Therapy

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