Abdominal compartment syndrome in trauma patients: New insights for predicting outcomes

Shaheen, Aisha; Crandall, Marie; Nicolson, Norman G.; Smith-Singares, Eduardo; Merlotti, Gary J.; Jalundhwala, Yash J.; Issa, Nabil

doi:10.4103/0974-2700.179452

Cited by 16 publications

(4 citation statements)

References 16 publications

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“…This can be done with any of the following procedures: Laparotomy, a full midline incision in the abdomen. Laparoscopy or Keyhole surgery uses small incisions and cameras to open the abdominal wall, and fasciotomy, an Incision of the abdominal wall fascia to, release pressure [40,46].…”

Section: Abdominal Compartment Syndromementioning

confidence: 99%

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Late Complications of Acute Pancreatitis: A Surgical Approach

Coral

2023

OAJS

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Acute pancreatitis, a severe inflammatory pancreas disorder, often leads to significant morbidity and mortality due to its late complications, including fluid collections, pseudocysts, necrosis, obstruction, fistulation, and abdominal compartment syndrome. Despite its rising incidence and associated healthcare costs, the surgical management of these complications remains a clinical challenge due to the complex nature of the disease and patient comorbidities. Current literature provides an understanding of the pathophysiology, epidemiology, and standard management of these complications. However, there's a need to focus on the surgical approach to address these complications more effectively. This article reviewed these late complications and discussed their clinical presentation and diagnostic methods, emphasizing surgical management and prognosis. The primary goal of the review was to provide clinicians with a comprehensive understanding of the surgical management of these complications, thereby improving patient outcomes. Our analytical methods involved a thorough review of current literature, including clinical studies, reviews, and case reports. The review revealed that surgical intervention plays a pivotal role in managing severe or complicated cases. However, the surgical technique choice depends on the complication's type and severity, the patient's overall condition, and the surgeon's expertise. Further research is recommended to develop standardized protocols for the surgical management of these complications.

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Section: Abdominal Compartment Syndromementioning

confidence: 99%

“…However, the mortality rises above 50% in patients with severe and refractory ACS. Overall, ACS is a life-threatening condition requiring a high index of suspicion, early diagnosis, and prompt surgical decompression to achieve the best outcomes [40,[46][47][48].…”

Section: Abdominal Compartment Syndromementioning

confidence: 99%

Late Complications of Acute Pancreatitis: A Surgical Approach

Coral

2023

OAJS

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“…Rapid fluid administration, together with reperfusion injury and activation of inflammatory mediators, leads to increased capillary permeability and an increased risk of developing IAH and ACS [120,121]. There are seven prospective studies investigating the relationship between intravenous fluids and IAH in 1329 trauma patients [47][48][49][50][51][52]74], fourteen retrospective studies in 4233 trauma patients [38,39,[53][54][55][56][57][58][59][60][61][62]69,75], five case reports [63][64][65][66]73], and five case reports in children [37,67,68,70,71] (Supplementary Table S3).…”

Section: Trauma Patientsmentioning

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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“…According to previous studies in mixed ICU patients, slightly more than 50% of patients develop IAH within the first week of ICU admission [6,7]. Other studies have also shown high IAH prevalence following cardiac surgery (31.8%), burns (53%), trauma (36%), liver cirrhosis (82.1%), severe acute pancreatitis (72.2%), general surgery (67.3%), and sepsis (43.5%) [8][9][10][11][12][13][14]. During IAH, higher external pressure is applied to the abdominal blood vessels, which in turn results in reduced venous return, lower cardiac output (CO), and perfusion pressure, and finally, results in a vicious cycle of multiple organ dysfunction and failure depending on the magnitude and duration of IAH [15].…”

Section: Introductionmentioning

confidence: 96%

In Vitro Validation of a Novel Continuous Intra-Abdominal Pressure Measurement System (TraumaGuard)

Tayebi,

Wise,

Zarghami

et al. 2023

JCM

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Introduction: Intra-abdominal pressure (IAP) has been recognized as an important vital sign in critically ill patients. Due to the high prevalence and incidence of intra-abdominal hypertension in surgical (trauma, burns, cardiac) and medical (sepsis, liver cirrhosis, acute kidney injury) patients, continuous IAP (CIAP) monitoring has been proposed. This research was aimed at validating a new CIAP monitoring device, the TraumaGuard from Sentinel Medical Technologies, against the gold standard (height of a water column) in an in vitro setting and performing a comparative analysis among different CIAP measurement technologies (including two intra-gastric and two intra-bladder measurement devices). A technical and clinical guideline addressing the strengths and weaknesses of each device is provided as well. Methods: Five different CIAP measurement devices (two intra-gastric and three intra-vesical), including the former CiMON, Spiegelberg, Serenno, TraumaGuard, and Accuryn, were validated against the gold standard water column pressure in a bench-top abdominal phantom. The impacts of body temperature and bladder fill volume (for the intra-vesical methods) were evaluated for each system. Subsequently, 48 h of continuous monitoring (n = 2880) on top of intermittent IAP (n = 300) readings were captured for each device. Using Pearson’s and Lin’s correlations, concordance, and Bland and Altman analyses, the accuracy, precision, percentage error, correlation and concordance coefficients, bias, and limits of agreement were calculated for all the different devices. We also performed error grid analysis on the CIAP measurements to provide an overview of the involved risk level due to wrong IAP measurements and calculated the area under the curve and time above a certain IAP threshold. Lastly, the robustness of each system in tracking the dynamic variations of the raw IAP signal due to respirations and heartbeats was evaluated as well. Results: The TraumaGuard was the only technology able to measure the IAP with an empty artificial bladder. No important temperature dependency was observed for the investigated devices except for the Spiegelberg, which displayed higher IAP values when the temperature was increased, but this could be adjusted through recalibration. All the studied devices showed excellent ability for IAP monitoring, although the intra-vesical IAP measurements seem more reliable. In general, the TraumaGuard, Accuryn, and Serenno showed better accuracy compared to intra-gastric measurement devices. On average, biases of +0.71, +0.93, +0.29, +0.25, and −0.06 mm Hg were observed for the CiMON, Spiegelberg, Serenno, TraumaGuard, and Accuryn, respectively. All of the equipment showed percentage errors smaller than 25%. Regarding the correlation and concordance coefficients, the Serenno and TraumaGuard showed the best results (R2 = 0.98, p = 0.001, concordance coefficient of 99.5%). Error grid analysis based on the Abdominal Compartment Society guidelines showed a very low associated risk level of inappropriate treatment strategies due to erroneous IAP measurements. Regarding the dynamic tracings of the raw IAP signal, all the systems can track respiratory variations and derived parameters; however, the CiMON was slightly superior compared to the other technologies. Conclusions: According to the research guidelines of the Abdominal Compartment Society (WSACS), this in vitro study shows that the TraumaGuard can be used interchangeably with the gold standard for measuring continuous IAP, even in an empty artificial bladder. Confirmation studies with the TraumaGuard in animals and humans are warranted to further validate these findings.

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Abdominal compartment syndrome in trauma patients: New insights for predicting outcomes

Cited by 16 publications

References 16 publications

Late Complications of Acute Pancreatitis: A Surgical Approach

Late Complications of Acute Pancreatitis: A Surgical Approach

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

In Vitro Validation of a Novel Continuous Intra-Abdominal Pressure Measurement System (TraumaGuard)

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