Análise do conhecimento de intensivistas sobre a síndrome do compartimento abdominal

Abstract

Intensivists' knowledge on ACS was low, as most were not able to measure, interpret the results and recognize important risk factors for IAP. These data demonstrate that educational efforts concerning ACS are necessary in order to standardize the measurement of IAP in populations at risk, aiming at a better outcome in critically ill patients.

Síndrome compartimental abdominal: análise do conhecimento da equipe médica de um Hospital Universitário de Curitiba

“…Identifying patients at risk for developing IAH is the initial step to recognize and early diagnose abdominal compartment syndrome 3 . The current recommendation is that the IAP be assessed under the following conditions: A) need for volume resuscitation (shock, large burns); B) increased intraabdominal content (bulky ascites, hemoperitoneum, acute pancreatitis); C) increased content of hollow viscera (gastroparesis, ileus, pseudo-obstruction); D) sepsis with organic dysfunction; and E) acute respiratory failure, especially when secondary to acute respiratory distress syndrome (ARDS) 5,7,8 . In the hospital studied, more than half of the physicians (52.53%) would indicate IAP measurement only in patients predisposed to develop ACS; 84.22% of the interviewees would not indicate IAP measurement after aggressive volume replacement and 92.11% did not indicate it for ARDS patients.…”

“…several hospitals, a fact that is due to the lack of previous knowledge of the definitions, diagnosis and treatment by the professionals, who, in turn, claim that there is no standardized protocol 2,5,6 .…”

“…The involvement of the medical staff, especially of surgeons and intensivists, is fundamental, since it is a syndrome of great prevalence in surgical patients 2 . Studies indicate that many professionals are still unaware of the definitions related to ACS, indications for treatment and the best course of action to be adopted 2,5,7 .…”

“…ACS is a serious complication due to the extreme and sustained increase in IAP, which is responsible for significant morbidity and mortality, leading to neurological, cardiovascular, pulmonary, renal, hepatic and gastrointestinal adverse clinical manifestations 1,3,4 . The reliable diagnosis of ACS should be performed according to the criteria recommended by the WSACS, by measuring the intravesical pressure with a scale using millimeters of mercury (mmHg) 1,4,5 . The IAP considered normal is in the range of 0mmHg to 12mmHg, but in critically ill patients, it is expected to be between 5mmHg and 7mmHg.…”