Awareness and management of intra-abdominal hypertension and abdominal compartment syndrome by paediatric intensive care physicians: a national survey

Rezeni, Nader; Thabet, Farah

doi:10.5114/ait.2022.120366

Cited by 3 publications

(7 citation statements)

References 19 publications

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“…This is consistent with the survey results of Wise et al, where 18% of respondents never measured IAP, only relying on clinical examination [6]. Rezeni's survey results also showed, that 45% incorrectly relied on clinical examination [5].…”

Section: Measurement Of Iapsupporting

confidence: 89%

“…During the 6-year follow-up period, the proportion of ICUs correctly defining an ACS rose to 58%. In contrast both, the Newcombe survey, where the percentage of participants who knew the correct ACS definition decreased (19.5 to 13.2%) and the Rezeni survey, where only 10% of participants knew the correct definition of an ACS our survey shows a positive trend regarding the correct diagnosis of ACS in German-speaking countries [1,5]. Unfortunately, the present survey results give the impression that many cases of IAH and ACS are being missed because respondents ignore the valid definitions or even do not know them.…”

Section: Definition and Diagnosis Of Iah And Acsmentioning

confidence: 61%

“…In both the 2010 and 2016 surveys, more than half of the respondents said they did not measure IAP. In Newcombe's survey, only one quarter of respondents said they did not measure IAP, while in Rezeni's survey only one third did not measure the IAP [1,5].…”

Section: Measurement Of Iapmentioning

confidence: 94%

“…No more than one other survey among pediatric health care providers has been published since the WSACS guidelines were issued in 2013. We compared our findings regarding awareness and intra-abdominal pressure measurement with those of Rezeni et al, who conducted a survey among all physicians in PICUs in Saudi Arabia in 2022 and with those of Newcombe et al, who published their follow up survey of pediatric nurses in 2012, before WSACS released its updated guidelines [1,5]. Due to the small number of exclusively pediatric surveys, we additionally compared our results with large, international surveys where at least some of the respondents were pediatricians [6,7].…”

Section: Literature Overviewmentioning

confidence: 99%

“…Jacobs et al demonstrated in their review the importance of considering fluid balance in the management of IAH and ACS [11]. Rezeni provided an overview of the knowledge and prevalence of the use of conservative non-invasive treatment options [5].…”

Section: Therapeutical Strategies Concerning the Management Of Iah/ A...mentioning

confidence: 99%

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Awareness and diagnosis for intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) in neonatal (NICU) and pediatric intensive care units (PICU) – a follow-up multicenter survey

et al. 2023

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Background Constantly elevated intra-abdominal pressure (IAH) can lead to abdominal compartment syndrome (ACS), which is associated with organ dysfunction and even multiorgan failure. Our 2010 survey revealed an inconsistent acceptance of definitions and guidelines among pediatric intensivists regarding the diagnosis and treatment of IAH and ACS in Germany. This is the first survey to assess the impact of the updated guidelines on neonatal/pediatric intensive care units (NICU/PICU) in German-speaking countries after WSACS published those in 2013. Methods We conducted a follow-up survey and sent 473 questionnaires to all 328 German-speaking pediatric hospitals. We compared our findings regarding awareness, diagnostics and therapy of IAH and ACS with the results of our 2010 survey. Results The response rate was 48% (n = 156). The majority of respondents was from Germany (86%) and working in PICUs with mostly neonatal patients (53%). The number of participants who stated that IAH and ACS play a role in their clinical practice rose from 44% in 2010 to 56% in 2016. Similar to the 2010 investigations, only a few neonatal/pediatric intensivists knew the correct WSACS definition of an IAH (4% vs 6%). Different from the previous study, the number of participants who correctly defined an ACS increased from 18 to 58% (p < 0,001). The number of respondents measuring intra-abdominal pressure (IAP) increased from 20 to 43% (p < 0,001). Decompressive laparotomies (DLs) were performed more frequently than in 2010 (36% vs. 19%, p < 0,001), and the reported survival rate was higher when a DL was used (85% ± 17% vs. 40 ± 34%). Conclusions Our follow-up survey of neonatal/pediatric intensivists showed an improvement in the awareness and knowledge of valid definitions of ACS. Moreover, there has been an increase in the number of physicians measuring IAP in patients. However, a significant number has still never diagnosed IAH/ACS, and more than half of the respondents have never measured IAP. This reinforces the suspicion that IAH and ACS are only slowly coming into the focus of neonatal/pediatric intensivists in German-speaking pediatric hospitals. The goal should be to raise awareness of IAH and ACS through education and training and to establish diagnostic algorithms, especially for pediatric patients. The increased survival rate after conducting a prompt DL consolidates the impression that the probability of survival can be increased by timely surgical decompression in the case of full-blown ACS.

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Section: Measurement Of Iapsupporting

confidence: 89%

Section: Definition and Diagnosis Of Iah And Acsmentioning

confidence: 61%

Section: Measurement Of Iapmentioning

confidence: 94%

Section: Literature Overviewmentioning

confidence: 99%

Section: Therapeutical Strategies Concerning the Management Of Iah/ A...mentioning

confidence: 99%

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Awareness and diagnosis for intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) in neonatal (NICU) and pediatric intensive care units (PICU) – a follow-up multicenter survey

et al. 2023

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Avoiding High Pressure Abdominal Closure of Congenital Abdominal Wall Defects—One Step Further to Improve Outcomes

Mocanu,

Cîrstoveanu,

Bizubac

et al. 2023

Children

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The main goal of surgical treatment for gastroschisis and omphalocele is the reduction of viscera in the abdominal cavity and closure of the abdomen, but the challenge is to succeed without the detrimental effects of increased intraabdominal pressure. In this regard, we performed a retrospective study for all patients admitted for gastroschisis and omphalocele to the Neonatal Intensive Care Unit of ‘Marie Sklodowska Curie’ Emergency Clinical Hospital for Children, from January 2011 until June 2021. Our aim was to highlight the presence of postoperative abdominal compartment syndrome. We observed that six out of forty-seven patients developed clinical signs of abdominal compartment syndrome, five associated with primary closure and one with staged closure with a polyvinyl chloride patch. Following the results, we decided to implement the trans-bladder measurement of intraabdominal pressure to avoid closing the abdomen at pressures higher than 10 mmHg in order to prevent the development of abdominal compartment syndrome. We consider that there is still place for the improvement of congenital abdominal wall defects management and that the measurement of intraabdominal pressure might help us reach our goal.

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Hands off Trans-Femoral Venous Intra-Abdominal Pressure Estimates in Children: Results of a Sobering Single-Center Study

Gutting

Klischke

Kaussen

2023

Life

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Background: For a long time, trans-femoral venous pressure (FVP) measurement was considered a simple alternative for estimating intra-abdominal pressure (IAP). Since intravesical [IVP] and intragastric [IGP] pressure measurements are sometimes contraindicated for anatomical and pathophysiological reasons, FVP raised hopes, especially among pediatricians. Pediatric FVP validation studies have never been published; recent results from adult studies cast doubt on their interchangeability. Therefore, we compared for the first time the measurement agreement between FVP and IVP and IGP in children. Material and methods: We prospectively compared FVP with IVP and IGP, according to the Abdominal Compartment Society validation criteria. Additionally, we analyzed the agreement as a function of IAP or right heart valve regurgitation and pulmonary hypertension. Results: In a real-life PICU study design, n = 39 children were included (median age 4.8 y, LOS-PICU 23 days, PRISM III score 11). In n = 660 FVP–IGP measurement pairs, the median IAP was 7 (range 1 to 23) mmHg; in n = 459 FVP–IVP measurement pairs, the median IAP was 6 (range 1to 16) mmHg. The measurement agreement was extremely low with both established methods (FVP–IGP: r2 0.13, mean bias −0.8 ± 4.4 mmHg, limits of agreement (LOA) −9.6/+8.0, percentage error (PE) 55%; FVP–IVP: r2 0.14, bias +0.5 ± 4.2 mmHg, limit of agreement (LOA) −7.9/+8.9, percentage error (PE) 51%). No effect of the a priori defined influencing factors on the measurement agreement could be demonstrated. Conclusions: In a study cohort with a high proportion of critically ill children suffering from IAH, FVP did not agree reliably with either IVP or IGP. Its clinical use in critically ill children must therefore be strongly discouraged.

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Awareness and management of intra-abdominal hypertension and abdominal compartment syndrome by paediatric intensive care physicians: a national survey

Cited by 3 publications

References 19 publications

Awareness and diagnosis for intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) in neonatal (NICU) and pediatric intensive care units (PICU) – a follow-up multicenter survey

Awareness and diagnosis for intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) in neonatal (NICU) and pediatric intensive care units (PICU) – a follow-up multicenter survey

Avoiding High Pressure Abdominal Closure of Congenital Abdominal Wall Defects—One Step Further to Improve Outcomes

Hands off Trans-Femoral Venous Intra-Abdominal Pressure Estimates in Children: Results of a Sobering Single-Center Study

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