Decompressive laparotomy for abdominal compartment syndrome

Waele, Jan J. De; Kimball, Edward J.; Malbrain, Manu L N G; Nesbitt, I.; Cohen, Jonathan; Kaloiani, V.; Ivatury, Rao R.; Mone, Mary C.; Debergh, Dieter; Björck, Martin

doi:10.1002/bjs.10097

Cited by 101 publications

(126 citation statements)

References 30 publications

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“…In one such early experiment, urine production was reduced upon raising renal venous pressure to 20 mmHg, and abolished at pressures .25 mmHg (17). Similarly, extrinsic compression of the renal veins (18) and increased intra-abdominal pressure impair renal function (19,20), and the abdominal compartment syndrome is a well-described cause of renal failure (21), which improves with decompression in some (22) but not all studies (23).…”

Section: Discussionmentioning

confidence: 99%

Peripheral Edema, Central Venous Pressure, and Risk of AKI in Critical Illness

Chen

Cavender

Lee

et al. 2016

Clinical Journal of the American Society of Nephrology

133

105

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Background and objectives Although venous congestion has been linked to renal dysfunction in heart failure, its significance in a broader context has not been investigated.Design, setting, participants, & measurements Using an inception cohort of 12,778 critically ill adult patients admitted to an urban tertiary medical center between 2001 and 2008, we examined whether the presence of peripheral edema on admission physical examination was associated with an increased risk of AKI within the first 7 days of critical illness. In addition, in those with admission central venous pressure (CVP) measurements, we examined the association of CVPs with subsequent AKI. AKI was defined using the Kidney Disease Improving Global Outcomes criteria.Results Of the 18% (n=2338) of patients with peripheral edema on admission, 27% (n=631) developed AKI, compared with 16% (n=1713) of those without peripheral edema. In a model that included adjustment for comorbidities, severity of illness, and the presence of pulmonary edema, peripheral edema was associated with a 30% higher risk of AKI (95% confidence interval [95% CI], 1.15 to 1.46; P,0.001), whereas pulmonary edema was not significantly related to risk. Peripheral edema was also associated with a 13% higher adjusted risk of a higher AKI stage (95% CI, 1.07 to 1.20; P,0.001). Furthermore, levels of trace, 1+, 2+, and 3+ edema were associated with 34% (95% CI, 1.10 to 1.65), 17% (95% CI, 0.96 to 1.14), 47% (95% CI, 1.18 to 1.83), and 57% (95% CI, 1.07 to 2.31) higher adjusted risk of AKI, respectively, compared with edema-free patients. In the 4761 patients with admission CVP measurements, each 1 cm H 2 O higher CVP was associated with a 2% higher adjusted risk of AKI (95% CI, 1.00 to 1.03; P=0.02).Conclusions Venous congestion, as manifested as either peripheral edema or increased CVP, is directly associated with AKI in critically ill patients. Whether treatment of venous congestion with diuretics can modify this risk will require further study.

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Section: Discussionmentioning

confidence: 99%

Peripheral Edema, Central Venous Pressure, and Risk of AKI in Critical Illness

Chen

Cavender

Lee

et al. 2016

Clinical Journal of the American Society of Nephrology

133

105

View full text Add to dashboard Cite

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“…When all the above listed treatment options fail to provide a sufficient decrease in IAP and IAV, the only definite solution is to perform a decompressive laparotomy that will assist with IAP, IAV and C ab [49].…”

Section: Sixth Step: Less Invasive Surgerymentioning

confidence: 99%

The Neglected Role of Abdominal Compliance in Organ-Organ Interactions

Malbrain¹,

Peeters²,

Wise³

2016

Annual Update in Intensive Care and Emergency Medicine

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“…Animal models of SAP treated with 25 mmHg IAH/ACS undergoing delayed decompression had a higher grade of lung and intestinal injury (7). Increased oxygenation index and urinary output were the most pronounced effects of decompressive laparotomy, with a mortality rate of 49.2% (8). Surgical abdominal incision decompression resulted in a rapid decline in intra-abdominal pressure by 50%, without improving the Sepsis-Related Organ Failure Assessment (SOFA) score (9).…”

Section: Introductionmentioning

confidence: 99%

Rhubarb vs. glycerin enema for treatment of critically ill patients with intra-abdominal hypertension

Wan

Zhang

Yin

et al. 2017

Experimental and Therapeutic Medicine

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Abstract. Rhubarb has been used as an evacuant for thousands of years. However, recent research has indicated that rhubarb inhibits inflammation and protects organ function. In the current study, the use of rhubarb was investigated in patients with intra-abdominal hypertension (IAH). Specifically, its dual role in attenuating lung and bowel injury by catharsis and inhibiting inflammation was evaluated. Patients in the glycerin group (n=56) received 110 ml of glycerin enema by coloclysis once daily for 7 to 9 days. Patients in the rhubarb group (n=56) were treated with a mixture of 0.3 g/kg body weight rhubarb powder in 100 ml warm water. The Acute Physiology and Chronic Health Evaluation II (APACHE II), Sepsis-Related Organ Failure Assessment (SOFA), intra-abdominal pressure, procalcitonin (PCT), C-reactive protein (CRP), tumor necrosis factor-α (TNF-α) and interleukin (IL)-6 levels were recorded. The duration of mechanical ventilation (MV), respiratory parameters, first day of enteral nutrition (EN), intensive care unit (ICU) hospital stay and 30-day mortality were also recorded. The APACHE II scores were significantly lower in the rhubarb group compared with the glycerin group from day 3 to 9 (P<0.05 at day 3 and 4; P<0.01 at day 5, 7 and 9). The SOFA scores were significantly lower in the rhubarb group compared with the glycerin group from day 5 to 9 (P<0.05). PCT levels were significantly lower from day 4 to 9 (P<0.05) and the CRP level was significantly lower from day 3 to 9 (P<0.05) in the rhubarb group compared with the glycerin group. The TNF-α and IL-6 were significantly lower in the rhubarb group compared with the glycerin group from day 3 to 9 (P<0.05 at day 3 and 4, P<0.01 at day 5, 7 and 9). The positive end-expiratory pressure and peak inspiratory pressure were significantly lower in the rhubarb group compared with the glycerin group at day 3, 5 and 7 (P<0.05 at day 3 and 5, P<0.01 at day 7), while the oxygenation index (P<0.05) and alveolar-arterial partial pressure of oxygen (P<0.05 at day 3 and 5, P<0.01 at day 7) were significantly improved. Significantly shorter durations of MV and ICU hospital stay, and earlier EN, were observed in the rhubarb group compared with the glycerin group (all P<0.05). Rhubarb treatment was indicated to be beneficial in IAH, by inhibiting inflammation and restoring intestinal function. IntroductionCritically ill patients are prone to developing intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS). IAH has been reported in 35% of intensive care unit (ICU) patients, 5% of which also manifest ACS (1), which is an important factor leading to an increased mortality rate in ICU patients. In critically ill patients, contributing factors often overlap, leading to elevated intra-abdominal pressure (IAP), and resulting in multiple organ failure (2-4).The severity and duration of IAH is associated with the incidence and mortality of multiple organ dysfunction syndrome (MODS) (5). Previous results have indicated that global hemodynamics, oxygenation and o...

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Decompressive laparotomy for abdominal compartment syndrome

Cited by 101 publications

References 30 publications

Peripheral Edema, Central Venous Pressure, and Risk of AKI in Critical Illness

Peripheral Edema, Central Venous Pressure, and Risk of AKI in Critical Illness

The Neglected Role of Abdominal Compliance in Organ-Organ Interactions

Rhubarb vs. glycerin enema for treatment of critically ill patients with intra-abdominal hypertension

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