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

Jacobs, Rita; Wise, Robert; Myatchin, Ivan; Vanhonacker, Domien; Minini, Andrea; Mekeirele, Michaël; Kirkpatrick, Andrew W.; Pereira, Bruno M.; Sugrue, Michael; Keulenaer, Bart De; Bodnár, Zsolt; Acosta, Stefan; Ejike, J. Chiaka; Tayebi, Salar; Stiens, Johan; Cordemans, Colin; Regenmortel, N. Van; Elbers, Paul; Monnet, Xavier; Wong, Adrian; Dąbrowski, Wojciech; Jorens, Philippe G.; Waele, Jan J. De; Roberts, Derek J.; Kimball, Edward J.; Blaser, Annika Reintam; Malbrain, Manu L N G

doi:10.3390/life12091390

Cited by 23 publications

(21 citation statements)

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“…IAH and ACS result in significant morbidity and mortality, and a significant proportion of these patients are obese [ 11 , 19 ]. This systematic review analysed existing literature and illustrated that obesity is associated with increased IAP and comorbidities.…”

Section: Discussionmentioning

confidence: 99%

Impact of Obesity on Clinical Outcomes of Patients with Intra-Abdominal Hypertension and Abdominal Compartment Syndrome

Mohan

Lim

Chan

et al. 2023

Life

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Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are associated with high morbidity and mortality. Obesity may result in increased intra-abdominal pressure (IAP) and affect clinical outcomes of patients with IAH and/or ACS. This study aims to establish the impact of obesity on the clinical outcomes of IAH and ACS patients. A systematic search of Medline, Embase, and Scopus was performed in August 2022. Nine studies comprising 9938 patients were included. There were 65.1% males (n=6250/9596). Patient demographics, comorbidities, and morbidities were analyzed in correlation with obesity and IAP. Obese patients had a higher risk of IAH (OR 8.5, p < 0.001). Obesity was associated with the need for renal replacement therapy, intensive care unit-acquired infections, systemic inflammatory response syndrome, acute respiratory distress syndrome, length of hospital stay, and mortality. This review highlights the lacunae in the existing literature to underpin the direct impact of obesity, independent of obesity-associated comorbidities, on the clinical outcomes of IAH and ACS.

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Section: Discussionmentioning

confidence: 99%

Impact of Obesity on Clinical Outcomes of Patients with Intra-Abdominal Hypertension and Abdominal Compartment Syndrome

Mohan

Lim

Chan

et al. 2023

Life

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“…As over-resuscitation becomes less common (90,91), it is intuitive that there will be more abdomens in non-trauma IAS patients which may be technically closed without inducing intra-abdominal hypertension (IAH). However, although these abdomens may be closed, should they be closed?…”

Section: Discussionmentioning

confidence: 99%

The Unrestricted Global effort to complete the Closed Or Open after Source Control Laparotomy for Severe Complicated Intra-Abdominal Sepsis (COOL) Trial

Kirkpatrick

Coccolini

Tolonen

et al. 2023

Preprint

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· Background: Severe complicated intra-abdominal sepsis (SCIAS) has an increasing incidence with mortality rates over 80% in some settings. Mortality typically results from disruption of the gastrointestinal tract, progressive and self-perpetuating bio-mediator generation, systemic inflammation, and multiple organ failure. A further therapeutic option may be open abdomen (OA) management with negative peritoneal pressure therapy (NPPT) to remove inflammatory ascites and attenuate the systemic damage from SCIAS, although there are definite risks of leaving the abdomen open whenever it might possibly be closed. This potential therapeutic paradigm is the rationale being assessed in the Closed Or Open after Laparotomy (COOL-trial)(https://clinicaltrials.gov/ct2/show/NCT03163095). Initially, the COOL-trial received Industry sponsorship; however, this funding mandated the use of a specific trademarked and expensive NPPT device in half of patients allocated to the intervention (open) arm. In August 2022, the 3M/Acelity Corporation without consultation but within the terms of the contract cancelled the financial support of the trial. Although creating financial difficulty, there is now no restriction on specific NPPT devices and removing a cost-prohibitive intervention creates an opportunity to expand the COOL trial to a truly global basis. This document describes the evolution of the COOL trial, with a focus on future opportunities for global growth of the study. · Methods: The COOL trial is the largest prospective randomized controlled trial examining the random allocation of SCIAS patients intra-operatively to either formal closure of the fascia or use of the OA with application of an NPPT dressing. Patients are eligible if they have free uncontained intra-peritoneal contamination and physiologic derangements exemplified by septic shock OR severely adverse predicted clinical outcomes. The primary outcome is intended to definitively inform global practice by conclusively evaluating 90-day survival. Initial recruitment has been lower than hoped but satisfactory, and the COOL steering committee and trial investigators intend with increased global support to continue enrollment until recruitment ensures a definitive answer. · Discussion: OA is mandated in many cases of SCIAS such as the risk of abdominal compartment syndrome associated with closure, or a planned second look as for example part of ‘damage control’, however improved source control (locally and systemically) is the most uncertain indication for an OA. The COOL-trial trial seeks to expand potential sites and proceed with evaluation of NPPT agnostic to device, to properly examine the hypothesis that this treatment attenuates systemic damage and improves survival. This approach will not affect internal validity and should improve the external validity of any observed results of the intervention. · Trial registration: National Institutes of Health (https://clinicaltrials.gov/ct2/show/NCT03163095).

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“…Damage to the vascular endothelium and the endothelial glycocalyx in sepsis may increase fluid extravasation (Figure 1). Tissue edema due to increased venous pressure has been associated with organ dysfunction and potential complications such as intra-abdominal hypertension and compartment syndrome . Fluid therapy should be tailored to maximize early benefits while minimizing adverse effects.…”

Section: Pathophysiology Of Fluid Therapymentioning

confidence: 99%

“…Critically ill adults with sepsis may experience edema and organ failure due to excess accumulation of fluids administered during critical illness and reduced capacity for fluid elimination (eg, due to acute kidney injury). Daily documentation of fluid intake, output, balance, and weights, and setting specific goals for fluid management may help clinicians prevent adverse outcomes due to fluid accumulation such as acute kidney injury, abdominal compartment syndrome, and mortality . During recovery from critical illness, patients may spontaneously excrete excess accumulated fluid.…”

Section: Administration Of Fluid Therapymentioning

confidence: 99%

Fluid Therapy for Critically Ill Adults With Sepsis

Zampieri

Bagshaw

Semler

2023

JAMA

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ImportanceApproximately 20% to 30% of patients admitted to an intensive care unit have sepsis. While fluid therapy typically begins in the emergency department, intravenous fluids in the intensive care unit are an essential component of therapy for sepsis.ObservationsFor patients with sepsis, intravenous fluid can increase cardiac output and blood pressure, maintain or increase intravascular fluid volume, and deliver medications. Fluid therapy can be conceptualized as 4 overlapping phases from early illness through resolution of sepsis: resuscitation (rapid fluid administered to restore perfusion); optimization (the risks and benefits of additional fluids to treat shock and ensure organ perfusion are evaluated); stabilization (fluid therapy is used only when there is a signal of fluid responsiveness); and evacuation (excess fluid accumulated during treatment of critical illness is eliminated). Among 3723 patients with sepsis who received 1 to 2 L of fluid, 3 randomized clinical trials (RCTs) reported that goal-directed therapy administering fluid boluses to attain a central venous pressure of 8 to 12 mm Hg, vasopressors to attain a mean arterial blood pressure of 65 to 90 mm Hg, and red blood cell transfusions or inotropes to attain a central venous oxygen saturation of at least 70% did not decrease mortality compared with unstructured clinical care (24.9% vs 25.4%; P = .68). Among 1563 patients with sepsis and hypotension who received 1 L of fluid, an RCT reported that favoring vasopressor treatment did not improve mortality compared with further fluid administration (14.0% vs 14.9%; P = .61). Another RCT reported that among 1554 patients in the intensive care unit with septic shock treated with at least 1 L of fluid compared with more liberal fluid administration, restricting fluid administration in the absence of severe hypoperfusion did not reduce mortality (42.3% vs 42.1%; P = .96). An RCT of 1000 patients with acute respiratory distress during the evacuation phase reported that limiting fluid administration and administering diuretics improved the number of days alive without mechanical ventilation compared with fluid treatment to attain higher intracardiac pressure (14.6 vs 12.1 days; P &lt; .001), and it reported that hydroxyethyl starch significantly increased the incidence of kidney replacement therapy compared with saline (7.0% vs 5.8%; P = .04), Ringer lactate, or Ringer acetate.Conclusions and RelevanceFluids are an important component of treating patients who are critically ill with sepsis. Although optimal fluid management in patients with sepsis remains uncertain, clinicians should consider the risks and benefits of fluid administration in each phase of critical illness, avoid use of hydroxyethyl starch, and facilitate fluid removal for patients recovering from acute respiratory distress syndrome.

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

Cited by 23 publications

References 174 publications

Impact of Obesity on Clinical Outcomes of Patients with Intra-Abdominal Hypertension and Abdominal Compartment Syndrome

Impact of Obesity on Clinical Outcomes of Patients with Intra-Abdominal Hypertension and Abdominal Compartment Syndrome

The Unrestricted Global effort to complete the Closed Or Open after Source Control Laparotomy for Severe Complicated Intra-Abdominal Sepsis (COOL) Trial

Fluid Therapy for Critically Ill Adults With Sepsis

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