Outcomes in pediatric patients with abdominal compartment syndrome following urgent exploratory laparotomy

Thomas, Sharon; Kriplani, Disha; Crane, Clarkson; Dehom, Salem; Oei, Grace; Baerg, Joanne; Wright, Chris; Xu, Ying; Ejike, J. Chiaka

doi:10.1016/j.jpedsurg.2016.09.071

Cited by 11 publications

(6 citation statements)

References 10 publications

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“…Despite surgical decompression, eight of our patients died. This overall mortality rate of 57% in patients with ACS is similar to other recent publications which reported mortality rates between 40 and 60% [12,[22][23][24].…”

Section: Discussionsupporting

confidence: 90%

“…DL is still considered the standard of care in patients with ACS, as it is the only available effective treatment. Its efficacy has previously been shown by other authors and is reflected also by our results [22,23]. Prior to DL, all patients with ACS were oliguric, on high ventilator support, and showed signs of splanchnic hypoperfusion and impaired renal function.…”

Section: Discussionsupporting

confidence: 86%

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Abdominal compartment syndrome and decompressive laparotomy in children: a 9-year single-center experience

et al. 2020

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Purpose Abdominal compartment syndrome (ACS) in children results in 100% mortality if left untreated. Decompressive laparotomy (DL) is the only effective treatment if conservative medical therapies have failed. This study aims to determine the incidence of ACS among pediatric patients who underwent an emergency laparotomy (EL), to describe the effect of DL on clinical and laboratory parameters and, to make a better prediction on fatal outcome, to analyze variables and their association with mortality. Methods This retrospective study includes 418 children up to the age of 16 years who underwent EL between January 2010 and December 2018 at our tertiary pediatric referral center. ACS was defined according to the latest guidelines of the World Society of the Abdominal Compartment Syndrome. Results Fourteen patients had emergency DL for ACS. 6 h preoperatively; median intra-abdominal pressure (IAP) and abdominal perfusion pressure (APP) were 22.5 mmHg and 29 mmHg, respectively. After DL, IAP decreased and APP increased, both by an average of 60%. Six patients survived, eight patients had a fatal outcome, resulting in a mortality of 57%. An age under 1 year, weight under the 3rd percentile, an open abdomen treatment, an intestinal resection and an elevated serum lactate > 1.8 mmol/L were associated with an increased relative risk of death. Conclusions Improving the outcome in pediatric patients with ACS by removing or attenuating risk factors is difficult. This emphasizes the need for early diagnosis and prompt DL once the diagnosis of ACS is made.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 86%

Abdominal compartment syndrome and decompressive laparotomy in children: a 9-year single-center experience

et al. 2020

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“…A pesar de sus probadas ventajas y cualidades, y la relativa gran frecuencia en pediatría de heridas complejas, síndrome de compartimiento y sepsis abdominal, la terapia de presión negativa tiene un uso excepcional en los departamentos de cirugía pediátrica, en comparación con las unidades de cirugía plástica, ortopédica y de cirugía general de adultos 17 . Esto puede atribuirse a la limitada exposición de los cirujanos pediatras a este método y la poca difusión de la evidencia científica de su eficacia y seguridad en la población pediátrica.…”

Section: Discussionunclassified

Terapia de presión negativa en pediatría

Figueroa-Gutiérrez

Martínez-Cano²,

Giraldo-Ossa³

et al. 2020

Rev Colomb Cir

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Introducción. La terapia de presión negativa es un recurso utilizado cada vez con mayor frecuencia en el manejo de heridas complejas en pediatría. El objetivo de este estudio fue describir la experiencia con esta terapia en diferentes situaciones clínicas. Métodos. Se llevó a cabo un estudio descriptivo retrospectivo en un grupo de pacientes pediátricos en quienes se utilizó la terapia de presión negativa entre el año 2010 y el 2015. Se analizaron las variables sociodemográficas, los diagnósticos que indicaron la terapia, el tiempo de uso, sus complicaciones y la mortalidad. Resultados. Se incluyeron 41 pacientes. La terapia se indicó en 39 casos con heridas localizadas en el abdomen, en uno con infección de los tejidos blandos perianales y en otro con una herida de esternotomía infectada. De las heridas abdominales, 14 fueron por complicaciones relacionadas con apendicitis aguda, 6 por enfermedades relacionadas con megacolon, 5 por obstrucción intestinal, 4 para el manejo de fístulas, 4 por enterocolitis necrosante del recién nacido, 3 por pancreatitis aguda y 3 por otras causas. El tiempo promedio de uso de la terapia fue de 7 días. Se presentaron fallas en el sistema de vacío en dos pacientes, pero no hubo complicaciones por el uso de la terapia. Dos pacientes fallecieron por complicaciones relacionadas con su enfermedad de base. Conclusión. La terapia de presión negativa es un recurso efectivo en el manejo de heridas complejas en la población pediátrica.

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“…3 Emergency laparotomy is a challenging surgical procedure in paediatric practice and data are scarce for this age group. 4 For this reason, we performed the first paediatric emergency laparotomy audit (PELA) in the UK, based on the NELA and EPOCH trial frameworks, to investigate the demographics, processes of care, standards of care and outcomes in the paediatric age group with a view to identifying the current status compared with adult practice.…”

Section: Introductionmentioning

confidence: 99%

The need for Paediatric Emergency Laparotomy Audit (PELA) in the UK

Sunderland

et al. 2020

annals

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Introduction The National Emergency Laparotomy Audit (NELA) has raised serious concerns about the processes of care and outcomes in adult emergency laparotomies in the UK. To date, no comparable data have been published for children. The aim of this study was to investigate the need for a similar audit in children. Methods Data were collected retrospectively following NELA guidelines. Results were analysed using QuickCalcs (GraphPad Software, La Jolla, CA, US). Results The study period spanned 7.5 years. A total of 161 patients were identified for inclusion in the audit. The median patient age was 2.8 years. Half (49%) of the cohort were deemed ASA (American Society of Anesthesiologists) grade ≥2. A history of previous abdominal surgery was noted in 37% of the patients. The median time from admission to operation was 15 hours. Over a third (39%) of the operations were performed out of hours. The most common indications for surgery comprised adhesive bowel obstruction (37%), intussusception (27%) and volvulus (9%). The median length of hospital stay was 8 days with the median postoperative stay being 6 days (NELA data 10.6 days). Half (51%) of the cases required intensive care following surgery. The 30-day mortality rate was 3.1%. The overall mortality rate was 4.3% (NELA data 16%). Patient care was led by a consultant surgeon in 100% of cases (NELA data 89%). Conclusions This is the first study in children that provides baseline data about the standards of care and outcomes from a single centre paediatric emergency laparotomy audit. A larger study using data from multiple centres would be of great benefit.

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Outcomes in pediatric patients with abdominal compartment syndrome following urgent exploratory laparotomy

Cited by 11 publications

References 10 publications

Abdominal compartment syndrome and decompressive laparotomy in children: a 9-year single-center experience

Abdominal compartment syndrome and decompressive laparotomy in children: a 9-year single-center experience

Terapia de presión negativa en pediatría

The need for Paediatric Emergency Laparotomy Audit (PELA) in the UK

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