Recognition and management of intra-abdominal hypertension and abdominal compartment syndrome; a survey among Dutch surgeons

Abstract

PurposeIntra-abdominal hypertension (IAH) and Abdominal compartment syndrome (ACS) are relatively rare, but severe complications. Although many advances were made in recent years, the recognition and management remain subject of debate. The aim of this study was to determine the current state of awareness, knowledge and use of evidence-based medicine regarding IAH and ACS among Dutch surgeons.MethodsA literature-based and expert consensus survey was developed. One surgeon in every hospital in The Netherlands was asked to complete the online questionnaire.ResultsSixty of 87 (69 %) invited surgeons completed the questionnaire. Intra-abdominal pressure (IAP) was measured using intra-vesical methods by 55 (98 %) respondents. Diuretics (N = 38; 63 %) and laparotomy (N = 33; 55 %) were considered useful treatments for IAH or prevention of ACS by a majority. Only 16 (27 %) respondents used these guidelines in daily practice, and 37 (62 %) respondents are willing to do so. Although 35 (58 %) surgeons agreed that IAH is only a symptom, not requiring treatment. Forty-one percent of experienced respondents suggested that prevalence of ACS remained unchanged. Nearly all respondents (N = 59; 98 %) believed that open abdomen management improves patient outcomes, many (N = 46; 77 %) confirm the high complications rate of this treatment.ConclusionThe definitions of IAH and ACS and the related diagnostic and therapeutic challenges are relatively well known by Dutch surgeons. Despite limited use of the evidence-based guidelines, the willingness to do so is high. Most respondents favor open abdomen treatment for patients with imminent ACS, despite the high complication rates associated with this treatment.

Superior primary fascial closure rate and lower mortality after open abdomen using negative pressure wound therapy with continuous fascial traction

“…The intricate process begins with the critical decision-making about whether the patient would profit from laparostomy, which often associates with potentially crippling complications. [12][13] This nationwide study included both minor-volume and major-volume centers and revealed that in centers with over 10 OA patients per year, the mortality was significantly reduced. This implies that these complex patients mostly requiring ICU monitoring and the feasibility of reacting operatively 24/7 should be centralized in tertiary referral hospitals.…”

Incidence of Intra-Abdominal Hypertension and Abdominal Compartment Syndrome: A Systematic Review

“…This is contrary to survey data which suggest many intensivists and surgeons underappreciate the prevalence of IAH and demonstrate low awareness of the WSACS guidelines. [23][24][25] While the elimination of IAH and ACS is the ultimate goal of research in the field, we are not even close to achieving it. The most recent IAH study, and the only multicenter trial, reported the highest incidence of ACS (6.1%) to date.…”

Protocolos Para Diagnóstico E Manejo Da Hipertensão Intra-Abdominal Em Centros De Tratamento Intensivo

“…Some considerations when thinking about the surgical abdominal compartment syndrome approach should be considered; the first is to define it as primary or secondary 3 .…”

“…Despite its high lethality, as demonstrated by several authors, this condition is underdiagnosed by many professionals, as it has been demonstrated by qualitative observational studies of medical professionals in large hospitals 2,3 .…”