Renal Decapsulation in the Prevention of Post-ischemic Oliguria

Stone, H. Harlan; Fulenwider, J T

doi:10.1097/00000658-197709000-00012

Cited by 96 publications

(54 citation statements)

References 23 publications

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“…Even if cardiac and renal failure are not precipitated, salt and water excess can cause tissue oedema irrespective of the transcapillary escape rate of albumin. Oedema compromises both pulmonary gas exchange and tissue oxygenation, and produces an increase in tissue pressure in organs surrounded by a non-expansible capsule, thereby slowing micovascular perfusion, increasing arterio-venous shunting and reducing lymphatic drainage, all of which facilitate further oedema formation (Stone & Fulenwider, 1977).…”

Section: Consequences Of Salt and Water Imbalancementioning

confidence: 99%

Fluid, electrolytes and nutrition: physiological and clinical aspects

Lobo

2004

Proc. Nutr. Soc.

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Fluid and electrolyte balance is often poorly understood and inappropriate prescribing can cause increased post-operative morbidity and mortality. The efficiency of the physiological response to a salt or water deficit, developed through evolution, contrasts with the relatively inefficient mechanism for dealing with salt excess. Saline has a Na + :Cl -of 1 :1 and can produce hyperchloraemic acidosis, renal vasoconstriction and reduced glomerular filtration rate. In contrast, the more physiological Hartmann's solution with a Na + :Cl -of 1 . 18 :1 does not cause hyperchloraemia and Na excretion following infusion is more rapid. Salt and water overload causes not only peripheral and pulmonary oedema, but may also produce splanchnic oedema, resulting in ileus or acute intestinal failure. This overload may sometimes be an inevitable consequence of resuscitation, yet it may take 3 weeks to excrete this excess. It is important to avoid unnecessary additional overload by not prescribing excessive maintenance fluids after the need for resuscitation has passed. Most patients require 2-2 . 5 litres water and 60-100 mmol Na/d for maintenance in order to prevent a positive fluid balance. This requirement must not be confused with those for resuscitation of the hypovolaemic patient in whom the main aim of fluid therapy is repletion of the intravascular volume. Fluid and electrolyte balance is a vital component of the metabolic care of surgical and critically-ill patients, with important consequences for gastrointestinal function and hence nutrition. It is also of importance when prescribing artificial nutrition and should be given the same careful consideration as other nutritional and pharmacological needs.

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Section: Consequences Of Salt and Water Imbalancementioning

confidence: 99%

Fluid, electrolytes and nutrition: physiological and clinical aspects

Lobo

2004

Proc. Nutr. Soc.

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“…[103][104][105] This is associated with an increase in ADH production 106,107 and stimulation of the renin-angiotensin-aldosterone mechanism 108 which is not ameliorated by fluid resuscitation except in the rat. 109,110 The concept of impaired Renal Perfusion Pressure (RPP) is akin to that of APP and CPP previously mentioned although there is no evidence that restoration of MABP (where RPP=MABP-IAP) prevents the development of renal failure in these patients.…”

Section: Renal Function In Intra-abdominal Hypertensionmentioning

confidence: 99%

“…9,102 The aetiology of renal failure in IAH is unknown but probably multi-factorial including an overall decreased CO, reduced renal perfusion pressure and arterial flow, increased renal venous pressure and vascular resistance, enhanced cortico-medullary shunting (with consequent reduced GFR) and renal parenchymal and ureteric compression. [103][104][105] This is associated with an increase in ADH production 106,107 and stimulation of the renin-angiotensin-aldosterone mechanism 108 which is not ameliorated by fluid resuscitation except in the rat.…”

Section: Renal Function In Intra-abdominal Hypertensionmentioning

confidence: 99%

Primary Intra-Abdominal Hypertension and Abdominal Compartment Syndrome: Pathophysiology and Treatment

Ap¹,

Wun²,

Chiappa³

et al. 2015

Emerg Med Open J

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Abdominal Compartment Syndrome (ACS) is a potentially lethal condition caused by various events that produce intra-abdominal hypertension. The most common cause is blunt abdominal trauma. Increasing intra-abdominal pressure causes progressive hypoperfusion and ischemia of the intestines and other peritoneal and retroperitoneal structures. Pathophysiological effects include release of cytokines, production of oxygen free radicals, and decreased cellular formation of adenosine triphosphate. These processes may lead to translocation of bacteria from the gut and intestinal edema, predisposing patients to multiorgan dysfunction syndrome. The consequences of abdominal compartment syndrome are profound and affect many vital body systems. Respiratory, hemodynamic, cardiovascular, renal, and neurological abnormalities are signs of abdominal compartment syndrome. Medical management of critically ill patients with raised intra-abdominal pressure should be instigated early to prevent further organ dysfunction and to avoid progression to ACS. Many treatment options are available and are often part of routine daily management in the ICU (nasogastric, rectal tube, prokinetics, enema, sedation, body position). Some of the newer treatments are very promising options in specific patient populations with raised IAP. Nursing care involves vigilant monitoring for early detection, including serial measurements of intra-abdominal pressure.KEYWORDS: Intra-abdominal hypertension; Abdominal compartment syndrome; Damage control laparotomy; Laparostomy; Open abdomen. DEFINITIONS, INCIDENCE AND MEASUREMENT STRATEGIES IN INTRA-ABDOMINAL HY-PERTENSION (IAH) AND ABDOMINAL COMPARTMENT SYNDROME (ACS)The concept of the Abdominal Compartment Syndrome (ACS) has been rediscovered as a final common pathway of the physiologic sequelae of increased Intra-Abdominal Pressure In each case if the graph shifts to the right, higher IAP and lower APP values may not be associated with significant end-organ dysfunction creating a degree of "ACS-resistance." Shifts to the left would create "ACS-sensitivity" where lower values of IAP (higher APP values) may still be associated with organ dysfunction which might not occur normally. This results in difficulty for broader acceptance of critical IAP and APP levels for individual cases. ACS-sensitivity may potentially occur in patients where there is pre-existing partial end-organ failure, morbid obesity or following fluid hyper-resuscitation in patients with severe burns, haemorrhagic pancreatitis, massive blood loss, widespread intra-peritoneal sepsis and high-output intestinal fistulae. 6-8There is no strict definition of what represents abnormal IAP, but there is a general acceptance that measured pressures >12 mmHg when recorded 1-6 hours apart are considered to represent IAH, where Sugrue, et al. have shown that this represents up to 40% of cases admitted to a surgical Intensive Care Unit (ICU). 9 Although there are biases in the prospective assessment of a selective population admitted to an ICU who ...

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“…Acute kidney injury may occur due to abdominal compartment syndrome compressing the kidney externally 98-100 and increased intra-capsular pressure due to oedematous renal tissue. 101 7. A sustained increase in systemic capillary permeability allows albumin and its attendant fluid (18 ml for every gram of albumin) to leak into the interstitial space 77,102,103 into the interstitial space, thereby worsening interstitial oedema.…”

Section: Overview Of Fluid and Electrolyte Therapy In Injury Illnessmentioning

confidence: 99%

Acute kidney injury in surgical patients

Kishen¹

2014

Anesthesia and Perioperative Care of the High-Risk Patient

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Renal Decapsulation in the Prevention of Post-ischemic Oliguria

Cited by 96 publications

References 23 publications

Fluid, electrolytes and nutrition: physiological and clinical aspects

Fluid, electrolytes and nutrition: physiological and clinical aspects

Primary Intra-Abdominal Hypertension and Abdominal Compartment Syndrome: Pathophysiology and Treatment

Acute kidney injury in surgical patients

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