Respiratory functions of burn patients undergoing decompressive laparotomy due to secondary abdominal compartment syndrome

Struck, Matthias; Reske, Andreas; Schmidt, Thomas; Hilbert, P.; Steen, Michael; Wrigge, Hermann

doi:10.1016/j.burns.2013.05.007

Cited by 14 publications

(10 citation statements)

References 27 publications

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“…By repeated measurements of the intraabdominal pressure, patients at risk for increased abdominal pressure-mechanically ventilated, with a high BMI, trauma patients-can be treated sooner in order to decrease intraabdominal pressure, by decompressive laparotomy, administering muscle relaxants, punctures [10][11][12].…”

Section: Discussionmentioning

confidence: 99%

Influence of Ventilation Parameters on Intraabdominal Pressure

Puiac

Szederjesi

Lazăr

et al. 2016

The Journal of Critical Care Medicine

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Introduction: Intraabdominal pressure monitoring is not routinely performed because the procedure assumes some invasiveness and, like other invasive procedures, it needs to have a clear indication to be performed. The causes of IAH are various. Mechanically ventilated patients have numerous parameters set in order to be optimally ventilated and it is important to identify the ones with the biggest interference in abdominal pressure. Although it was stated that mechanical ventilation is a potential factor of high intraabdominal pressure the set parameters which may lead to this diagnostic are not clearly named. Objectives: To evaluate the relation between intraabdominal pressure and ventilator parameters in patients with mechanical ventilation and to determine the correlation between intraabdominal pressure and body mass index. Material and method: This is an observational study which enrolled 16 invasive ventilated patients from which we obtained 61 record sheets. The following parameters were recorded twice daily: ventilator parameters, intraabdominal pressure, SpO2, Partial Oxygen pressure of arterial blood. We calculated the Body Mass Index (BMI) for each patient and the volume tidal/body weight ratio for every recorded data point. Results: We observed a significant correlation between intraabdominal pressure (IAP) and the value of PEEP (p=0.0006). A significant statistical correlation was noted regarding the tidal volumes used for patient ventilation. The mean tidal volume was 5.18 ml/kg. Another significant correlation was noted between IAP and tidal volume per kilogram (p=0.0022). A positive correlation was found between BMI and IAP (p=0.0049), and another one related to the age of the enrolled patients. (p=0.0045). Conclusions:The use of positive end-expiratory pressures and high tidal volumes during mechanical ventilation may lead to the elevation of intraabdominal pressure, a possible way of reducing this risk would be using low values of PEEP and also low volumes for the setting of ventilation parameters. There is a close positive correlation between the intraabdominal pressure levels and body mass index.

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Section: Discussionmentioning

confidence: 99%

Influence of Ventilation Parameters on Intraabdominal Pressure

Puiac

Szederjesi

Lazăr

et al. 2016

The Journal of Critical Care Medicine

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“…Thus data for emergency laparotomies outside the OR are scarce and mostly refer to decompressive laparotomy in refractory ACS, for example in burns patients [15] or in trauma patients [13,14,25]. Unlike emergency bedside laparotomy, there are good data for emergency laparotomy in the OR, especially regarding the outcome of patients [8].…”

Section: Discussionmentioning

confidence: 99%

“…Struck et al . recently reported on a cohort of 35 burns patients with ACS undergoing emergency laparotomy [15]. Overall mortality was 71.4%, but only six patients underwent a bedside laparotomy in the ICU.…”

Section: Discussionmentioning

confidence: 99%

“…Few studies have analyzed bedside laparoscopy in critically ill patients with acute abdomen [9,10] or emergency thoracotomy in the emergency room [11,12]. Reports on resuscitative laparotomy in the ICU are scarce and have analyzed heterogeneous cohorts with respect to the degree of urgency (emergency and elective surgery) [13,14] or with respect to the instability and the site of surgery (surgery in the ICU and in the OR) [15-18]. Attempting emergency surgery at the bedside might equally result in an adverse outcome.…”

Section: Introductionmentioning

confidence: 99%

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Rescue bedside laparotomy in the intensive care unit in patients too unstable for transport to the operating room

et al. 2014

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IntroductionThe prognoses of critically ill patients with a requirement for emergency laparotomy and severe respiratory and/or hemodynamic instability precluding transport to the operating room (OR) are often fatal without surgery. Attempting emergency surgery at the bedside might equally result in an adverse outcome. However, risk factors and predictors that could support clinical decision making have not been identified so far. This study describes the clinical characteristics, indicative pathophysiology and outcomes in patients undergoing resuscitative laparotomy in the intensive care unit (ICU).MethodsThis was a retrospective observational study of all critically ill adult patients undergoing resuscitative laparotomy in the ICUs of a German university hospital from January 2005 to July 2013. Clinical characteristics, risk factors, and treatments were compared between survivors and non-survivors. The primary endpoint was 28-day survival.ResultsA total of 41 patients with a median age of 64 (21 to 83) were included. The most frequent reasons for ICU admission were sepsis, pneumonia, and pancreatic surgery. All patients were mechanically ventilated, receiving vasopressors, and were in multiple organ failure. Twenty-nine patients (70.7%) were on renal replacement therapy and two patients (4.9%) on extracorporeal membrane oxygenation. The main reasons for surgery were suspected intra-abdominal bleeding (39.0%), suspected intestinal ischemia (24.4%) or abdominal compartment syndrome (24.4%). Twenty-eight-day, ICU and hospital mortalities were 75.6%, 80.5%, and 82.9%, respectively. In six out of ten patients (60%) who survived surgery for more than 28 days, bedside laparotomy was rated as a life-saving procedure by an interdisciplinary group of the investigators.ConclusionsThese findings suggest that in selected critically ill patients with a vital indication for emergency laparotomy and severe cardiopulmonary instability precluding transport to the OR, a bedside resuscitative laparotomy in the ICU can be considered as a rescue procedure, even though very high mortality is to be expected.

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“…Depending on the course of disease and concomitant organ dysfunction, some cases of ACS can be managed conservatively whereas some cases of IAH may require immediate aggressive treatment including fast decision to proceed to decompressive laparotomy before reaching the value of 20 mmHg of IAP. This is important because use of decompressive laparotomy is associated with a number of potential complications (e.g., massive ventral hernia, enteric fistulae, and intra-abdominal sepsis), increased morbidity, and decreased quality of life, especially in younger patients [9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%