The role of point-of-care ultrasound in intra-abdominal hypertension management

Pereira, Bruno M.; Pereira, Renato G; Wise, Robert; Sugrue, Gavin; Zakrison, Tanya L.; Dorigatti, Alcir Escócia; Fiorelli, Rossano Kepler Alvim; Malbrain, Manu L N G

doi:10.5603/ait.a2017.0074

Cited by 31 publications

(20 citation statements)

References 11 publications

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“…Abdominal POCUS is widely used as a clinical tool for the management and diagnosis of patients with abdominal pathology [144][145][146][147][148]. Evaluation of free fluid is particularly useful when sudden clinical deterioration and hypotension occur and may provide insight into the ongoing pathophysiologic process [149,150] A renal ultrasound is useful to easily detect the presence of hydronephrosis even by novices [152][153][154]. Urinary retention can be evaluated by POCUS assessing postvoid residual volumes.…”

Section: Pocus-guided Technique Is Helpful Formentioning

confidence: 99%

International evidence-based guidelines on Point of Care Ultrasound (POCUS) for critically ill neonates and children issued by the POCUS Working Group of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC)

et al. 2020

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Background: Point-of-care ultrasound (POCUS) is nowadays an essential tool in critical care. Its role seems more important in neonates and children where other monitoring techniques may be unavailable. POCUS Working Group of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC) aimed to provide evidence-based clinical guidelines for the use of POCUS in critically ill neonates and children. Methods: Creation of an international Euro-American panel of paediatric and neonatal intensivists expert in POCUS and systematic review of relevant literature. A literature search was performed, and the level of evidence was assessed according to a GRADE method. Recommendations were developed through discussions managed following a Quaker-based consensus technique and evaluating appropriateness using a modified blind RAND/UCLA voting method. AGREE statement was followed to prepare this document. Results: Panellists agreed on 39 out of 41 recommendations for the use of cardiac, lung, vascular, cerebral and abdominal POCUS in critically ill neonates and children. Recommendations were mostly (28 out of 39) based on moderate quality of evidence (B and C). Conclusions: Evidence-based guidelines for the use of POCUS in critically ill neonates and children are now available. They will be useful to optimise the use of POCUS, training programs and further research, which are urgently needed given the weak quality of evidence available.

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Section: Pocus-guided Technique Is Helpful Formentioning

confidence: 99%

International evidence-based guidelines on Point of Care Ultrasound (POCUS) for critically ill neonates and children issued by the POCUS Working Group of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC)

et al. 2020

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“…Despite the fact that there are no existing predictive factors for IAH diagnosis, except for the risk factors, new technologies are already being used in the management of IAH. Recently, a study demonstrated the usefulness of bedside ultrasound for the management of critically ill patients with elevated IAP [8]. Accordingly, we believe that soon new studies will demonstrate clinical, laboratory and respiratory parameters as possible predictors of IAH, which in view of the observed differences among the admission SOFA scores of patients who developed ACS would possibly be used in addition to other parameters.…”

Section: Discussionmentioning

confidence: 98%

Septic shock patients admitted to the intensive care unit with higher SOFA score tend to have higher incidence of abdominal compartment syndrome – a preliminary analysis

Pereira

Dorigatti

Melek

et al. 2019

ait

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Background: Intra-abdominal hypertension (IAH) is relatively frequent in critical patients. According to the most recent consensus of the World Society of Abdominal Compartment Society (WSACS), there are no predictive factors for IAH diagnosis. Risk factors are the only motivators to date for early IAH diagnosis. Abdominal compartment syndrome (ACS) is defined as sustained intra-abdominal pressure (IAP) maintained above 20 mm Hg (> 3 kPa), with or without abdominal perfusion pressure below 60 mm Hg (< 8 kPa), associated with a new organ dysfunction. Sepsis is a recognized cause of secondary ACS, but to date there is no correlation with admission SOFA (sequential organ failure assessment) score and ACS onset incidence. The objective of the present study is to determine the profile of extra-abdominal septic shock patients with IAH/ACS admitted to the intensive care unit (ICU) and correlating with admission SOFA score. Better understanding of this population may bring to light clinical predictive factors for IAH/ACS early diagnosis.Methods: In this observational study IAH/ACS incidence was correlated with SOFA score calculated at ICU admission. The study enrolled all critically ill patients more than 18 years old admitted to the Medical Intensive Care Unit (MICU) of a university teaching hospital between April and October 2016, who had been diagnosed with extraabdominal septic shock, according to the Surviving Sepsis Campaign and SEPSIS-3.Results: Twenty-five patients were evaluated during 10 hospitalization days. The average age was 51.13 ± 16.52 years, and 64% of the patients were male. Most patients (76%) had pneumonia. On admission, the SOFA score was 6.54 ± 2.71. Mortality rate in the population studied was 52%. The incidence of IAH was 43.5%, while the incidence of ACS in the IAH population was 28%. SOFA admission score in patients with the diagnosis of ACS was of 8.42 ± 1.27. In this study SOFA score higher than 7 is correlated with IAH, with an accuracy of 68.8% (P < 0.03). Conclusions:The incidence of ACS in patients with extra-abdominal septic shock admitted to a university teaching hospital MICU was higher than those found in the literature. Higher admission and consecutive SOFA score of more than 7 was associated with higher ACS incidence and higher mortality rate.

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“…They concluded that IAH simulation was associated with decreased inferior vena cava cross-section area and an increased resistive index in renal arteries [29]. Pereira et al (2017) reporting on a group of fifty critically ill patients who developed IAH, showed that the point of care ultrasound (POCUS) proved to be extremely useful in evaluation of bowel activity, identification of large intestinal contents, the identification of patients who would benefit from bowel evacuation as an adjuvant to lower IAP and the diagnosis of moderate to large amounts of free intra-abdominal fluid [30]. Echocardiography can detect indirect but non-specific signs of ACS, decreased preload as well as dysfunctions of systolic and diastolic ventricular functions [31].…”

Section: Diagnosismentioning

confidence: 99%

Abdominal Compartment Syndrome as a Multidisciplinary Challenge. A Literature Review

Popescu

Bara

Rad

2018

The Journal of Critical Care Medicine

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Abdominal Compartment Syndrome (ACS), despite recent advances in medical and surgical care, is a significant cause of mortality. The purpose of this review is to present the main diagnostic and therapeutic aspects from the anesthetical and surgical points of view. Intra-abdominal hypertension may be diagnosed by measuring intra-abdominal pressure and indirectly by imaging and radiological means. Early detection of ACS is a key element in the ACS therapy. Without treatment, more than 90% of cases lead to death and according with the last reports, despite all treatment measures, the mortality rate is reported as being between 25 and 75%. There are conflicting reports as to the importance of a conservative therapy approach, although such an approach is the central to treatment guidelines of the World Society of Abdominal Compartment Syndrome, Decompressive laparotomy, although a backup solution in ACS therapy, reduces mortality by 16-37%. The open abdomen management has several variants, but negative pressure wound therapy represents the gold standard of surgical treatment.

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The role of point-of-care ultrasound in intra-abdominal hypertension management

Abstract: POCUS is a powerful systematic ultrasound technique that can be used as an adjuvant in intra-abdominal hypertension management. It has the potential to be used in both diagnosis and treatment during the course of IAH.

Cited by 31 publications

References 11 publications

International evidence-based guidelines on Point of Care Ultrasound (POCUS) for critically ill neonates and children issued by the POCUS Working Group of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC)

International evidence-based guidelines on Point of Care Ultrasound (POCUS) for critically ill neonates and children issued by the POCUS Working Group of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC)

Septic shock patients admitted to the intensive care unit with higher SOFA score tend to have higher incidence of abdominal compartment syndrome – a preliminary analysis

Abdominal Compartment Syndrome as a Multidisciplinary Challenge. A Literature Review

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