Acta clinica Belgica. Supplementum (Acta Clin Belg Suppl )

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  • Other titles
    Acta clinica Belgica. Supplementum
  • ISSN
    0567-7386
  • OCLC
    1781259
  • Material type
    Series
  • Document type
    Journal / Magazine / Newspaper

Publications in this journal

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    ABSTRACT: Acute kidney injury (AKI) is a serious complication in critically-ill patients and portends a high mortality. The incidence of AKI continues to increase and is often underestimated. The intriguing question to both the intensivists and nephrologists is whether the kidney is an innocent bystander in the process of multi-organ systems failure or whether the kidney is initiating various complex metabolic and humoral pathways affecting distant organs contributing to the overall mortality. There is a renewed interest in the last two decades to gain greater insight into various disease pathways and to understand the role of the kidney in multi-organ failure. It is well known that AKI results in significant physiological derangements that underpin remote organ failure. For example, risk of infection and bleeding increase with AKI. Volume overload and acid-base derangements typical of renal dysfunction have serious consequences in the duration and weaning of mechanical ventilation. Recent animal studies suggest that acutely ischaemic kidneys may induce both functional and transcriptional changes in the lung, independent of uraemia. In this review, we have attempted to discuss various physiological derangements and their clinical effects, in the setting of AKI.
    Acta clinica Belgica. Supplementum 02/2007;
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    ABSTRACT: Delayed and slow graft function (DGF/SGF) in de novo kidney transplantation endanger outcomes of graft and patient, while predisposing the patient to acute rejection and lesser graft function. Causes and work-up of DGF/SGF are described in the present paper. Also, the epidemiology and pathophysiology of chronic renal failure both in kidney graft recipients and in recipients of other solid organs is discussed, especially in relation to calcineurin inhibitor (CNI) immunosuppression. An acute kidney injury event will have a greater and faster impact on impaired renal reserve in case of chronic renal failure. Major causes of acute kidney injury (AKI) of the native kidneys of solid organ recipients and of the transplanted kidney are: severe infections, acute toxic kidney injury caused by CNI treatment concomitant CYP450 3A4 inhibiting medication, toxic and infectious events inducing haemolytic uraemic syndrome, toxic rhabdomyolysis, acute interstitial nephritis, rapid IV immunoglobulin infusion and exposure to other well-known nephrotoxins, such as NSAIDs, amphotericin and aminoglycosides.
    Acta clinica Belgica. Supplementum 02/2007;
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    ABSTRACT: Renal dysfunction following cardiac surgery is well recognised and mainly is of ischaemic origin. The spectrum varies from subclinical injuryto established renal failure requiring renal replacement therapy. Depending on definitions, acute kidney injury (AKI) may occur in up to 30% of post cardiac surgery patients. A new grading system for renal dysfunction, based on three levels of plasma creatinine and urine output, as well as the use of biomarkers may help the early identification of patients at risk and thereby hopefully improve outcome. Despite therapeutic advances, the morbidity and mortality associated with AKI have not changed markedly in the last decade.
    Acta clinica Belgica. Supplementum 02/2007;
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    ABSTRACT: To summarize the general guidelines for drug dosing in critically-ill patients with acute kidney injury and continuous venovenous haemofiltration (CVVH), and to discuss whether the predicted dose adjustment is an as reliable estimate than one based on observed data, considering the recent literature. Literature search was done in PubMed database for human studies. In critically-ill patients receiving CVVH, dosing of antibiotics based on the predicted clearances yield rough estimates. Because of interpatient variability observed in the clearance of many antibiotics, monitoring of plasma concentration is highly recommended whenever possible, and especially for those antibiotics that are eliminated predominantly by the kidney, and that have a low therapeutic threshold such as aminoglycosides and glycopeptides, or in patients requiring protracted treatment. However, for many antibiotics, monitoring of blood concentrations is not routinely available and adequate concentrations can only be inferred from clinical response. Therefore, it is important to realize that among many other causes, failure to respond within the first few days of antibiotic treatment may be due to inadequate dosing.
    Acta clinica Belgica. Supplementum 02/2007;
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    ABSTRACT: Significant visceral edema associated with massive fluid resuscitation, paralytic ileus and formation of pancreatic ascites in patients with severe acute pancreatitis (SAP) can lead to abdominal compartment syndrome (ACS) that can contribute to the early development of multiple organ dysfunction syndrome (MODS), especially in the early stages of the disease. The prevalence of intra-abdominal hypertension (IAH) in SAP is about 40% and a manifest ACS occurs in about 10% of the patients warranting close monitoring of intra-abdominal pressure (lAP) in all patients with the severe form of the disease. Although nonsurgical management utilizing percutaneous drainage of ascites or continuous hemodiafiltration may decrease IAP, most patients require decompressive laparostomy and temporary abdominal closure. The primary aim in managing the ensuing open abdomen is delayed fascial closure during initial hospitalization. On many occasions a planned hernia approach, either with early skin grafting over the exposed bowel or managing the ASC primarily with a subcutaneous linea alba fasciotomy, is the only available option. The development of ACS in patients with SAP seems to be associated with increased mortality.
    Acta clinica Belgica. Supplementum 02/2007;
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    ABSTRACT: This review focuses on the available literature published about the evaluation of haemodynamic consequences of the abdominal compartment syndrome (ACS). Animal and clinical studies described decreased venous return, systemic vasoconstriction, systolic and diastolic dysfunction of left and right ventricles. Doppler echocardiography is a non-invasive bedside procedure which provides a complete haemodynamic evaluation of patients with ACS. Despite numerous evaluations in anesthesia during laparoscopic surgery, the use of echocardiography remains scarce in critically ill patients with ACS.
    Acta clinica Belgica. Supplementum 02/2007;
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    ABSTRACT: The acute abdominal compartment syndrome (ACS) is most often treated with surgical abdominal decompression. After the acute phase, primary closure of the abdominal wall may not be possible, due to tissue loss and retraction of the abdominal wall and its musculofascial components. This article gives an update of the reconstructive ladder for abdominal wall defects. Because of improved intensive care treatment and wound dressing, reconstruction can usually be delayed until infection and oedema have settled. Recent developments in bioprosthetics and new surgical techniques like component separation make better results with less donor site morbidity possible. However, there is still a place for local and distant flaps.
    Acta clinica Belgica. Supplementum 02/2007;
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    ABSTRACT: Abdominal compartment syndrome and intra-abdominal hypertension are frequently associated with peritonitis. The aim of this study is to establish the relationship between intra-abdominal hypertension and intra-abdominal sepsis especially in critically ill patients. Relevant information was identified through a Medline search (1966-October 2006). The terms used were "intra-abdominal sepsis", "peritonitis", "abdominal compartment syndrome", "intra-abdominal hypertension" and "relaparotomy for sepsis". The search was limited to English- and French-language publications. Only a few clinical trials exist on this specific topic. Further investigations are required to define the incidence of intra-abdominal hypertension in intra-abdominal sepsis, and the prognostic impact of this setting and finally the potential specific treatment. Abdominal compartment syndrome is more likely linked to the abdominal surgery than to peritonitis itself. Intra-abdominal pressure monitoring can be valuable in critically ill patients with suspicion of persisting intra-abdominal sepsis after surgical peritonitis treatment.
    Acta clinica Belgica. Supplementum 02/2007;
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    ABSTRACT: Diagnostic imaging technology has advanced considerably during the past two decades. Different imaging techniques have been proposed for abdominal imaging in critically ill patients like plain radiography, sonography, computed tomography (CT), magnetic resonance and positron emission tomography. Sonography has been proven to be effective to detect free intra-peritoneal fluid and it is considered one of the primary diagnostic modalities for abdominal evaluation for trauma assessment. In our opinion sonography should replace other invasive techniques to rapidly triage blunt trauma patients with unstable vital signs and examine the peritoneal cavity as a site of major haemorrhage to expedite exploratory laparotomy. On the other hand, CT has become the imaging modality of choice in hemodynamically stable patients with multisystem blunt and penetrating trauma. New developments in the quantitative analysis of the CT images will improve our knowledge of pathophysiology, diagnostic and therapeutic management of abdominal pathologies in critically ill patients.
    Acta clinica Belgica. Supplementum 02/2007;
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    ABSTRACT: South Africa has very high levels of accidental trauma as well as interpersonal violence. There are more admissions for trauma in South Africa than for any other disease; therefore it can be regarded as the Number 1 disease in the country. Complex abdominal injuries are common, requiring specific management techniques. The aim is to document our experience with the Modified Sandwich Vacuum Pack technique for temporary closure of abdominal wounds. After providing a short historical overview, we will demonstrate the technique which we carefully adapted over the last decade to the present Modified Sandwich Vacuum Pack technique. In the Last 5 years we utilized our Modified Sandwich Vacuum Pack technique 153 times in 69 patients. Five (5) patients were under the age of 12 years. In the patient group over 12 years the most common indication for using our technique were penetrating injuries (40), abdominal sepsis (28), visceral edema (10), abdominal compartment syndrome (9), abdominal packs (6),Abdominal wall defects (2). In the group under 12-years the 2 children had liver ruptures (posttraumatic) and 3 liver transplantations. The average cost for the materials used with our technique was ZAR 96. (10 Euro and 41 cents). In our experience the Modified Sandwich Vacuum Pack technique is an effective, cheap methodology to deal with open abdomens in the African setting.A drawback may be the technical expertise required, particular in centers dealing with low numbers of complex abdominal trauma.
    Acta clinica Belgica. Supplementum 02/2007;
  • Acta clinica Belgica. Supplementum 02/2007;
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    ABSTRACT: There has been an exponentially increasing interest in intraabdominal hypertension (IAH) and the abdominal compartment syndrome (ACS) over the last decade, and different definitions have been suggested. Nevertheless, there has been an impetus from experts in the field to modify these definitions to reflect our current understanding of the pathophysiology of these syndromes. An international multidisciplinary group of interested doctors met with the goal of agreeing on a set of definitions that could be applied to patients with IAH and ACS. The goal of this consensus group was to provide a conceptual and practical framework to further define ACS, a progressive injurious process that falls under the generalized term 'IAH' and that includes IAH-associated organ dysfunction. In total, 21 North American, Australasian and European surgical, trauma and critical care specialists agreed to standardize the current definitions for IAH, ACS and related conditions in preparation for the second World Congress on Abdominal Compartment Syndrome (WCACS). The WCACS-meeting was endorsed by the European Society of Intensive Care Medicine (ESICM) and the World Society on Abdominal Compartment Syndrome (WSACS). The consensus conference (Noosa, Australia; December 7, 2004) was attended by 21 specialists from Europe, Australasia and North America and approximately 70 other congress participants. In advance of the conference, a blueprint for the various definitions was suggested. After the conference the participants corresponded electronically with feedback. A writing committee was formed at the conference and developed the final manuscript based on executive summary documents generated by each participant. The final report of the 2004 International ACS Consensus Definitions Conference has recently been published. This article will describe the long road towards this final publication with the evolution of the different definitions and recommendations from the initial suggestions in 2004 to the further refinement and final publications in 2006 and 2007. It will try to explain how we got there and will also give the percentage of agreement with each proposed definition by the participants. New definitions were offered for some terms, while others were discarded and not kept in the final manuscript. Different cut-offs for defining IAH and ACS were given, as well as broad definitions of primary, secondary and recurrent IAH/ACS. A classification system was introduced taking into account the duration, origin, and etiology of IAH. The use of an organ severity scoring method, by means of the Sequential Organ Failure Assessment (SOFA) score when dealing with ACS patients was not recommended as an adjunctive tool to assess morbidity in the final publication. This document reflects a process whereby a group of experts and opinion leaders suggested definitions for IAH and ACS. This document should be used as a reference for the next consensus definitions conference in March 2007.
    Acta clinica Belgica. Supplementum 02/2007;
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    ABSTRACT: Most frequent reasons for intensive care unit (ICU) admission in vasculitis patients are severe respiratory insufficiency due to diffuse alveolar haemorrhage, sepsis and/or pneumonia and an acute abdomen due to bowel infarction. Other reasons are massive gastrointestinal bleeding, thromboembolism and/or scissures. In a patient, not previously diagnosed as having vasculitis, diagnosis can be difficult and must be made as soon as possible, since immunosuppressive therapy should be instituted immediately. Immunosuppressive therapy in severe cases consists of high-dose corticosteroids and cyclophosphamide. In addition, in many cases plasma exchange has to be instituted as well. Prognosis is related to disease activity scores of vasculitis and of severity of illness as measured by the APACHE III scoring system and/or the SOFA score. Septic shock is still the leading cause of death in patients with vasculitis. Nowadays, death due to active untreated vasculitis is rare in experienced clinics.
    Acta clinica Belgica. Supplementum 02/2007;
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    ABSTRACT: Non-closure of abdominal fascia and the resultant open abdomen after laparotomy has become a major advance in the management of critically ill or injured patients. The benefits of open abdomen are many and include the prevention of intra-abdominal hypertension and the consequent abdominal compartment syndrome. Appropriately and exquisitely managed, it can provide all the benefits and prevent highly morbid complications of leaving the abdomen open. This review will provide some insights into such management.
    Acta clinica Belgica. Supplementum 02/2007;
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    ABSTRACT: The increasing recognition of abdominal compartment syndrome's adverse effect on patient outcome has been coupled with our expanding knowledge of techniques of temporary abdominal closure. Temporary abdominal closure can be used prophylactically to prevent abdominal compartment syndrome developing and more commonly in the treatment of patients with progressing or advanced abdominal compartment syndrome. The preferred technique involves a negative suction dressing protecting the fascial and skin edges, collecting intraperitoneal fluid and reducing contamination. Attempts of early closure will facilitate recovery.
    Acta clinica Belgica. Supplementum 02/2007;
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    ABSTRACT: Abdominal Compartment Syndrome (ACS) occurs relatively infrequent in a paediatric population when compared with adults. Overall mortality is still high. Also, the pathophysiologic mechanism that leads to ACS is different in children. In this review, we will present an overview on ACS in children admitted to a paediatric intensive care unit.
    Acta clinica Belgica. Supplementum 02/2007;
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    ABSTRACT: Intra-abdominal hypertension (IAH) and subsequent abdominal compartment syndrome (ACS) in burned patients is common. This sequence of events typically occurs in patients with larger burns receiving high volume fluid resuscitation. A review of the literature was performed. The National Library of Medicine (PUBMED) was queried for "Burn" and "Abdominal Compartment Syndrome". Twenty-nine articles were retained for study. Abdominal pressure monitoring is appropriate in all patients with burns that require significant volume resuscitation (>30% total burned surface area-TBSA). Prevention of ACS in burns includes limiting fluid resuscitation, burn escharotomy, and percutaneous drainage when abdominal pressures are reaching perilous levels. Treatment includes all of the above and in addition, decompressive laparotomy when needed. However, despite decompressive laparotomy, mortality rates among burn victims with ACS remain unacceptably high. Increasing amounts of volume delivery are associated with an increased risk of IAH. Therefore, intra-abdominal pressure should be monitored in all burn patients requiring massive fluid resuscitation. Escharotomy, paracentesis, and decompressive laparotomy may all be needed to counter the side effects of appropriate fluid resuscitation in the severely burned patient. Nevertheless, the prognosis in burn patients developing ACS is grim.
    Acta clinica Belgica. Supplementum 02/2007;
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    ABSTRACT: Intra-abdominal hypertension (IAH) and abdominal compartment syndrome are a common occurrence in ICU patients. The deleterious effects of IAH on organ function are well known and increasingly appreciated in recent years, especially where renal and respiratory function are concerned. This review will focus on the available literature from the last years.A Medline and PubMed search was performed in order to find an answer to the question "What is the impact of increased IAP on neurologic function in the critically ill?" The amount of data on the influence of IAH on the central nervous system is more scarce, but several animal and human studies have demonstrated a clear correlation between intra-abdominal pressure (IAP) and intracranial pressure (ICP). This correlation is probably due to transmission of the increased IAP to the thorax leading to increased intrathoracic, pleural pressure and central venous pressure, decreased venous return from the brain and increased ICP. This hypothesis is supported by the observation that the increase in ICP is abolished when a sternotomy and pleuropericardotomy are performed, and by the fact that abdominal decompression has produced good results in treating refractory intracranial hypertension (ICH) in patients with both IAH and ICH. A close relationship between IAP and ICP has been observed in several animal and human studies. The clinical impact of this association is dependent on the baseline ICP and the compensatory reserve of the patient. Some studies have reported good results in treating refractory ICH by abdominal decompression in patients with concomitant IAH. Monitoring of IAP and ICP in risk patients is essential.
    Acta clinica Belgica. Supplementum 02/2007;
  • Acta clinica Belgica. Supplementum 02/2007;

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