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Article: Mensuração da Presão Intra-Abdominal nas Unidades de Tratamento Intensivo. A Opinião dos Médicos Intensivistas

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    • "Associadas à enfermidade de base, a HIA/SCA são consideradas fatores independentes de mortalidade em pacientes humanos, acrescido de comprovações, por estudos de prevalência em modelos críticos, de altas taxas de morbimortalidade devido à evolução para síndrome de disfunção de múltiplos órgãos (SDMO). Seu diagnóstico normalmente é demorado por se tratar de uma entidade de repercussão fisiopatológica multifatorial e insidiosa, concomitante ainda à falta de uniformidade das condutas em centros de terapia intensiva (Hong et al. 2002, Japiassú et al. 2007). Originalmente descrito por Kron et al. (1984), o diagnóstico de elevação da PIA atualmente considerado como padrão ouro é baseado na técnica indireta de sondagem vesical, uma vez que a bexiga preenchida com pequenos volumes serve como reservatório passivo da PIA, permitindo sua mensuração sem qualquer influência da mesma. "
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    ABSTRACT: In order to favor the homogeneity of scientific studies and to provide guidelines on the diagnosis and therapy, human basal values of the intra-abdominal pressure (IAP) and their probable thresholds in morbid cases were recently established. However, basal values and changes in the intra-abdominal pressure in animals are still partly unknown and not scientifically confirmed. Veterinarians have the need to expand their knowledge on morbid conditions that develop with Intra-Abdominal Hypertension (IAH) or Abdominal Compartment Syndrome (ACS). The present study aims to test in dogs the technique adopted in human medicine as a model for measurement of intra-abdominal pressure (1) and determine normal values for the species (2). Fifteen known mongrel healthy dogs, males and females and homogenous were tested. The measurement of IAP was done through an indirect technique which involves catheterizing the bladder and using a water column with a graduate ruler in cm of H20 - its final value converted to mm of Hg. The values observed ranged from a minimum sub atmospheric value (below of zero mm of Hg) to 3,75 mmHg. There was a considerable variation within the individual values observed in some animals, bringing up considerations related to body mass, frequency/total volume of the physiologic solution to be administered and inquietude of these dogs during the treatment. The thresholds values found are considered physiologic, indicating reliability of the technique and possibility of its clinical use. The absence of sedation and the use of urethral catheter did not compromised the measurement, however could have resulted in under- or overestimation of the values found.
    Pesquisa Veterinária Brasileira 09/2011; 31(9):812-816. DOI:10.1590/S0100-736X2011000900014 · 0.36 Impact Factor
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    ABSTRACT: The Abdominal Compartment Syndrome (ACS) is a clinical entity recognized for over a century, but only recently its risk criteria, monitorization and treatment have been defined by the World Society of the Abdominal Compartment Syndrome (WSACS). The general surgeon's involvement is vital since this syndrome is common in surgical patients and because its treatment may culminate in a laparostomy. 250 questionnaires of 17 questions were distributed among general surgeons attending the XXVIII Portuguese Congress of Surgery. The data were analyzed using SPSS® v16. We received 36,4% (91) of the delivered questionnaires, most of which from male surgeons (63,7%), from central hospitals (75,8%), working 42 h per week (70.3%), whose average of age was 38 years. About half of the respondents received training in Intensive Care Units. All surgeons had already heard about measuring the Intra- abdominal Pressure (IAP), which was being performed at 89% of their hospitals. About 40% of surgeons only admitted intra-abdominal hypertension above 20 mmHg (only 22% indicated the correct value of 12 mmHg). 36,3% of surgeons suggested that a decompressive laparostomy must be carried out for primary ACS if IAP greater then 20 mmHg with new organ failure; 36.3% favoured the "Vacuum-pack"-like system, and 56% only re-operate the patients "as needed". 48,4% of surgeons had already performed decompressive laparostomy, 66% of which had residence training in a ICU (p = 0,005). Respondents also pointed an average mortality related to ACS of 81% without laparostomy, and a reduction to 38,5% after performing that procedure. Only 26% of the surgeons were aware of the WSACS consensus definitions and recommendations, of those, 83% had already performed a laparostomy (P<0,001). It can be concluded that, in spite of recognizing the ACS as a clinical entity, portuguese general surgeons are quite unaware of the WSACS definitions and treatment guidelines, urging the need for its divulgation.
    Acta medica portuguesa 12/2011; 24 Suppl 2:131-6. · 0.36 Impact Factor
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    ABSTRACT: : Early recognition of abdominal compartment syndrome (ACS) is essential, as delay in the diagnosis may induce a negative impact on prognosis. However, there are some evidences suggesting a low level of knowledge concerning ACS in intensive care units (ICU). The aim of this study was to evaluate the intensivist's knowledge on ACS. We distributed 49 questionnaires, with 13 multiple choice questions, in seven ICU, which addressed the concept, diagnosis, and management of ACS. Thirty-two questionnaires were answered. Forty-seven percent of respondents have more than 16 years of medical practice and spend more than 50% of their time in ICU. Although 75% reported having knowledge of ACS' concept, only 34% had measured intra-abdominal pressure (IAP). The most used method for measurements was urinary catheterization (91%). For 37%, the frequency of measurement should be based on clinical data rather than IAP values. Regarding the indication to IAP monitoring, the choices were performing the measurement after urgent laparotomy (25%), in massive volemic replacement (18%) and in other hazardous conditions (57%). The lack of information about measurement techniques was the main reason for not measuring IAP. Most respondents (90%) suggested the measurement of IAP as a routine in ICU. Intensivists' knowledge on ACS was low, as most were not able to measure, interpret the results and recognize important risk factors for IAP. These data demonstrate that educational efforts concerning ACS are necessary in order to standardize the measurement of IAP in populations at risk, aiming at a better outcome in critically ill patients.
    Revista brasileira de anestesiologia 07/2012; 62(4):531-7. DOI:10.1016/S0034-7094(12)70151-4 · 0.51 Impact Factor
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