Acute intestinal distress syndrome: the importance of intra-abdominal pressure.

Intensive Care Unit, Ziekenhuis Netwerk Antwerpen, Antwerpen, Belgium.
Minerva anestesiologica (Impact Factor: 2.27). 11/2008; 74(11):657-73.
Source: PubMed

ABSTRACT This review article will focus primarily on the recent literature on abdominal compartment syndrome (ACS) as well as the definitions and recommendations published by the World Society for the Abdominal Compartment Syndrome (WSACS, The risk factors for intra-abdominal hypertension (IAH) and the definitions regarding increased intra-abdominal pressure (IAP) will be listed, followed by a brief but comprehensive overview of the different mechanisms of end-organ dysfunction associated with IAH. Measurement techniques for IAP will be discussed, as well as recommendations for organ function support in patients with IAH. Finally, noninvasive medical management options for IAH, surgical treatment for ACS and management of the open abdomen will be briefly discussed.

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    ABSTRACT: A compartment syndrome is defined as an increase in the compartmental pressure to such an extent that the viability of the tissues and organs within the compartment are threatened. The term describes a syndrome and not a disease, and as such there are many diseases and underlying pathophysiological processes that may lead to such a scenario. The aim of this review is to give a state-of-the-art overview on the current knowledge on different compartment syndromes and how they may interact. Suggested definitions are included. There are four major compartments in the human body: the head, chest, abdomen, and the extremities. Initially, the term multicompartment syndrome was suggested when more than one compartment was affected. But this led to confusion as the term multi- or multiple compartment syndromes is mostly used in relation to multiple limb trauma leading to compartment syndrome requiring fasciotomy. Only recently was the term 'polycompartment syndrome' coined to describe a condition where two or more anatomical compartments have elevated pressures. When more than one compartment is affected, an exponential detrimental effect on end-organ function to both immediate and distant organs can occur. Within each compartment, the disease leading towards a compartment syndrome can be primary or secondary. The compliance of each compartment is the key to determining the transmission of a given compartmental pressure from one compartment to another. The intra-abdominal pressure helps to explain the severe pathophysiological condition occurring in patients with cardiorenal, hepatopulmonary and hepatorenal syndromes. Initial treatment of a compartment syndrome should be focused on the primary compartment and is based on three principles: lowering of compartmental pressure, supporting organ perfusion, and optimisation and prevention of specific adverse events. Clinicians need to be aware of the existence of the polycompartment syndrome and the interactions of increased compartmental pressures between compartments.
    11/2014; 46(5):433-50. DOI:10.5603/AIT.2014.0064
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    ABSTRACT: A constipação intestinal é uma complicação comumente identificada entre pacientes graves. Sua incidência é bastante variável devido à carência de uma definição aplicável a estes pacientes. Além das consequências já conhecidas da constipação, nos últimos anos tem-se percebido que essa complicação também pode estar relacionada ao pior prognóstico de pacientes críticos. Ao longo desta revisão procurou-se descrever as principais evidências científicas disponíveis mostrando ser a constipação um marcador prognóstico e uma das representações clínicas da disfunção intestinal, além da possibilidade de interferir no prognóstico com o tratamento. Revisou-se também a síndrome de Ogilvie, importante causa de morbidade e mortalidade nas unidades de terapia intensiva. Conclui-se, por todo o exposto, ser necessária mais atenção a esse distúrbio nas unidades de terapia intensiva, com elaboração de protocolos de diagnóstico e manejo em pacientes graves.
    Revista Brasileira de Terapia Intensiva 08/2009; 21(3):324-331.
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    ABSTRACT: Objective-To assess effects of body position on direct measurements of intra-abdominal pressure (IAP) and abdominal perfusion pressure (APP) in horses anesthetized with total intravenous anesthesia (TIVA). Animals-9 healthy adult horses. Procedures-Instrumentation in unsedated standing horses involved insertion of an arterial catheter for blood pressure measurements and 3 intraperitoneal cannulas (left flank, right flank, and ventral abdomen) for IAP measurements. Baseline values were measured for heart rate, respiratory rate, systolic arterial blood pressure, mean arterial blood pressure (MAP), diastolic arterial blood pressure, and IAP. Horses were medicated with xylazine, and pressures were measured again. Anesthesia was induced with ketamine-diazepam and maintained with a ketamine-guaifenesin infusion. Horses were positioned twice into left lateral recumbency, right lateral recumbency, or dorsal recumbency. Hemodynamic pressures and accessible abdominal pressures were measured for each recumbency position. The APP was calculated as MAP - IAP. Differences in IAP, MAP, APP and sedation (standing horses) or body position (anesthetized horses) were compared by means of repeated-measures ANOVA or paired t tests. Results-Baseline hemodynamic and IAPs were not different after xylazine administration. Ventral abdomen IAP and MAP were lower for horses in dorsal recumbency than in right or left lateral recumbency. Ventral abdomen APP remained unchanged. For lateral recumbencies, flank IAP was lower and APP was higher than pressure measurements at the same sites during dorsal recumbency. Conclusions and Clinical Relevance-Body position affected IAP and APP in healthy anesthetized horses. These effects should be considered when developing IAP acquisition methods for use in horses with abdominal disease.
    American Journal of Veterinary Research 03/2014; 75(3):301-8. DOI:10.2460/ajvr.75.3.301 · 1.21 Impact Factor


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Dec 15, 2014