The American surgeon
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The American surgeon · Jul 2011
ReviewIntra-abdominal hypertension and abdominal compartment syndrome in nontrauma surgical patients.
Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are commonly encountered in nontrauma surgical patients. Depending on the etiology of the patient's surgical illness (ruptured abdominal aortic aneurysm, acute pancreatitis, burns, etc.), both the incidence and mortality of IAH/ACS may be quite high. Recent advances in both the diagnosis and resuscitation of these surgical patients have resulted in significantly improved survival over that seen in years past. Intra-abdominal pressure measurements should be performed in any surgical patient who demonstrates risk factors for IAH/ACS.
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The American surgeon · Jul 2011
ReviewPatient populations at risk for intra-abdominal hypertension and abdominal compartment syndrome.
Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are critical care conditions with significant morbidity and mortality. The surgical measure to treat ACS (decompressive laparotomy) is hazardous and results in an open abdomen with potential major complications such as fistulas, abscesses, and large ventral hernias. ⋯ Knowledge of the patient populations at high risk for developing IAH/ACS is crucial. The aim of this review is to discuss the high-risk populations for acute IAH/ACS among surgical patients.
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The American surgeon · Jul 2011
ReviewIntra-abdominal measurement techniques: is there anything new?
Intra-abdominal pressure (IAP) measurements are essential to the diagnosis and management of intra-abdominal hypertension (IAH) and abdominal compartment syndrome. A variety of IAP measurement techniques have been described. The intravesicular or "bladder" technique remains the gold standard. ⋯ Putting patients in the semirecumbent position changes the IAP measurement significantly. The role of prone positioning in unstable patients with IAH remains unclear. PEEP has a small effect on IAP.
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The American surgeon · Jul 2011
ReviewDefinitions and pathophysiological implications of intra-abdominal hypertension and abdominal compartment syndrome.
For any syndrome or disease process, uniform definitions are essential to facilitate effective clinical communication as well as evaluation of the scientific literature and standardization of research. The following consensus definitions for intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) have been proposed by the World Society of the Abdominal Compartment Syndrome and are now widely accepted around the world. The use of these definitions, and their subsequent revisions as new evidence becomes published, will further improve communication and future research in this area. This review briefly addresses the present definitions as well as the pathophysiological effects of IAH/ACS on end-organ function.
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The American surgeon · Jul 2011
ReviewResuscitation in intra-abdominal hypertension and abdominal compartment syndrome.
Resuscitation and the development of abdominal compartment syndrome (ACS) are closely associated and frequently overlapping critical care topics. Elevated intra-abdominal pressure (IAP) can cause major deterioration of cardiac function by affecting preload, contractility, and afterload. ⋯ Excessive or overzealous resuscitation in an attempt to restore perfusion and correct these organ dysfunctions and failures can worsen elevated IAP and increase the risk of ACS. The aim of this review is to discuss these multilevel interactions between resuscitation and ACS identifying appropriate resuscitative strategies for the patient with elevated IAP.