The American surgeon
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The American surgeon · Jul 2011
Comparative StudyPredictors and outcomes of prolonged ventilation after coronary artery bypass graft surgery.
This study investigated and compared the risk factors and outcomes of patients undergoing coronary artery bypass graft surgery with and without the occurrence of prolonged mechanical ventilation. Data in a cardiac surgery database were examined retrospectively. Data selected included any isolated coronary artery bypass graft surgery performed by the surgical group from August 2005 to June 2009. ⋯ Patients undergoing coronary artery bypass graft that experienced a prolonged ventilation time (cases) were more likely female, had a New York Hospital Association functional class of III or IV, and had a longer perfusion time. There was no significant difference between cases and controls with diabetes, chronic obstructive pulmonary disease, left ventricular ejection fraction, or body mass index while controlling for all significant risk factors. Careful patient selection and preparation during preoperative evaluation may help identify patients at risk for prolonged mechanical ventilation and thus help prevent the added morbidity and mortality associated with it.
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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
ReviewIntra-abdominal hypertension and abdominal compartment syndrome in the medical patient.
Critically ill medical patients are at significant risk for developing intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS). Although surgical IAH/ACS is commonly acute and dramatic in onset, medical IAH/ACS is more slow and insidious in its development but no less deadly. ⋯ A variety of effective medical management strategies for reducing elevated intra-abdominal pressure (IAP), coupled with early abdominal decompression when necessary, has been demonstrated to significantly improve patient survival from IAH/ACS. Serial IAP measurements, increased collaboration between surgeon and nonsurgeon, institution of medical management strategies, and early abdominal decompression for refractory IAH/ACS will lead to decreased rates of organ failure and improved survival for medical patients who develop IAH/ACS.