The American surgeon
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The American surgeon · Jul 2011
Nonoperative management of intra-abdominal hypertension and abdominal compartment syndrome: evolving concepts.
Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are associated with significant morbidity and mortality. Nonoperative medical management strategies play an important role in the current treatment of IAH and ACS. There are five medical treatment options to be considered to reduce elevated intra-abdominal pressure (IAP): 1) improvement of abdominal wall compliance; 2) evacuation of intraluminal contents; 3) evacuation of abdominal fluid collections; 4) optimization of systemic and regional perfusion; and 5) correction of positive fluid balance. Nonsurgical management is an important treatment option in critically ill patients with raised IAP.
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The American surgeon · Jul 2011
Intra-abdominal hypertension and abdominal compartment syndrome: the journey forward.
Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are recognized causes of significant morbidity and mortality among a wide variety of critically ill patient populations. Our understanding of IAH and ACS as causes of organ failure and patient death has increased significantly over the past two decades since their "rediscovery" as clinically important disease processes. The development of consensus definitions and recommendations for the diagnosis and management of IAH/ACS, patient care algorithms, an international clinical research working group, and other educational tools have advanced efforts to improve patient outcome. ⋯ Tremendous progress has been made in recent years with regard to our understanding of the diagnosis and management of IAH and ACS. Within this special supplement of The American Surgeon, you will find a series of "state-of-the-art" reviews authored by a number of the world's experts on IAH/ACS as well as abstracts of research that will be presented at the Fifth World Congress on the Abdominal Compartment Syndrome (Lake Buena Vista, Florida, August 10-13, 2011). This commentary will review where we were, where we are today, and where we are going with respect to the future of IAH and ACS.
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Open abdomen treatment (OAT) is increasingly used, most often to prevent intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) after emergency abdominal surgery. The goal of temporary abdominal closure (TAC) techniques no longer is abdominal coverage alone, but fluid control and facilitation of early fascial closure are now important aspects. ⋯ Mesh-mediated vacuum-assisted wound closure is emerging as one of the most promising approaches for OAT. In the intensive care unit, continued attention to IAH/ACS and measures to prevent or treat these conditions is imperative.
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The American surgeon · Jul 2011
Surgical management of intra-abdominal hypertension and abdominal compartment syndrome.
The initial management of intra-abdominal hypertension (IAH) is medical measures to reduce intra-abdominal pressure (IAP). These, in combination with percutaneous drainage of peritoneal free fluid, may serve to reduce IAH. ⋯ Surgical decompression of IAH associated with acute pancreatitis or secondary abdominal compartment syndrome has other surgical options besides a complete celiotomy. Attention to detail in surgical technique and postoperative care is essential for optimal outcome.
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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.