The American surgeon
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The American surgeon · Aug 2011
Comparative StudyErrors in administrative-reported ventilator-associated pneumonia rates: are never events really so?
Ventilator-associated pneumonia (VAP) is a common problem in an intensive care unit (ICU), although the incidence is not well established. This study aims to compare the VAP incidence as determined by the treating surgical intensivist with that detected by the hospital Infection Control Service (ICS). Trauma and surgical patients admitted to the surgical critical care service were prospectively evaluated for VAP during a 5-month time period. ⋯ When compared with BAL, SIS-VAP had 61.3 per cent sensitivity and ICS-VAP had 29 per cent sensitivity. VAP rates reported by hospital administrative sources are significantly less accurate than physician-reported rates and dramatically underestimate the incidence of VAP. Proclaiming VAP as a never event for critically ill for surgical and trauma patients appears to be a fallacy.
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Cardiopulmonary dysfunction and failure are commonly encountered in the patient with intra-abdominal hypertension (IAH) or abdominal compartment syndrome. Accurate assessment and optimization of preload, contractility, and afterload in conjunction with appropriate goal-directed resuscitation and assessment of fluid responsiveness are essential to restore end-organ perfusion. In patients with IAH, the traditional "barometric" preload indicators such as pulmonary artery occlusion pressure and central venous pressure are erroneously increased. ⋯ IAH also markedly affects the mechanical properties of the chest wall and consequently also the respiratory function. Altered mechanical properties of the chest wall may limit ventilation, influence the work of breathing, affect the interaction between the respiratory muscles, hasten the development of respiratory failure, and interfere with gas exchange. Pulmonary monitoring is important to understand the relationships between intra-abdominal pressure and chest wall mechanics and the impact of IAH on ventilator-induced lung injury, lung distention, recruitment, and lung edema.
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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
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.