The American surgeon
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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
Comparative StudyA critical assessment of outcomes in emergency versus nonemergency general surgery using the American College of Surgeons National Surgical Quality Improvement Program database.
Emergent operations are thought to carry higher morbidity and mortality than nonemergent cases. However, there is a lack of specific outcomes data for emergent general surgery procedures. The objective of our study was to assess and quantify postoperative morbidity and mortality for emergency versus nonemergency general surgery operations. ⋯ General surgery patients who undergo emergent operations have significantly poorer outcomes when compared with nonemergent patients; our analysis has quantified these differences. Emergent patients seem to manifest unique clinical, pathophysiologic, and inflammatory responses to their surgical disease. This data suggests that there is a need for improvement in both methods and systems of care for the emergent population.
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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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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.