Langenbeck's archives of surgery
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Langenbecks Arch Surg · Nov 2008
ReviewCurrent insights in intra-abdominal hypertension and abdominal compartment syndrome: open the abdomen and keep it open!
The abdominal compartment syndrome (ACS) is associated with organ dysfunction and mortality in critically ill patients. Furthermore, the deleterious effects of increased IAP have been shown to occur at levels of intra-abdominal pressure (IAP) previously deemed to be safe. The aim of this article is to provide an overview of all aspects of this underrecognized pathological syndrome for surgeons. ⋯ The ACS was first described in surgical patients with abdominal trauma, bleeding, or infection, but in recent years ACS has also been described in patients with other pathologies such as burn injury and sepsis. Some of these so-called nonsurgical patients will require surgery to treat their ACS. This review article is intended to provide surgeons with a clear insight into the current state of knowledge regarding IAH, ACS, and the impact of IAP on the critically ill patient.
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Langenbecks Arch Surg · Nov 2008
ReviewClinical sepsis and septic shock--definition, diagnosis and management principles.
Sepsis remains a common problem in critically ill patients. ⋯ Considerable advances have been made in our understanding of the pathophysiology of sepsis and recent years have seen a surge of potential new therapeutic agents for sepsis. Definitions have been rethought and strategies proposed to better characterise patients with sepsis as the importance of individually targeted treatment packages has been realised. Current management aims to control infection, to achieve haemodynamic stabilisation, to modulate the immune response and to provide metabolic and organ support. As new therapies are introduced, treatment recommendations will need to be adapted accordingly.
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Langenbecks Arch Surg · Nov 2008
ReviewHealth services research in surgery--definitions, approaches and methods.
Health services research (HSR) investigates the translation of clinical studies into the practice of health care in relation to quality and efficiency from the individual and socioeconomic perspective. Given the fact that HSR has become increasingly popular during the last decade, this article aims at providing an overview of the significance and benefit of HSR in general and especially in the field of surgery. ⋯ This overview shows that HSR is by now regarded as an essential field, at least in developed countries, and that we are just at the beginning to understand why demonstrated effective strategies in the clinical context do not or rarely translate into routine patient's care.
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Multiple injury results in a complex pathophysiological and immunological response. Depending on the individual injury pattern, the time elapsed after injury, and the systemic "danger response", the surgical treatment has to be modified. ⋯ Individually adjusted surgical "damage control" and "immune control" are important interactive concepts in polytrauma management.