Acta Clin Belg
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Up to a little while ago there was no uniform definition for acute kidney injury (AKI). Recently, the Acute Dialysis Quality Initiative proposed the RIFLE consensus classification for AKI. This classification was adapted and modified by the Acute Kidney Injury Network into the AKI staging system. ⋯ The prognosis of patients with AKI treated with RRT is still dim, with mortality rates between 50% and 60%. It is important to know that AKI is not only a consequence of severe disease, but also contributes to its worse outcome. Severe AKI, and less severe AKI, as defined by the AKI classification, have an independent association with mortality.
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Cardiovascular dysfunction and failure are commonly encountered in the patient with intraabdominal hypertension or abdominal compartment syndrome. Accurate assessment and optimization of preload, contractility, and afterload, in conjunction with appropriate goal-directed resuscitation and abdominal decompression when indicated, are essential to restoring end-organ perfusion and maximizing patient survival. The validity of traditional hemodynamic resuscitation endpoints, such as pulmonary artery occlusion pressure and central venous pressure, must be reconsidered in the patient with intra-abdominal hypertension as these pressure-based estimates of intravascular volume have significant limitations in patients with elevated intra-abdominal pressure. ⋯ Volumetric monitoring techniques have been proven to be superior to traditional intra-cardiac filling pressures in directing the appropriate resuscitation of this patient population. Calculation of the "abdominal perfusion pressure", defined as mean arterial pressure minus intra-abdominal pressure, has been shown to be a beneficial resuscitation endpoint as it assesses not only the severity of the patient's intra-abdominal hypertension, but also the adequacy of abdominal blood flow. Application of a goal-directed resuscitation strategy, including abdominal decompression when indicated, improves cardiac function, reverses end-organ failure, and minimizes intra-abdominal hypertension-related patient morbidity and mortality.
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Since the second World Congress on the Abdominal Compartment Syndrome (WCACS) in Noosa 2 years ago, interest and publications on intra-abdominal hypertension (IAH) and ACS have increased exponentially. This paper aimed to critically review recent publications and put this new data into the context of already acquired knowledge concerning IAH/ACS. ⋯ After publication of consensus guidelines on IAH/ACS, there is an urgent need for human intervention studies and, in parallel, clinically relevant animal models. Given moderately low incidence of ACS and the complex and interrelated pathologies of the critically ill patient with IAH/ACS, large animal models of pathology-induced IAH/ACS might create the opportunity to gain clinically relevant knowledge on the treatment of IAH/ACS.
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Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) can develop within 12 hours of ICU admission in high-risk patients. Until recently the intermittent intra-abdominal pressure (IAP) measurement via the urinary catheter was the clinical standard. This is a relatively labour intensive technique and its intermittent nature could prevent timely recognition of significant changes in IAP. The historical continuous IAP (CIAP) measurements were poorly reproducible (gastric route) or invasive/impractical (direct measurement). The aim of this paper is to review the current evidence on CIAP monitoring. ⋯ Until a better technique is available the CIAP monitoring via the bladder or stomach should be considered as the standard for continuous monitoring of the IAP. It is a less labour intensive, safe, less invasive and reliable method.
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There has been an exponentially increasing interest in intra-abdominal hypertension (IAH). The intra-abdominal pressure (IAP) markedly affects the function of the respiratory system. ⋯ Increased IAP markedly affects respiratory function in such a way that it has an impact on daily clinical practise.