Acta Clin Belg
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Abdominal compartment syndrome and intra-abdominal hypertension are frequently associated with peritonitis. The aim of this study is to establish the relationship between intra-abdominal hypertension and intra-abdominal sepsis especially in critically ill patients. ⋯ Intra-abdominal pressure monitoring can be valuable in critically ill patients with suspicion of persisting intra-abdominal sepsis after surgical peritonitis treatment.
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Intra-abdominal hypertension (IAH) and abdominal compartment syndrome are a common occurrence in ICU patients. The deleterious effects of IAH on organ function are well known and increasingly appreciated in recent years, especially where renal and respiratory function are concerned. ⋯ A close relationship between IAP and ICP has been observed in several animal and human studies. The clinical impact of this association is dependent on the baseline ICP and the compensatory reserve of the patient. Some studies have reported good results in treating refractory ICH by abdominal decompression in patients with concomitant IAH. Monitoring of IAP and ICP in risk patients is essential.
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Current treatment of the abdominal compartment syndrome (ACS) is based on consensus definitions but several questions regarding fluid regime or critical level of intra-abdominal hypertension (IAH)) remain unsolved. It is questionable whether these issues can be addressed in prospective randomized trials in the near future. This review aimed to summarize current animal models and to outline requirements for the best model. ⋯ In contrast to IAH or pneumoperitoneum for surgical exposure, ACS in an animal may be stated if an artificially increased IAP leads to circulatory, respiratory and renal insufficiency. A next step in animal research would be the development of a "pathological" model in which haemorrhage or systemic inflammation together with resuscitation lead to abdominal fluid accumulation and increased intra-abdominal pressure.
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Sepsis is a major disease entity with important clinical and economic implications. Sepsis is the hosts' reaction to infection and is characterized by a systemic inflammatory response. Because of difficulties in defining sepsis, the SIRS was introduced trying to summarize the inflammatory response in a limited set of elementary characteristics (fever or hypothermia, leucocytosis or leucopenia, tachycardia, hyperventilation). ⋯ Conclusively, almost all patients admitted to the intensive care unit meet or develop the systemic inflammatory response syndrome. Therefore, it is difficult to distinguish patients with true sepsis from those with severe inflammation due to non-infectious causes. This review highlights the current sepsis definitions, and discusses their strengths as well as their shortcomings for daily intensive care unit practice.
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Autoinflammatory diseases can be specified as inborn errors of the innate immune system. The main component of autoinflammatory diseases is the group of hereditary periodic fevers which are characterised by intermittent bouts of clinical inflammation with focal organ involvement mainly: abdomen, musculoskeletal system and skin. The most frequent one is familial Mediterranean fever that affects patients of Mediterranean descent all over the world. ⋯ A thorough diagnosis is warranted, as clinical and therapeutic management is specific for each of these diseases. In addition to hereditary periodic fever, autoinflammatory diseases also encompass Blau, Majeed, and PAPA syndromes. The underlying genetic defects of these inflammatory diseases appear to be specific for each type, involving several so far unknown proteins involved in innate immunity, and have already opened new avenues in our understanding of the inflammatory response.