Annals of intensive care
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Annals of intensive care · Jul 2012
Intra-abdominal pressure and abdominal perfusion pressure in cirrhotic patients with septic shock.
The importance of intra-abdominal pressure (IAP) and abdominal perfusion pressure (APP) in cirrhotic patients with septic shock is not well studied. We evaluated the relationship between IAP and APP and outcomes of cirrhotic septic patients, and assessed the ability of these measures compared to other common resuscitative endpoints to differentiate survivors from nonsurvivors. ⋯ IAH is highly prevalent in cirrhotic patients with septic shock and is associated with increased ICU morbidity and mortality.
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Annals of intensive care · Jul 2012
Moderate intra-abdominal hypertension is associated with an increased lactate-pyruvate ratio in the rectus abdominis muscle tissue: a pilot study during laparoscopic surgery.
The development of intra-abdominal hypertension [IAH] in critically ill patients admitted to the ICU is an independent predictor of mortality. In an attempt to find an early, clinically relevant metabolic signal of modest IAH, we investigated abdominal wall metabolite concentrations in a small group of patients undergoing laparoscopic surgery. We hypothesized that elevated intra-abdominal pressure [IAP] due to pneumoperitoneum leads to an increased lactate/pyruvate [L/P] ratio in the rectus abdominis muscle [RAM], indicating anaerobic metabolism. ⋯ IAH of 12 to 13 mmHg, even for a relatively short duration, is associated with metabolic changes in the abdominal wall muscle tissue of patients undergoing laparoscopic surgery. We suggest that tissue hypoperfusion occurs even during a modest increase in IAP, and intramuscular metabolic monitoring could therefore serve as an early warning sign of deteriorating tissue perfusion.
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Annals of intensive care · Jul 2012
Incidence and prognosis of intra-abdominal hypertension in critically ill medical patients: a prospective epidemiological study.
The aim of this study was to determine the incidence of intra-abdominal hypertension (IAH) in patients with two or more categorized risk factors (CRF) for IAH, and their morbidity and mortality during their intensive care unit (ICU) stay. ⋯ Critically ill medical patients admitted to ICU with ≥2 CRF have high morbidity, mortality rate, and incidence of IAH, so IAP should be measured and monitored as recommended by the WSACS. Our study highlights the importance of implementing screening and assessment protocols for an early diagnosis of IAH.
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Annals of intensive care · Jul 2012
Intra-abdominal pressure, intra-abdominal hypertension, and pregnancy: a review.
The last several decades have seen many advances in the recognition and prevention of the abdominal compartment syndrome (ACS) and its precursor, intra-abdominal hypertension (IAH). There has also been a relative explosion of knowledge in the critical care, trauma, and surgical populations, and the inception of a society dedicated to its understanding, the World Society of the Abdominal Compartment Syndrome (WSACS). ⋯ This review highlights the importance and relevance of IAP in the critically ill parturient, the current lack of normative IAP values in pregnancy today, along with a review of the potential relationship between IAH and maternal diseases such as preeclampsia-eclampsia and its potential impact on fetal development. Finally, current IAP measurement guidelines are questioned, as they do not take into account the gravid uterus and its mechanical impact on intra-vesicular pressure.
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Annals of intensive care · Jun 2012
Comparison of superior vena cava and femoroiliac vein pressure according to intra-abdominal pressure.
Previous studies have shown a good agreement between central venous pressure (CVP) measurements from catheters placed in superior vena cava and catheters placed in the abdominal cava/common iliac vein. However, the influence of intra-abdominal pressure on such measurements remains unknown. ⋯ We reported that intra-abdominal pressure affected agreement between CVP measurements from catheter placed in superior vena cava and catheters placed in the femoroiliac vein. Agreement was excellent when intra-abdominal pressure was below 14 mmHg.