Intra-abdominal hypertension and abdominal compartment syndrome in burns, obesity, pregnancy, and general medicine
| Autor: | Rao R. Ivatury, Jun Oda, Derek J. Roberts, Andrew W. Kirkpatrick, Jan J. De Waele, Bart De Keulenaer, Manu L N G Malbrain, Edward J. Kimball, Inneke De Laet |
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| Přispěvatelé: | Supporting clinical sciences, Intensive Care |
| Jazyk: | angličtina |
| Rok vydání: | 2015 |
| Předmět: |
medicine.medical_specialty
obesity Abdominal compartment syndrome END-EXPIRATORY PRESSURE INTRACRANIAL-PRESSURE medicine.medical_treatment Review Critical Care and Intensive Care Medicine Preeclampsia Sepsis abdominal hypertension burns Hepatorenal syndrome DECOMPENSATED HEART-FAILURE medicine Medicine and Health Sciences Humans PERITONEAL-DIALYSIS PATIENTS Intensive care medicine Medicine(all) Eclampsia obstetrics business.industry Research Support Non-U.S. Gov't Organ dysfunction gynecology General Medicine medicine.disease BODY-MASS HEPATORENAL-SYNDROME specific conditions Pregnancy Complications abdominal compartment syndrome CONTRACTILE PROPERTIES internal medicine INTERNATIONAL-CONFERENCE Anesthesiology and Pain Medicine PSEUDOTUMOR CEREBRI OBESITY Escharotomy Female pregnancy Intra-Abdominal Hypertension medicine.symptom business OVARIAN HYPERSTIMULATION SYNDROME |
| Zdroj: | ANAESTHESIOLOGY INTENSIVE THERAPY |
| ISSN: | 1642-5758 |
| Popis: | Intra-abdominal hypertension (IAH) is an important contributor to early organ dysfunction in trauma and sepsis. However, relatively little is known about the impact of intra-abdominal pressure (IAP) in general internal medicine, pregnant patients, and those with obesity or burns. The aim of this paper is to review the pathophysiologic implications and treatment options for IAH in these specific situations. A MEDLINE and PubMed search was performed and the resulting body-of-evidence included in the current review on the basis of relevance and scientific merit. There is increasing awareness of the role of IAH in different clinical situations. Specifically, IAH will develop in most (if not all) severely burned patients, and may contribute to early mortality. One should avoid over-resuscitation of these patients with large volumes of fluids, especially crystalloids. Acute elevations in IAP have similar effects in obese patients compared to non-obese patients, but the threshold IAP associated with organ dysfunction may be higher. Chronic elevations in IAP may, in part, be responsible for the pathogenesis of obesity-related co-morbid conditions such as hypertension, pseudotumor cerebri, pulmonary dysfunction, gastroesophageal reflux disease, and abdominal wall hernias. At the bedside, measuring IAP and considering IAH in all critical maternal conditions is essential, especially in preeclampsia/eclampsia where some have hypothesized that IAH may have an additional role. IAH in pregnancy must take into account the precautions for aorto-caval compression and has been associated with ovarian hyperstimulation syndrome. Recently, IAP has been associated with the cardiorenal dilemma and hepatorenal syndrome, and this has led to the recognition of the polycompartment syndrome. In conclusion, IAH and ACS have been associated with several patient populations beyond the classical ICU, surgical, and trauma patients. In all at risk conditions the focus should be on the early recognition of IAH and prevention of ACS. Patients at risk for IAH should be identified early through measurements of IAP. Appropriate actions should be taken when IAP increases above 15 mm Hg, especially if pressures reach above 20 mm Hg with new onset organ failure. Although non-operative measures come first, surgical decompression must not be delayed if these fail. Percutaneous drainage of ascites is a simple and potentially effective tool to reduce IAP if organ dysfunction develops, especially in burn patients. Escharotomy may also dramatically reduce IAP in the case of abdominal burns. |
| Databáze: | OpenAIRE |
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