Intraabdominal hypertension and Abdominal Compartment Syndrome in patients with COVID-19: an integrative review / Hipertensão Intra-abdominal/Síndrome Compartimental Abdominal em pacientes com COVID-19: uma revisão integrativa

ABSTRACT The first cases of COVID-19 were diagnosed in China, rapidly evolving with worldwide spread, turning into a pandemic. A percentage of these patients develop the severe form of the disease and progress to respiratory distress syndrome, requiring support in Intensive Care Units. Intra-abdominal Hypertension and Abdominal Compartment Syndrome are characterized by increased intra-abdominal pressure, and are subject to several predisposing factors, such as mechanical ventilation assistance, extracorporeal membrane oxygenation, elevated PEEP, intestinal obstructions, excessive fluid replacement, major burns and coagulopathies. Hence, for the management of patients with severe COVID-19, there are numerous risk factors for the development of intra-abdominal hypertension and abdominal compartment syndrome. Therefore, this study proposes to analyze the variables that directly interfere with the increase in intra-abdominal pressure in patients with COVID-19, as well as the changes in the organic systems caused, through an integrative literature review.

RESUMO Os primeiros casos de COVID-19 foram diagnosticados na China, evoluindo rapidamente com uma disseminação a nível mundial, transformando-se em uma pandemia. Uma porcentagem desses pacientes desenvolve a forma grave da doença e evolui com Síndrome do Desconforto Respiratório, necessitando de suporte em Unidades de Terapia Intensiva. A Hipertensão Intra-abdominal e a Síndrome Compartimental Abdominal são caracterizadas pelo aumento da pressão intra-abdominal, e estão sujeitas a diversos fatores predisponentes, como assistência por ventilação mecânica, oxigenação por membrana extracorpórea, PEEP elevada, obstruções intestinais, reposição excessiva de fluidos, grandes queimados e coagulopatias. Com isso, para o manejo dos pacientes com COVID-19 grave, numerosos são os fatores de risco para o desenvolvimento da Hipertensão intraabdominal e da Síndrome Compartimental Abdominal. Por isso, esse estudo se propõe a analisar as variáveis que interferem diretamente no aumento da pressão intra-abdominal em pacientes com COVID-19, assim como as alterações nos sistemas orgânicos provocadas, por meio de uma revisão integrativa da literatura.

Establishment of prediction model for severe acute pancreatitis complicated with abdominal hypertension / 中华胰腺病杂志

Objective:To construct the prediction model of SAP complicated with intra-abdominal hypertension (IAH), and evaluate the prediction efficiency of the model.Methods:The clinical data of 322 SAP patients admitted to the emergency department of Cangzhou Hospital of Integrated Chinese and Western Medicine in Hebei Province from January 2017 to December 2021 were retrospectively analyzed. They were divided into IAH group ( n=153) and control group ( n=169) according to whether they had IAH complications or not. The clinical characteristics and laboratory test results of the two groups were compared. Multifactor logistic step-up regression was used to analyze the risk factors of SAP patients complicated with IAH. A nomogram model for predicting SAP complicated with IAH was established by using R software. The receiver operating characteristic curve (ROC) of the model was plotted, and the area under the curve (AUC) was calculated to evaluate its prediction efficiency. Calibration chart, Hosmer-Lemesshow test and decision curve analysis were used to evaluate the prediction accuracy and clinical application value of the model. The Bootstrap method was applied to verify the model internally. Results:In IAH group, cases with body mass index, CRP, procalcitonin (PCT), WBC, acute physiological and chronic health assessmentⅡ (APACHEⅡ) score, modified CT Severity Index score (MCTSI), incidence of complications (abdominal effusion, abdominal infection, gastrointestinal dysfunction, shock, multiple organ dysfunction syndrome), mechanical ventilation, the number of high-volume fluid reactivation (24 h≥4 L) were more than those in control group; serum albumin and serum calcium in IAH group were lower than those in control group, and the differences were statistically significant (all P value <0.05). Multivariate logistic regression analysis showed that serum albumin ( OR=0.815, 95% CI 0.710-0.937), CRP ( OR=1.005, 95% CI 1.002-1.008), MCTSI ( OR=2.043, 95% CI 1.695-2.463), complication of gastrointestinal dysfunction ( OR=4.179, 95% CI 2.170-8.049), and high-volume fluid resuscitation ( OR=4.265, 95% CI 2.269-8.015) were independent risk factors for IAH in SAP.The Nomogram prediction model was established using the five factors above as parameters, and the AUC value for predicting IAH complication was 0.886. The Hosmer-Lemesshow test showed a high consistency between the prediction results and the actual clinical observation results ( P=0.189). The results of decision curve analysis showed that the prediction probability of the model was between 10% and 85%, which could bring more benefits to patients. Conclusions:The early prediction model of SAP with concurrent IAH is successfully established, which can better predict the risk of SAP with concurrent IAH.

Cambios de la presión intraabdominal en pacientes grandes quemados / Changes of the intra-abdominal pressure in severely burned patients

RESUMEN Introducción: Los cambios de la presión intraabdominal en pacientes grandes quemados influyen en su evolución y se asocia con un mal pronóstico. Objetivo: Determinar los cambios de la presión intraabdominal en pacientes grandes quemados. Métodos: Se realizó un estudio observacional, descriptivo de corte transversal para determinar los cambios de la presión intraabdominal en pacientes grandes quemados, ingresados en el servicio de Cirugía Plástica y Caumatología del Hospital Universitario Manuel Ascunce Domenech de la provincia Camagüey desde enero de 2019 hasta junio de 2021.Se estudiaron 35 pacientes, se utilizaron las variables: presión intraabdominal como variable dependiente y el índice de gravedad, la presencia de quemaduras abdominales, los volúmenes de líquidos administrado y el estado al egreso de los pacientes como variables independientes. Resultados: En los tres grupos con índice pronóstico de muy grave, crítico y crítico extremo la mayoría de los pacientes presentaron niveles de presión intraabdominal grado I. De aquellos pacientes que presentaban más de un cinco por ciento de quemaduras hipodérmicas en el abdomen, 19 presentaron presión intraabdominal grado I. De los 22 pacientes que necesitaron para su reanimación diez o más litros de cristaloides, el 60 % desarrolló algún grado de hipertensión intraabdominal.Del total de la muestra, 18 de los enfermos resultaron fallecidos. Conclusiones: El índice pronóstico, la presencia de quemaduras hipodérmicas en el abdomeny la reanimación con diez o más litro de líquido, influye en los cambios de la presión intraabdominal en estos enfermos. La hipertensión intraabdominal repercute en la mortalidad en los grandes quemados.

ABSTRACT Introduction: The changes of the intra-abdominal pressure in severely burned patients influence their evolution and it has been associated with a bad forecast. Objective: To determine the changes of the intra-abdominal pressure in severely burned patients. Methods: An observational, descriptive cross-section study was carried out to determine the changes of the intra-abdominal pressure in severely burned patients, entered in the service of Plastic Surgery and Caumatology of the University Hospital Manuel Ascunce Domenech of Camagüey province in the period understood from January, 2019 to June, 2021. 35 patients were studied and the following variables were used: intra-abdominal pressure as dependent variable and severity rate, the presence of abdominal burns, the volumes of liquids administered and the state to the expenditure of the patients as independent variables. Results: In the three groups with forecast index of very bad, critic and extreme critic most of the patients presented levels of intra-abdominal pressure degree I. Of those patients that introduced more of one and five percent of hypodermic burns in the abdomen, 19 presented intra-abdominal pressure. Of the 22 patients that needed for their revival ten or more liters of crystalloids, the 60 % developed some degree of intra-abdominal hypertension. Of the total of the sample, 18 of the patients deceased. Conclusions: The forecast index, the presence of hypodermic burns in the abdomen and the revival with ten or more liter of liquid, influence the changes of the intra-abdominal pressure in these patients. The intraabdominal hypertension has influence upon the mortality in the severely burned patients.

Acute Compartment Syndrome exists and can lead to irreversible outcomes if not treated in time / A Síndrome Compartimental Aguda existe e pode conduzir a desfechos irreversíveis se não tratada a tempo

ABSTRACT ACS is a potentially lethal condition caused by any event that produces an increase in IAP, inducing systemic collapse, tissue hypoperfusion and organ dysfunction. Thus, ACS is not exclusively a problem of the traumatic and surgical patient population.Iatrogenic ACS predisposes patients to multiple organ failure if no urgent action is taken.

RESUMO A SCA é uma condição potencialmente letal causada por qualquer evento que produza aumento da PIA induzindo colapso sistêmico, hipoperfusão tecidual e disfunção orgânica. Assim, a SCA não é um problema exclusivamente da população de pacientes traumáticos e cirúrgicos. A SCA iatrogénica predispõe os pacientes à falência de múltiplos órgãos se nenhuma ação urgente for tomada.

Research progress on the relationship between treatment and prognosis of intraperitoneal compartment syndrome in the pediatric intensive care unit / 中华危重病急救医学

Abdominal compartment syndrome (ACS) in children is a neglected complication in the pediatric intensive care unit (PICU) because the onset is insidious. ACS develops rapidly, involves the systemic organs, has a high mortality, and is a very serious complication in PICU. Timely and effective treatment of children with suspected or confirmed ACS is of significance to prevent the progression of the disease, improve prognosis and reduce mortality. However, most clinicians have limited understanding of the treatment measures for children with ACS and are unable to correctly choose appropriate treatment strategies, which affect the prognosis of children. To make the optimal treatment plan for ACS in children, the extent of elevated intra-abdominal pressure, the degree of organ dysfunction and the underlying diseases should be considered comprehensively. Mechanical ventilation, continuous renal replacement therapy (CRRT), and extracorporeal membrane oxygenation (ECMO) have a bidirectional effect on the occurrence and therapeutic effect of ACS. On the one hand, this article reviews the individualized treatment of ACS in PICU, so that more pediatricians could have a comprehensive and clear systematic understanding of the treatment plan of ACS in children. On the other hand, special treatment strategies and prognoses of ACS in PICU were also reviewed in this article, and the effects of intra-abdominal hypertension (IAH) on mechanical ventilation parameters, ECMO, and CRRT were illuminated. As well as the management strategy of mechanical ventilation, CRRT type in ACS children, and the treatment of ACS during ECMO were revealed.

Evidence summary of intra-abdominal pressure-guided enteral nutrition in patients with intra-abdominal hypertension / 中国实用护理杂志

Objective:To retrieve and obtain relevant evidence of intra-abdominal pressure-oriented enteral nutrition assessment and management in patients with intra-abdominal hypertension, in order to provide evidence-based evidence for clinical medical staff to make enteral nutrition-related clinical decisions for patients with intra-abdominal hypertension.Methods:Systematic retrieval of Chinese National Knowledge Infrastructure, Wanfang, Chinese Biomedical Literature, UpToDate, PubMed, Cochrane Library, BMJ Best Practice and other English data, as well as domestic and foreign guidelines such as American Society for Parenteral and Enteral Nutrition, Scottish Intercollegiate Guidelines Network, etc. All evidence available on the Internet in both Chinese and English on intra-abdominal pressure-guided enteral nutrition strategies in adults with intra-abdominal hypertension, study types including clinical decision-making, systematic reviews/meta-analyses, evidence summaries, expert consensus, guidelines or related to the subject of this study closely related high-quality original research. The retrieval time was from the establishment of the database to November 2021. The literature evaluation tool was selected according to the research type. Two researchers trained in the evidence-based system independently evaluate the quality of the included literature, fully considering the clinical situation and expert opinions, and completed the evidence. Extracted and summarized.Results:Totally 13 articles were finally included, including 5 guidelines, 3 expert consensuses, 1 evidence summary and 4 original studies, and 29 evidence-based practice evidence of enteral nutrition in patients with intra-abdominal hypertension were collected, including the monitoring timing of enteral pressure, the pressure of enteral high pressure and the way of enteral nutrition, the pressure measurement of the abdominal cavity, the setting of abdominal pressure, the temperature conditions for early start of enteral nutrition, the selection of enteral pressure, the temperature setting of enteral nutrition nine aspects such as speed and regulation of internal nutrition and abdominal compartment syndrome prevention.Conclusions:This study summarizes the best evidence of intra-abdominal pressure management and enteral nutrition therapy in patients with intra-abdominal hypertension, and provides evidence-based basis for risk management, standardizing clinical practice, and ensuring treatment safety. In the stage of evidence transformation, clinical medical staff need to comprehensively weigh the benefits and risks of early enteral nutrition, and integrate evidence in combination with clinical practical application scenarios, so as to form a standardized early enteral nutrition management plan suitable for patients with intra-abdominal hypertension.

Ultrasound-guided enema for a case of severe acute pancreatitis patient complicated with intra-abdominal hypertension / 中国实用护理杂志

objective:This paper summarizes the nursing care of a case of severe acute pancreatitis complicated with intra-abdominal hypertension by ultrasonic-guided enema.Methods:One patient with severe acute pancreatitis internal high pressure from February 28, 2021 in Shandong Provincial Hospital Affiliated to Shandong First Medical University setting indiidualized enema scheme, advantage of the characteristics of ultrasonic visualization, before and after the enema examine case of intestinal cleaning and waste water accumulation, enema, positioning enemator catheter and cutting-edge position, ensure the accuracy of the enema, normal irrigation using configuration at the same time, the relaxation anal sphincter and so on, to observe the therapeutic effects enema.Results:After careful treatment and nursing, the patient achieved satisfactory results of exhaust and defecation, enema, abdominal distention improved, intra-abdominal pressure returned to normal, 10 days later, the condition was stable and transferred to the general ward.Conclusions:For the nursing of patients with severe acute pancreatitis complicated with intra-abdominal hypertension, it is particularly important to reduce intra-abdominal pressure by enema. Nurses should make reasonable use of new technology to implement individualized enema nursing, promote the excretion of stool, reduce intra-abdominal pressure, and facilitate the early recovery of the disease.

Influence and clinical application of acupuncture therapy on weaning from mechanical ventilation / 国际中医中药杂志

The use of mechanical ventilation is more common in the diagnosis and treatment of clinical critically ill patients. However, in the process of mechanical ventilation, it may be difficult to withdraw from the machine due to various factors other than the primary disease. Among them, intra-abdominal hypertension, accumulation of analgesic and sedative drugs, and weakness of diaphragmatic function are common causes of difficulty in weaning. Acupuncture has obvious efficacy in regulating gastrointestinal function, exerting analgesic and sedative effect and improving muscle weakness. Acupuncture intervention can optimize the scheme of mechanical ventilation weaning, and improve the success rate by correcting different concurrent factors.

A retrospective study of cisatracurium besilate-assisted treatment of severe acute pancreatitis complicated with intraabdominal hypertension / 中华麻醉学杂志

The clinical data of patients with severe acute pancreatitis complicated with intraabdominal hypertension or abdominal compartment syndrome admitted to our Department of Critical Care Medicine from January 1, 2018 to October 1, 2021 were collected and analyzed.Patients were divided into a conventional treatment group and conventional treatment plus IV infusion of cisatracurium besilate group (muscle relaxation group). A prediction model of treatment propensity score was developed for paired screening, with 31 cases in each group.The conventional treatment group adopted conventional basic treatment methods such as gastrointestinal decompression, spasmolysis and analgesia, fluid therapy, inhibition of gastric acid, suppression of parenzyme, nutritional support, mechanical ventilation, and enemata.In muscle relaxation group, cisatracurium besilate was intravenously infused on the basis of routine treatment with the initial dose of 0.15 mg/kg given to facilitate endotracheal intubation, followed by continuous intravenous infusion at 1-3 μg·kg -1·min -1, and the dose was adjusted according to the patient′s basic vital signs and clinical effects.The primary outcome was survival rate.Secondary outcome measures were changes in intraabdominal pressure, oxygenation index, the number of defecation, volume of defecation, and urination volume before treatment and on 7, 14 and 20 days of treatment.and the recovery time of bowel sounds, length of mechanical ventilation, time of intensive care unit treatment, and total hospitalization costs.Compared with conventional treatment group, the survival rate was significantly increased, the intraabdominal pressure was decreased on 7, 14 and 20 days of therapy, the oxygenation index was increased, the number of defecation and volume of defecation were increased on 7 and 14 days of therapy, urinary volume was increased before treatment and on day 7 of therapy, the recovery time of intestinal sound was significantly shortened ( P<0.05), and no significant change was found in urinary volume on days 14 and 20 of therapy, length of ventilation, time of intensive care unit treatment, and total hospitalization costs in muscle relaxation group ( P>0.05). In conclusion, cisatracurium besilate can improve oxygenation, promote the recovery of intestinal function and improve the survival rate when used to assist the treatment in the patients with severe acute pancreatitis complicated with intraabdominal hypertension.

Hemodynamic effects of increased intra-abdominal pressure in critically ill children

Abstract Objective: To evaluate the influence of intra-abdominal pressure on the cardiac index (CI) at different intra-abdominal hypertension grades achieved when performing an abdominal compression maneuver (ACM). Evaluating the effectiveness of the ACM in distending the left internal jugular vein (LIJV). Methods: Prospective observational study conducted in the PICU of a quaternary care teaching hospital. Participants underwent the ACM and the IAP was measured with an indwelling urinary catheter. At each IAH grade reached during the ACM, the CI was measured by transthoracic echocardiography and the LIJV cross-sectional area (CSA) was determined by ultrasonography. Results: Twenty-four children were included (median age and weight of 3.5 months and 6.37 kg, respectively). The median CI observed at baseline and during IAH grades I, II, III, and IV were 3.65 L/min/m2 (IQR 3.12−4.03), 3.38 L/min/m2 (IQR 3.04−3.73), 3.16 L/min/m2 (IQR 2.70−3.53), 2.89 L/min/m2 (IQR 2.38−3.22), and 2.42 L/min/m2 (IQR 1.91−2.79), respectively. A 25% increase in the LIJV CSA area was achieved in 14 participants (58%) during the ACM. Conclusion: The ACM significantly increases IAP, causing severe reversible impairment in the cardiovascular system and is effective in distending the LIJV in just over half of the subjects. Even low levels of HIA can result in significant cardiac dysfunction in children. Therefore, health professionals should be aware of the negative hemodynamic repercussions caused by the increased IAP.

Reinterventions after damage control surgery / Reintervención en cirugía de control de daños

Abstract Damage control has well-defined steps. However, there are still controversies regarding whom, when, and how re-interventions should be performed. This article summarizes the Trauma and Emergency Surgery Group (CTE) Cali-Colombia recommendations about the specific situations concerning second interventions of patients undergoing damage control surgery. We suggest packing as the preferred bleeding control strategy, followed by unpacking within the next 48-72 hours. In addition, a deferred anastomosis is recommended for correction of intestinal lesions, and patients treated with vascular shunts should be re-intervened within 24 hours for definitive management. Furthermore, abdominal or thoracic wall closure should be attempted within eight days. These strategies aim to decrease complications, morbidity, and mortality.

Resumen El control de daños es uno de los pilares de la cirugía de trauma. Sin embargo, la reintervención aún genera controversias en cuanto a quién, cuándo y cómo debe realizarse. El presente artículo presenta las recomendaciones del grupo de Cirugía de Trauma y Emergencias (CTE) de Cali, Colombia, respecto a las reintervenciones después de una cirugía de control de daños. Se recomienda el empaquetamiento como la estrategia de control de sangrado y se debe desempaquetar en un lapso entre 48 y 72 horas. La anastomosis diferida debe ser la opción de reparo en las lesiones intestinales. La reintervención vascular en los pacientes manejados con shunt vascular debe ser antes de las 24 horas para dar el manejo definitivo. En un lapso de 8 días se debe intentar realizar el cierre de la pared abdominal o torácica. Estas estrategias buscan disminuir la frecuencia de complicaciones y de morbimortalidad.

Variaciones de la presión intraabdominal en pacientes sometidas a dermolipectomía / Variations of the intra-abdominal pressure in patients submitted to dermolipectomy

RESUMEN Fundamento: la monitorización de la presión intraabdominal constituye un parámetro importante en las pacientes sometidas a dermolipectomía abdominal. Objetivo: determinar las variaciones de la presión intraabdominal en las pacientes sometidas a dermolipectomía. Métodos: se realizó un estudio descriptivo, de corte transversal para determinar las variaciones de la presión intraabdominal en pacientes sometidas a dermolipectomía; en el servicio de Cirugía Plástica del Hospital Universitario Manuel Ascunce Domenech de la provincia Camagüey en el período comprendido desde enero de 2018 hasta noviembre de 2019. Se estudiaron 22 pacientes en quienes se evaluaron la edad, el tipo de lipodistrofia abdominal, las cifras de PIA, el índice de masa corporal y la cantidad de centímetros plicados en la pared abdominal anterior. Resultados: las pacientes comprendidas en las edades entre 29 y 48 años fueron las que predominaron en el estudio. La mayoría tenían lipodistrofia grado II, 11 pacientes para un 50 %. Las pacientes con sobre peso (10) que fueron la mayoría en el estudio, de ellas seis registraron PIA grado I. La relación entre los diferentes niveles de PIA y la plicatura abdominal en centímetros, de las 14 pacientes que mostraron niveles de PIA grado I, a ocho se le plicó entre ocho y 10 cm y a cuatro de las pacientes 11 cm o más. Conclusiones: la mayoría de las pacientes operadas tenían edades comprendidas entre 29 y 48 años. Existió un predominio de lipodistrofia grado II en las pacientes trastadas. El índice de masa corporal y la cantidad de centímetros plicados de la pared abdominal influyen de manera directa en el incremento de los niveles de PIA.

ABSTRACT Background: the monitoring of the intra-abdominal pressure constitutes an important parameter in the patients submitted to abdominal dermolipectomy. Objective: to determine the variations of the intra-abdominal pressure in the patients submitted to dermolipectomy. Methods: a descriptive, cross-section study to determine the variations of the intra-abdominal pressure in patients submitted to dermolipectomy was carried out; in the service of Plastic Surgery of the Hospital Universitario Manuel Ascunce Domenech of the city of Camagüey in the period understood since January, 2018 to November, 2019. They studied twenty two patients in those who they evaluated the age, the type of abdominal lipodystrophy, the amounts of PIA, the Body Mass Index, and the quantity of plicate centimeters in the previous abdominal wall. Results: the patients understood in the ages between twenty nine to forty eight years were the ones that predominated in this study. The majority had lipodystrophy degree two, 11 patients for a 50 %. The patients with overweight (ten patients) that were the majority in this study, of them six patients registered PIA degree I. The relation between PIA's different levels and the abdominal plication in cm, of the patient fourteen that showed levels of PIA degree I, to eight were reduced between eight ten cm and to four of the patients eleven cm or more. Conclusions: most of the operated patients had ages understood between twenty nine to forty eight years. There was a predominance of lipodystrophy degree two in the treated patients. The Body Mass Index and the quantity of plicate centimeters of the abdominal wall have influence right into the increment of the levels of PIA.

Temporary abdominal closure combined with continuous negative pressure drainage in management of patients with severe pancreatic trauma / 中华肝胆外科杂志

Objective:To study the use of temporary abdominal closure combined with continuous negative pressure drainage in management of patients with severe pancreatic trauma.Methods:A retrospective analysis was conducted on the data of 33 patients with severe pancreatic trauma treated at the 908th Hospital of the Joint Logistics Support Force of PLA from June 2014 to June 2020. There were 28 males and 5 females, with an average age of 43.1 years. Sixteen patients were treated with temporary abdominal closure combined with continuous negative pressure drainage (the combined group), and 17 patients with direct abdominal closure and traditional drainage (the control group). The body temperature, heart rate, intra-abdominal pressure, length of hospital stay and postoperative complications were compared between groups.Results:There was no significant difference in the preoperative intra-abdominal pressure between the two groups ( P>0.05). The intra-abdominal pressure on the first, second and third postoperative days in the combined group were (11.7±2.6) mmHg (1 mmHg=0.133 kpa), (11.1±3.2) mmHg and (10.2±3.7) mmHg respectively, which were significantly lower than those in the control group of (18.1±5.3) mmHg, (15.6±6.2) mmHg, and (15.0±6.7) mmHg, respectively (all P<0.05). The total in-hospital and ICU stays in the combined group were (29.2±17.8) days and (7.1±3.2) days respectively, which were significantly less than those in the control group of (49.5±26.3) days and (11.8±7.6) days (both P<0.05). The decreases in body temperature and heart rate in the combined group were (-0.1±0.9)℃ and (18.2±17.2) times/min respectively, which were significantly more than those in the control group of (-1.2±0.7)℃ and (-5.9±17.2) times/min respectively (both P<0.05). The incidence of postoperative complication in the combined group was 18.8% (3/16), which was significantly lower than that in the control group of 52.9% (9/17)(χ 2=4.164, P=0.041). Conclusion:Significant advantages were obtained by using temporary abdominal closure combined with continuous negative pressure drainage to treat patients with severe pancreatic trauma. There were significantly lower abdominal pressure, less abdominal complications, and shorter hospital and ICU stays. This treatment is worthy of promotion in management of patients with severe pancreatic trauma.

Hipertensão intra-abdominal e síndrome compartimental abdominal: repercussões e tratamento clínico no paciente crítico / Intra-abdominal hypertension and abdominal compartment syndrome: repercussions and clinical treatment in critically ill patients

A hipertensão intra-abdominal e a síndrome compartimental abdominal foram durante muitas décadas mal compreendidas e dissociadas de suas repercussões clínicas. Trata-se de um distúrbio que pode levar à disfunção de múltiplos órgãos devido ao desequilíbrio circulatório desencadeado pelo aumento de pressão no compartimento abdominal. As manifestações envolvem os sistemas cardiovascular, respiratório, renal, nervoso e gastrintestinal e estão largamente relacionadas com o fator de morbimortalidade no paciente crítico. A despeito da importância clínica, a hipertensão intra-abdominal e à síndrome compartimental abdominal ainda são temas pouco dominados pelos médicos, e fazem-se necessários o reconhecimento precoce e o estabelecimento de estratégias clínicas objetivas no contexto de uma síndrome com desfecho tão desfavorável. Portanto, foi realizada uma revisão da literatura não sistematizada com objetivo de compreender os principais pontos sobre definições, prevalência, fatores de risco, fisiopatologia, diagnóstico e tratamento acerca da hipertensão intra-abdominal e a síndrome compartimental abdominal.

Intra-abdominal hypertension and abdominal compartment syndrome have been, for many decades, poorly understood and dissociated from their clinical repercussions. It is a disorder that can lead to organ dysfunction due to circulatory impairment triggered by increased pressure in the abdominal compartment. The manifestations involve cardiovascular, respiratory, renal, nervous, and gastrointestinal systems, and are widely associated with significant morbidity and mortality in critically ill patients. Despite their clinical importance, intra-abdominal hypertension and abdominal compartment syndrome are still not sufficiently known by physicians and, early recognition and the establishment of objective clinical strategies for managing these highly morbid syndromes are required. Therefore, a non-systematized review was carried out to understand the main points about definitions, prevalence, risk factors, pathophysiology, diagnosis, and treatment of intra-abdominal hypertension and abdominal compartment syndrome.

Síndrome compartimental abdominal / Abdominal compartment syndrome

Resumen El síndrome compartimental abdominal (SCA) se define como la disfunción orgánica causada por la hipertensión intraabdominal (HIA). Ambas son complicaciones frecuentes en pacientes graves ingresados en las unidades de cuidados intensivos (UCI). Las manifestaciones clínicas asociadas suelen ser inespecíficas, por lo que dichas entidades deben ser sospechadas ante pacientes críticos con factores de riesgo. El diagnóstico de la HIA se realiza midiendo de forma indirecta la presión intraabdominal (PIA), generalmente por medio de una sonda vesical. El tratamiento consiste en medidas de soporte, y en algunos casos es necesaria la descompresión abdominal quirúrgica. En esta revisión se presenta la fisiopatología de ambas entidades, así como el enfoque diagnóstico y terapéutico.

Abstract Abdominal compartment syndrome (ACS) is defined as an organ dysfunction caused by intra-abdominal hypertension (IAH). Both are common complications in severe patients admitted to intensive care units. The associated clinical manifestations are usually non-specific and, therefore, such entities should be suspected in critical patients with risk factors. The diagnosis of IAH is made by indirectly measuring intrabdominal pressure, usually by means of a urinary catheter. Treatment consists of supportive measures and, in some cases, surgical abdominal decompression. In this review the physiopathology of both entities is described, as well as the diagnostic and therapeutic approach.

Prevalence and Correlation of Intra-abdominal Hypertension with Incidence of Acute Kidney Injury in ICU Patients: A Cohort Study from A Tertiary Care Centre

Introduction: Intra-abdominal hypertension (IAH), asustained and repeated steady state rise in intra-abdominalpressure (IAP) above 12 mmHg, was reported as a hiddencause contributing to morbidity and mortality in criticallyill patients. This study was aimed to find out the possiblerelationship between IAH and acute kidney injury (AKI) inICU patients.Material and methods: Prospective cohort study wasconducted among patients admitted in medical and surgicalICU. Consecutive patients coming under the inclusioncriteria were selected and IAH was measured using pressuretransducer technique. IAP was measured at the time ofadmission, at 24 hours, 48hours and also at the end of 72hours.Other parameters were collected based on a standard proformaprepared.Results: Eighty patients were included in our study, of which24 patients had IAH. Mean age in patients with IAH wasobtained as 63.08 ± 12.37 years with a male predominance.Maximum patients were belonging to age group of 61-70yrs (25%), 9 patients were below 40 yrs and 14 patientswere above 81yrs. Mean IAP was calculated to be 11.65 ±3.15. Only 9 patients were in grade IV (11.3%). Risk factorsassociated were found to be ascites, upper GI bleed andmetabolic encephalopathy. IAH and AKI were found to besignificantly correlated (odds ratio=2.666 with CI 0.98-7.25).Conclusion: Rising intra-abdominal pressure is found to havehigher incidence of renal failure than those with establishedIAH. IAH has been found to be a clinically significant riskfactor for development of AKI in ICU patients.

Protocolos para diagnóstico e manejo da hipertensão intra-abdominal em centros de tratamento intensivo / Protocols for diagnosis and management of intra-abdominal hypertension in intensive care units

RESUMO Objetivo: A hipertensão intra-abdominal (HIA) é uma condição mórbida comum em pacientes críticos. A síndrome compartimental abdominal (SCA) é condição grave de tratamento cirúrgico que ocorre como evolução da HIA não diagnosticada e não tratada. O objetivo deste trabalho é disseminar evidências e propor protocolos de rastreio e condutas em casos de HIA e SCA para centros de terapia intensiva (CTI) Métodos: Foram realizadas buscas sobre o tema nas principais bases de dados e utilizadas as evidências e protocolos recomendadas pela World Society of the Abdominal Compartment Syndrome. Resultados: Apresentamos protocolos sobre investigação, aferição, manejo e controle da HIA, adequadas à realidade brasileira. Conclusão: Neste trabalho, apresentamos em detalhes os principais fatos e evidências sobre o manejo em casos de suspeita de HIA e como aferir a pressão intra-abdominal (PIA), de forma simples e reproduzível para qualquer CTI do nosso país.

ABSTRACT Objectives: Intra-abdominal hypertension (IAH) is a common morbid condition in critically ill patients. Abdominal compartment syndrome (ACS) is a severe condition that requires surgical treatment, and it is an evolution of undiagnosed and untreated IAH. This study aims to highlight the importance of clinical evidence, and proposes screening as well as medical protocols for IAH and ACS, in intensive care units. Methods: Database searches were performed and the recommended World Society of the Abdominal Compartment Syndrome standards and protocols were used. Results: Protocols for IAH and ACS investigation, measurements, management and control, tailored for the Brazilian ICU reality, were indicated. Conclusion: We extensively detailed IAH medical evidence, using the most up-to-date literature about IAH care and how to measure intra-abdominal pressure (IAP), which can be easily reproduced in any intensive care unit.

Síndrome compartimental abdominal en el paciente pediátrico: una revisión de la literatura / Abdominal compartment syndrome in the pediatric patient: a review of the literature

Resumen El presente artículo tiene como finalidad realizar una revisión bibliográfica acerca del síndrome compartimental abdominal en el paciente pediátrico, para actualizar a la población médica general respecto al tema en cuestión; debido a que no hay actualmente estudios de peso estadístico en cuanto a la patología; además, no hay estudios recientes a nivel nacional. El síndrome compartimental abdominal es una condición clínica seria, que presenta una mortalidad elevada sobre todo en la población pediátrica. El desconocimiento de la patología es el principal factor determinante en la mortalidad; ya que, es fundamental la sospecha médica oportuna para inicio de medidas terapéuticas evitando disfunción orgánica y muerte. Por lo tanto, en el siguiente trabajo, se desarrollarán los puntos fundamentales sobre su incidencia, presentación clínica, factores de riesgo, fisiopatología, abordaje diagnóstico y los distintos abordajes terapéuticos, tanto médicos como quirúrgicos; así como, complicaciones y pronósticos. Sin olvidar el punto clave que es conocer la técnica para la medición de la presión intraabdominal, lo que posibilita la detección precoz de complicaciones y consecuentemente, un accionar terapéutico oportuno.

Abstract The purpose of this article is to carry out a bibliographic review about abdominal compartment syndrome in the pediatric patient, to update the medical population about this topic, because currently there are no studies with enough statistical weight about this pathology. Furthermore, there aren´t recent studies at the national level. Abdominal compartment syndrome is a serious clinical condition that has an elevated mortality rate, especially in the pediatric population. The ignorance of the pathology it is the main determining factor in mortality because it is fundamentally the timely medical suspicion to start therapeutic measures avoiding organ dysfunction and death. Therefore, in the following work, the fundamental points will be developed about its incidence, clinical presentation, risk factors, pathophysiology, diagnosis, approach and the different therapeutic approaches medical and surgical as well as complications and prognosis. Without forgetting the key point which is knowing the technique for the measurement of intra abdominal pressure, which will allow the early detection of complications and consequently, a timely therapeutic action.

Pancreatitis aguda: fisiopatología y manejo inicial / Acute pancreatitis: pathophysiology and initial management

Resumen La pancreatitis aguda es un trastorno intracelular del calcio en las células pancreáticas, el cual constituye la vía final común de múltiples estímulos etiopatogénicos y puede desencadenar cambios necroinflamatorios locales, efectos multisistémicos y compromiso en órganos distantes. Todo esto lleva a los pacientes a múltiples complicaciones por disfunción orgánica e infección. El diagnóstico adecuado y oportuno, el abordaje según severidad y la optimización de la terapia nutricional, así como una adecuada analgésica, reanimación hídroelectrolítica, detección de disfunción orgánica y de complicaciones locales e infecciosas, determinan el desenlace clínico de dicha patología. Se realizó una revisión narrativa incluyendo estudios clínicos, guías de manejo, protocolos y revisiones pertinentes, y se aporta un enfoque desde el punto de vista de medicina crítica para el abordaje inicial de esta patología.

Abstract Acute pancreatitis is an intracellular calcium disorder in pancreatic cells, which constitutes the final common pathway of multiple etiopathogenic stimuli and can trigger local necroinflammatory changes, multisystemic effects and compromise distant organs. All of this leads to multiple complications due to organ dysfunction and infection in patients. The adequate and opportune diagnosis, the approach according to severity and the optimization of the nutritional therapy; as well as an adequate analgesic, hydroelectrolytic resuscitation, the detection of organic dysfunction and of local and infectious complications, determine the clinical outcome of this pathology. A narrative review was carried out including clinical studies, management guidelines, protocols and reviews. An initial approach for this pathology, from the critical medicine point of view, is provided.

Progress in surgical treatment for severe acute pancreatitis complicated with abdominal compartment syndrome / 国际外科学杂志

Acute pancreatitis is a clinically common acute abdomen, mild acute pancreatitis is a self-limiting disease, while severe acute pancreatitis (SAP) requires multidisciplinary treatment and the mortality rate remains high. A special complication of SAP is intra-abdominal hypertension, as the disease progresses, the intra-abdominal pressure is further increased, leading to abdominal compartment syndrome (ACS), which eventually leads to multiple organ dysfunction syndrome. This current surgical intervention for SAP combined with ACS has gradually replaced the conventional medical treatment program. This article reviews the various options for surgical treatment of SAP with ACS.