Presión intraabdominal y ventilación artificial mecánica. Hospital "Arnaldo Milián Castro". 2014-2015 / Intra-abdominal pressure and mechanical artificial ventilation. Arnaldo Milián Castro Hospital. 2014-2015

Introducción: La cavidad abdominal y la caja torácica se encuentran separadas por el diafragma, por lo que las variaciones en las presiones dentro de una, repercuten sobre las presiones de la otra. La hipertensión intraabdominal es hoy una entidad frecuente en el paciente crítico en el que constituye un factor de riesgo importante de complicaciones y mortalidad, ya que influye sobre órganos y sistemas. Objetivo: Relacionar la presión intraabdominal con presiones de la ventilación artificial mecánica y parámetros de la función respiratoria, cardiovascular y renal. Material y Métodos: Se realizó un estudio descriptivo y prospectivo de la presión intraabdominal en pacientes sometidos a ventilación mecánica, con enfermedades clínicas y quirúrgicas, en las Unidades de Cuidados Intensivos del Hospital Clínico Quirúrgico Arnaldo Milán Castro, durante el período comprendido entre enero 2014 hasta diciembre 2015. Resultados: Los pacientes clínicos con presiones de la vía aérea elevadas mostraron valores más altos de presión intraabdominal, y aquellos pacientes postquirúrgicos que cursaron con niveles altos de presión dentro del abdomen también presentaron los valores más elevados de presión pico y media registradas en el ventilador mecánico. Conclusiones: La tensión arterial media, el ritmo diurético y la saturación periférica de oxígeno disminuyeron, mientras que la presión venosa central, la presión parcial de dióxido de carbono en sangre y la creatinina aumentó ante los aumentos de la presión dentro del abdomen(AU)

Introduction: The abdominal cavity and the thoracic cage are separated by the diaphragm; therefore, the variations in the pressures within one of them have an effect on the pressures of the other. At present, intra-abdominal hypertension is a frequent entity in the critically ill patient, which constitutes an important risk factor for complications and mortality since it influences on different organs and systems. Objective: To relate intra-abdominal pressure with mechanical artificial ventilation pressures and parameters of respiratory, cardiovascular and renal function. Material and Methods: A descriptive prospective study of intra-abdominal pressure was conducted in patients undergoing mechanical ventilation with clinical and surgical diseases in the Intensive Care Units of the Arnaldo Milán Castro Hospital, during the period between January 2014 until December 2015. Results: Clinical patients with high values of airway pressures showed higher values of intra-abdominal pressure, and those post-surgical patients who presented with high levels of pressure inside the abdomen indicated the highest values of peak and average pressure recorded in the mechanical ventilator. Conclusions: Mean arterial pressure, diuretic rate and peripheral oxygen saturation decreased, whereas the central venous pressure, the partial pressure of carbon dioxide in blood, and creatinine increased due to raises in pressure within the abdomen(AU)

Injúria renal aguda e hipertensão intra-abdominal em paciente queimado em terapia intensiva / Acute kidney injury and intra-abdominal hypertension in burn patients in intensive care

RESUMO Objetivo: Avaliar a frequência de hipertensão intra-abdominal no paciente grande queimado e sua associação com a ocorrência de injúria renal aguda. Métodos: Estudo de coorte prospectivo, com população de pacientes queimados internados nos leitos de unidade de terapia intensiva especializada. Realizada amostragem de conveniência de pacientes adultos internados no período de 1º de agosto de 2015 a 31 de outubro de 2016. Foram coletados dados clínicos e da queimadura, além de medidas seriadas da pressão intra-abdominal. O nível de significância utilizado foi de 5%. Resultados: Foram analisados 46 pacientes. Evoluíram com hipertensão intra-abdominal 38 pacientes (82,6%). A mediana da maior pressão intra-abdominal foi 15,0mmHg (intervalo interquartílico: 12,0 - 19,0). Desenvolveram injúria renal aguda 32 (69,9%) pacientes. A mediana do tempo para desenvolvimento de injúria renal aguda foi de 3 dias (intervalo interquartílico: 1 - 7). A análise individual de fatores de risco para injúria renal aguda apontou associação com hipertensão intra-abdominal (p = 0,041), uso de glicopeptídeos (p = 0,001), uso de vasopressor (p = 0,001) e uso de ventilação mecânica (p = 0,006). Foi evidenciada associação de injúria renal aguda com maior mortalidade em 30 dias (log-rank, p = 0,009). Conclusão: Ocorreu hipertensão intra-abdominal em grande parte dos pacientes estudados, predominantemente nos graus I e II. Os fatores de risco identificados para ocorrência de injúria renal aguda foram hipertensão intra-abdominal, uso de glicopeptídeos, vasopressor e ventilação mecânica. Injúria renal aguda esteve associada à maior mortalidade em 30 dias.

ABSTRACT Objective: To evaluate the frequency of intra-abdominal hypertension in major burn patients and its association with the occurrence of acute kidney injury. Methods: This was a prospective cohort study of a population of burn patients hospitalized in a specialized intensive care unit. A convenience sample was taken of adult patients hospitalized in the period from 1 August 2015 to 31 October 2016. Clinical and burn data were collected, and serial intra-abdominal pressure measurements taken. The significance level used was 5%. Results: A total of 46 patients were analyzed. Of these, 38 patients developed intra-abdominal hypertension (82.6%). The median increase in intra-abdominal pressure was 15.0mmHg (interquartile range: 12.0 to 19.0). Thirty-two patients (69.9%) developed acute kidney injury. The median time to development of acute kidney injury was 3 days (interquartile range: 1 - 7). The individual analysis of risk factors for acute kidney injury indicated an association with intra-abdominal hypertension (p = 0.041), use of glycopeptides (p = 0.001), use of vasopressors (p = 0.001) and use of mechanical ventilation (p = 0.006). Acute kidney injury was demonstrated to have an association with increased 30-day mortality (log-rank, p = 0.009). Conclusion: Intra-abdominal hypertension occurred in most patients, predominantly in grades I and II. The identified risk factors for the occurrence of acute kidney injury were intra-abdominal hypertension and use of glycopeptides, vasopressors and mechanical ventilation. Acute kidney injury was associated with increased 30-day mortality.

Management of abdominal compartment syndrome after transurethral resection of the prostate / Manejo da síndrome do compartimento abdominal pós-ressecção transuretral de próstata

Acute abdominal compartment syndrome is most commonly associated with blunt abdominal trauma, although it has been seen after ruptured abdominal aortic aneurysm, liver transplantation, pancreatitis, and massive volume resuscitation. Acute abdominal compartment syndrome develops once the intra-abdominal pressure increases to 20-25 mm Hg and is characterized by an increase in airway pressures, inadequate ventilation and oxygenation, altered renal function, and hemodynamic instability. This case report details the development of acute abdominal compartment syndrome during transurethral resection of the prostate with extra- and intraperitoneal bladder rupture under general anesthesia. The first signs of acute abdominal compartment syndrome in this patient were high peak airway pressures and difficulty delivering tidal volumes. Management of the compartment syndrome included re-intubation, emergent exploratory laparotomy, and drainage of irrigation fluid. Difficulty with ventilation should alert the anesthesiologist to consider abdominal compartment syndrome high in the list of differential diagnoses during any endoscopic bladder or bowel case.

A síndrome compartimental abdominal aguda é mais comumente associada a trauma abdominal fechado, embora tenha sido observada após ruptura de aneurisma da aorta abdominal, transplante de fígado, pancreatite e reanimação com volume maciço. A síndrome compartimental abdominal aguda surge quando a pressão intra-abdominal aumenta para 20-25 mm Hg e é caracterizada pelo aumento das pressões das vias aéreas, ventilação e oxigenação inadequadas, função renal alterada e instabilidade hemodinâmica. Este relato de caso descreve o desenvolvimento da síndrome compartimental abdominal aguda durante a ressecção transuretral de próstata com ruptura da bexiga extra e intraperitoneal sob anestesia geral. Os primeiros sinais da síndrome compartimental abdominal aguda nesse paciente eram pressões de pico elevadas das vias aéreas e dificuldade para fornecer volumes correntes. O manejo da síndrome de compartimento inclui reintubação, laparotomia exploratória de emergência e drenagem de líquidos de irrigação. A dificuldade na ventilação deve alertar o anestesiologista para que considere a síndrome compartimental abdominal em primeiro lugar na lista de diagnósticos diferenciais durante qualquer caso de endoscopia de bexiga ou intestino.

Can selection of mechanical ventilation mode prevent increased intra-abdominal pressure in patients admitted to the intensive care unit?

Increased intra-abdominal pressure [IAP] results in dysfunction of vital organs. The aim of the present study was to evaluate the effect of mechanical ventilation mode on IAP. In a cohort study, a total of 60 patients aged 20-70 years who were admitted to the ICU and underwent mechanical ventilation were recruited. Mechanical ventilation included one of the three modes: Biphasic positive airway pressure [BIPAP] group, synchronize intermittent mandatory ventilation [SIMV] group, or continuous positive airway pressure [CPAP] group. For each patient, mechanical ventilation mode and its parameters, blood pressure, SpO2, and status of tube feeding and IAP were recorded. Our findings indicate that the study groups were not significantly different in terms of anthropometric characteristics including age [64.5 +/- 4, P = 0.1], gender [male/female 31/29, P = 0.63], and body mass index [24 +/- 1.2, P = 0.11]. Increase IAP was related to the type of respiratory mode with the more increased IAP observed in SIMV mode, followed by BIPAP and CPAP modes [P = 0.01]. There were significant correlations between increased IAP and respiratory variables including respiratory rate, pressure support ventilation, and inspiratory pressure [P < 0.05]. Tube feeding tolerance through NG-tube was lower in SIMV group, followed by BIPAP and CPAP groups [P < 0.05]. There is a significant relationship between respiratory modes and IAP; therefore, it is better to utilize those types of mechanical ventilation like CPAP and BIPAP mode in patients who are prone to Intra-abdominal hypertension

Intra-Abdominal Pressure in the Early Phase of Severe Acute Pancreatitis: Canary in a Coal Mine? Results from a Rigorous Validation Protocol

BACKGROUND/AIMS: Intra-abdominal hypertension (IAH) is being increasingly reported in patients with severe acute pancreatitis (SAP) with worsened outcomes. The present study was undertaken to evaluate intra-abdominal pressure (IAP) as a marker of severity in the entire spectrum of acute pancreatitis and to ascertain the relationship between IAP and development of complications in patients with SAP. METHODS: IAP was measured via the transvesical route by measurements performed at admission, once after controlling pain and then every 4 hours. Data were collected on the length of the hospital stay, the development of systemic inflammatory response syndrome (SIRS), multiorgan failure, the extent of necrosis, the presence of infection, pleural effusion, and mortality. RESULTS: In total, 40 patients were enrolled and followed up for 30 days. The development of IAH was exclusively associated with SAP with an APACHE II score > or =8 and/or persistent SIRS, identifying all patients who were going to develop abdominal compartment syndrome (ACS). The presence of ACS was associated with a significantly increased extent of pancreatic necrosis, multiple organ failure, and mortality. The mean admission IAP value did not differ significantly from the value obtained after pain control or the maximum IAP measured in the first 5 days. CONCLUSIONS: IAH is reliable marker of severe disease, and patients who manifest organ failure, persistent SIRS, or an Acute Physiology and Chronic health Evaluation II score > or =8 should be offered IAP surveillance. Severe pancreatitis is not a homogenous entity.

Hipertensión intra-abdominal: visión del gastroenterólogo / Intra-abdominal hypertension: perspective of the gastroenterologyst

Elevated intra-abdominal pressure (IAP) has deleterious effects in distant organ function. Sustained increase of IAP is known as intra-abdominal hypertension (IAH) and is associated with significant morbidity and mortality in critically ill patients. The aim of this article is to review basic pathophysiologic and clinical concepts about diagnosis and medical-surgical management of IAH and its most severe expression: the abdominal compartment syndrome, with emphasis on certain conditions as severe acute pancreatitis and end stage liver disease as these commonly associate with IAH.

El aumento de la presión intra-abdominal (PIA) se asocia a una serie de efectos deletéreos en la función de otros sistemas. El aumento sostenido de la PIA se denomina hipertensión intra-abdominal (HTIA) y es una entidad que aumenta la morbi-mortalidad en pacientes graves. La siguiente revisión expone los conceptos fisiopatológicos y clínicos básicos respecto al diagnóstico y manejo médico y quirúrgico de laHTIA y su grado máximo de expresión: el síndrome compartamental del abdomen, con énfasis en ciertas condiciones gastroenterológicas que se acompañan con frecuencia de HTIA como la pancreatitis aguda grave y el daño hepático crónico descompensado.

Value of abdominal pressure measurement in neonatal abdominal surgical emergencies

To assess the predictive and prognostic value of abdominal pressure measurement in neonatal abdominal surgical emergencies. Case series. Zagazig University Hospitals [Egypt] and King Fahd Hospital, Hofuf [KSA]. Seventy nine neonatal abdominal surgical emergencies admitted and managed over a four-year period [Jan 2005 to Jan 2009] Measurement of abdominal pressure through management period. Abdominal pressure was classified into pressure at presentation [T1], preoperative [T2], and postoperative pressure [T3]. The levels of pressure were classified into [pA] below 12 mmHg, [pB] 12-20 mmHg, and [pC] more than 20 mmHg. Seventy-nine neonates were included. There was significant high abdominal pressure in jejunoileal atresia, necrotizing enterocolitis [NEC], and duodenal obstruction. In pyloric stenosis, there was no significant abdominal hypertension all over the management period. Temporary elevations occurred preoperatively [T1] in meconium ileus, cecal perforation, and jejunal stenosis. Significant association was found between [T1] and mortality, postoperative blood transfusion, need for mechanical ventilation, and sepsis. No correlation was found with blood need or sepsis. Postoperative complications had significant association with elevated postoperative abdominal pressure [T3]. Intra-abdominal pressure [IAP] can be of importance in monitoring changes which accompany neonatal surgical emergencies. It can be of predictive and prognostic value in neonatal surgical emergencies. However, more controlled studies are needed to confirm this conclusion

Síndrome compartimental abdominal: atualização / Abdominaol compartment syndrome: update

A síndrome compartimental abdominal (SCA) é um conjunto de alterações fisiopatológicas, principalmente sobre os sistema cardiovascular, respiratório e renal, decorrentes da elevação aguda da pressão intra-abdominal (PIA). Possui como importantes fatores desencadeantes o trauma abdominal, peritonite, pancreatite, transplante hepático, ascite volumosa, laparotomia abreviada e a cirurgia videolaparoscópica. Os autores revisam aspectos atuais acerca da fisiopatologia, etiopatogenia e terapia desta afecção

The abdominal compartment syndrome (ACS) is a group of systemic alterations, mainly on the cardiovascular and respiratory systems, current of the sharp elevation of the intra-abdominal pressure (IAP). Important risk factors are the abdominal trauma, peritonitis, pancreatitis, hepatic transplant, voluminous ascites, abbreviated laparotomy and the videolaparoscopic surgery. Objective: the aim of this paper is to review the main aspects of this affection