Prevalence and diagnosis rate of intra-abdominal hypertension in critically ill adult patients: A single-center cross-sectional study / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>To investigate the prevalence and diagnosis rate of intra-abdominal hypertension (IAH) in a mixed-population intensive care unit (ICU), and to investigate the knowledge of ICU staff regarding the guidelines published by the World Society of Abdominal Compartment Syndrome (WSACS) in 2013.</p><p><b>METHODS</b>A one-day cross-sectional study based on the WSACS 2013 guidelines was conducted in the general ICU of a tertiary teaching hospital in Chongqing, China. The included patients were divided into intravesical pressure (IVP) measured group and IVP unmeasured group. The epidemiologic data were recorded, and potential IAH risk factors (RFs) were collected based on the guidelines. IVP measurements were conducted by investigators every 4 h and the result was compared to that measured by the ICU staff to evaluate the diagnosis rate. Besides, a questionnaire was used to investigate the understanding of the guidelines among ICU staff.</p><p><b>RESULTS</b>Thirty-two patients were included, 14 in the IVP measured group and 18 in the IVP unmeasured group. The prevalence of IAH during the survey was 15.63% (5/32), 35.71% (5/14) in IVP measured group. Only one case of IAH had been diagnosed by the ICU physician and the diagnosis rate was as low as 20.00%. Logistic regression analysis showed that sequential organ failure assessment (SOFA) score was an independent RF for IAH (OR: 1.532, 95% CI: 1.029-2.282, p=0.036. Fourteen doctors and 5 nurses were investigated and the response rate was 67.86%. The average scores of the doctors and nurses were 27.14±20.16 and 16.00±8.94 respectively. None of them had studied the WSACS 2013 guidelines thoroughly.</p><p><b>CONCLUSION</b>Patients with a higher SOFA score has a higher incidence of IAH. The IAH prevalence in 14 ICU patients with indwelling catheter was 35.71%. Strengthening the wide and rational use of WSACS guideline is important to improve the diagnosis of IAH.</p>

Abscess formation in vertebral canal and presacral area following penetrating injury of rectum and sacral vertebra by a steel rod / 中华创伤杂志(英文版)

Penetrating injury to the rectum, vertebral body and spinal cord by a steel rod is a rare condition. Treatment of this kind of injury is very challenging. Rectal injury requires repair and fecal diversion, while debridement of the spine is difficult, especially when the injury site is very long. Here we report a case of penetrating injury of rectum and sacral vertebra by a steel rod after falling onto the ground from 1 m height. The abscess cavity was irrigated with 3% hydrogen peroxide and physio-logical saline repeatedly. The bony canal was carefully debrided, curetted and bony fragments were removed. Spinal irrigation and drainage lasted for 2 months and sensitive antibiotic (amikacin sulfate) was given 7 days after surgery, but abscess was still formed in the vertebral canal. At 6-month follow-up, the patient was paralyzed without any neurological improvement, and the pain in low back and lower limb still continued.