Identification, management and complications of intra-abdominal hypertension and abdominal compartment syndrome in neonatal intensive care unit (a single centre retrospective analysis).

The abdominal compartment syndrome (ACS) is a result of increased intra-abdominal pressure (IAP) due to tissue edema or free fluid collecting in the abdominal cavity. Elevated pressure in the abdomen is referred to as intra-abdominal hypertension (IAH). The end result of ACS, if undetected and untreated, is multisystem organ failure and patient death. Intra-abdominal pressure monitoring should be strongly considered in all patients with this clinical presentation. Normal intra-abdominal pressure is 0-5 mm Hg. Physiologic compromise begins when the pressure rises above 8-10 mm Hg. Once the pressures increase beyond 20 mm Hg irreversible tissue injury occurs, ultimately resulting in ACS and multiple organ failure. Early recognition of rising abdominal pressure is critically important, because it allows prompt intervention which will prevent ACS from developing, leading to a much better prognosis for the patient. The purpose of the research was to: 1) Detect abdominal compartment syndrome in newborns with clinically suspicious intra-abdominal hypertension; 2) Identify intra-abdominal pressure numbers presented with clinical manifestation; 3) Measure and detect intra-abdominal pressure numbers presented with abdominal compartment syndrome; 4) Find correlation between intra-abdominal hypertension grade and patient outcome. For completion of our goal we selected and reviewed medical records of 155 neonatal patients from 2008 to 2010, who stayed in surgical neonatal intensive care unit for more than 7 days. We monitored IAP in patients with suspected ACS and different clinical presentation. According to our research we may come to the following conclusion: Intra-abdominal hypertension was confirmed in most suspected cases. Intra-abdominal pressure of >10 mmHg in patients with clinical suspicion may be considered as intra-abdominal hypertension. Intra-abdominal hypertension is in close correlation with presence of fluid in abdominal cavity proved by ultrasound investigation. Intra-abdominal pressure of ≥20 mmHg can be considered as a point of development of abdominal compartment syndrome. The grade of hypertension is in close correlation with patient outcome.

[Comparison of PIM and SOFA scoring systems for mortality risk prognosis in critically ill children with sepsis].

The task of the study was the comparison of 2 scoring systems SOFA and PIM for mortality risk assessment in intensive care units. SOFA score is evaluated on admission and thereafter 72 and 120 h until ICU discharge in Children's Central Clinical Hospital from 2001 to 2005 years. Total 200 patients were studied. Mean age was 234.5+/-14.5. Mortality rate was 54 (27%). 89 (44.5%) were females and 111 (55.5%) were mails. Mechanical ventilation was performed in 72 (36%) patients. Septic shock was developed in 39 (19.5%) cases. Diagnose was confirmed by bacteriology in 68 (34%) cases. Higher score was in 93 (46.5%) cases, middle scores in 94 (47%) cases and low in 13 (6.5%) cases at the first day of admission. After 72 h. higher score was in 33 (16.5%) cases, middle in 113 (56.5%) cases and low in 54 (27.5%) cases. By evaluation with PIM--Higher score was in 58 (29%) cases, middle scores in 51 (25.5%) cases and low in 91 (45.5%) cases at the first day of admission. There is a correlation between the SOFA and PIM scores and paediatric mortality. Sofa scores predict mortality in ICU better then PIM scoring system. Kendall's tau of SOFA 0.64+/-0.3. Kendall's tau of PIM 0.45+/-0.2. Sofa scores is an excellent tool to describe the extent of organ dysfunction in critically ill patients.