Aggressive Surveillance and Early Catheter-Directed Therapy in the Management of Intra-Abdominal Hypertension

AbstractSepsis-induced acute kidney injury (SAKI) remains an important challenge for intensive care unit clinicians. We reviewed current available evidence regarding prevention and treatment of SAKI thereby incorporating some major recent advances and developments. Prevention includes early and ample administration of “balanced” crystalloid solutions such as Ringer’s lactate. For monitoring of renal function during resuscitation, lactate clearance rate is preferred above ScvO2or renal Doppler. Aiming at high central venous pressures seems to be deleterious in light of the novel “kidney afterload” concept. Noradrenaline is the vasopressor of choice for preventing SAKI. Intra-abdominal hypertension, a potent trigger of acute kidney injury in postoperative and trauma patients, should not be neglected in sepsis. Renal replacement therapy (RRT) must be started early in fluid-overloaded patients refractory to diuretics. Continuous RRT (CRRT) is the preferred modality in hemodynamically unstable SAKI but its use in more stable SAKI is increasing. In the absence of hypervolemia, diuretics should be avoided. Antimicrobial dosing during CRRT needs to be thoroughly reconsidered to assure adequate infection control.

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Intra-Abdominal Hypertension: Pulmonary and Cerebral Complications

Transplantation Proceedings ◽

10.1016/j.transproceed.2008.03.117 ◽

2008 ◽

Vol 40 (4) ◽

pp. 1190-1192 ◽

Cited By ~ 20

Author(s):

V. Vegar-Brozovic ◽

J. Brezak ◽

I. Brozovic

Keyword(s):

Cerebral Complications ◽

Abdominal Hypertension

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The effect of reference position versus right lateral position on the intra-abdominal pressure in mechanically ventilated patients

Journal of Nursing Education and Practice ◽

10.5430/jnep.v8n6p93 ◽

2018 ◽

Vol 8 (6) ◽

pp. 93

Author(s):

Ghada Shalaby Khalaf Mahran ◽

Sayed K. Abd-Elshafy ◽

Manal Mohammed Abd El Neem ◽

Jehan A. Sayed

Keyword(s):

Mechanical Ventilation ◽

Critical Care ◽

Observational Study ◽

Prospective Observational Study ◽

Body Position ◽

Critical Issue ◽

Lateral Position ◽

Abdominal Pressure ◽

University Hospitals ◽

Abdominal Hypertension

Background and objective: Intra-abdominal hypertension (IAH) is a frequent plentiful problem in patients admitted to critical care units. It ranges from a surge incidence of morbidity and mortality to a particular need for nursing health care, so recognition of the occurrence of IAH is a very critical issue for critical care nurses and physician. This study aimed to recognize the effects of various body position with the various head of bed elevation on the intra-abdominal pressure (IAP) in patients with mechanical ventilation.Methods: Design: A non-randomized, prospective observational study was used. Setting: Trauma and general intensive care units at Assuit University Hospitals. Method: In a prospective observational study, during the third day of mechanical ventilation, 60 patients were screened for IAP via a urinary catheter, in two various body positions in three separate degrees of the head of the bed (HOB) elevation (0º, 15º, and 30º). The position was changed at least 4 hours apart over a 24-h period.Results: In lateral recumbence, IAP measurements were significantly elevated compared to supine position, they were 19.70 ± 3.09 mmHg versus 16.00 ± 3.14 (p < .001), 22.80 ± 3.56 mmHg versus 19.03 ± 2.95 (p < .001), and 26.08 ± 3.59 mmHg versus 21.46 ± 2.90 versus (p < .001) at 0º, 15º, and 30º respectively. The mean of IAP difference was 3.7 ± 3.0 mmHg at 0º, 3.8 ± 1.00 mmHg at 15º, and 5.5 ± 1.01 mmHg at 30 º (p < .005).Conclusions: IAP reading is significantly elevated by changing from supine to lateral position especially with HOB elevation and significantly correlated with mortality rate in patients with mechanical ventilation

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