Daily intra‐abdominal pressure, Sequential Organ Failure Score and fluid balance predict duration of mechanical ventilation

2018 ◽  
Vol 62 (10) ◽  
pp. 1421-1427 ◽  
Author(s):  
Dushyant Iyer ◽  
Leanne Hunt ◽  
Steven A. Frost ◽  
Anders Aneman
Keyword(s):  
Mechanical Ventilation ◽  
Organ Failure ◽  
Fluid Balance ◽  
Abdominal Pressure ◽  
Organ Failure Score

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

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

scholarly journals Relation between fluid balance and incidence of morbidity and mortality rates in critically ill patients prospective observational study

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
M G A Gerges ◽  
H M M Elazzazi ◽  
M H S A Elsersi ◽  
S A R Mustafa ◽  
M A Saeed
Keyword(s):  
Mechanical Ventilation ◽  
Observational Study ◽  
Critically Ill ◽  
Fluid Balance ◽  
Critically Ill Patients ◽  
Prospective Observational Study ◽  
Mortality Rates ◽  
Morbidity And Mortality ◽  
University Hospitals ◽  
Cumulative Fluid Balance

Abstract Background While administration of fluid can be lifesaving, it has been suggested that the fluid accumulation after initial resuscitation and hemodynamic stabilization can contribute to potentially avoidable adverse effects and less favorable outcomes. Objective The aim of this study is to assess whether positive fluid balance in comparison with negative or even fluid balance is associated with increased morbidity and mortality rates in critically ill patients. Patients and Methods This prospective observational study was performed on 145 Patients older than 18 years admitted to intensive care units at Helwan university hospitals and Ain shams university hospitals during the period from November 2017 till May 2018. Results A total of 145 patients with an ICU mortality rate of 14.5% were enrolled. The median cumulative fluid balance of the 124 patients who survive was -110 ml (IQR -2.1-2.2 L) after the fourth day following randomization while the median cumulative fluid balance of the 21 patients who not survive was 3800 ml (IQR 1.7-5.2 L) after the fourth day in ICU. In our study critically ill patients with fluid balance more than 1.2 litres per day had higher ICU complications: increased risk of AKI, longer ICU and hospital stays, and mechanical ventilation, and fluid balance was independently associated with mortality. Conclusion In the view of this study, we concluded that:Zero fluid balance and negative fluid balance independently associated with decrease mortality and morbidity rates in critically ill patients after 4 days from admission in ICU.There was higher cumulative fluid balance in non survivors compared to survivors. Cumulative fluid balance after 4 days from admission was independently predictive of mortality in a heterogeneous group of critically ill patients.96 hour negative fluid balance in critically ill patients was associated with less length of stay at ICU and less mechanical ventilation duration.Positive fluid balance, mechanical ventilation, vasopressors, and high admission SAPS II, SOFA, APACHE II and KIDGO were significantly associated with high mortality.

scholarly journals Intra-abdominal pressure monitoring in postoperative period in patients with diffuse peritonitis

2015 ◽  
Vol 96 (2) ◽  
pp. 214-219 ◽  
Author(s):  
E K Salakhov ◽  
K K Salakhov
Keyword(s):  
Organ Failure ◽  
Organ Dysfunction ◽  
Dynamic Assessment ◽  
Clinical Manifestations ◽  
Multiple Organ ◽  
Abdominal Pressure ◽  
Diffuse Peritonitis ◽  
Pressure Monitoring ◽  
Systemic Complications ◽  
Functional Changes

Epidemiology, etiology, pathologic and morphologic changes associated with increased intra-abdominal pressure are described. The most common ways of its measuring and monitoring are presented. Intra-abdominal pressure is increased by more than 15 mm Hg in patients with diffuse peritonitis. Increased intra-abdominal pressure is associated with the disease severity: the higher the intra-abdominal pressure, the more severe is the disease. If intra-abdominal pressure is increased over 20 mm Hg, treatment strategy depends on the signs of organ failure. In the absence of organ failure, intra-abdominal pressure should be monitored every 4 hours as long as the patient is in critical condition. Intra-abdominal pressure monitoring in case of peritonitis must be attributed to the mandatory manipulation, as pressure changes precede the clinical manifestations of intra-abdominal complications. Measurement of intra-abdominal pressure allows to detect the early signs of multiple organ failure, which is essential for the correction of systemic complications in pancreatogenic peritonitis. In this case, monitoring of intra-abdominal pressure in diffuse postoperative peritonitis should be considered only as a screening test for assessing of the organ dysfunction severity, as the development of multiple organ dysfunction syndrome involves complex pathophysiological mechanisms. Predictions that are more accurate can be made using such integrated indicators as APACHE II (Acute Physiology And Chronic Health Evaluation scale, which is used for assessing various acute and chronic diseases), SAPS (Simplified Acute Physiology Score - a simplified scale for acute functional changes assessment), SOFA (Sepsis-related Organ Failure Assessments Score - scale for dynamic assessment of organ failure in sepsis), MPI (Mannheim Peritonitis Index) scales.

scholarly journals Aiming for a negative fluid balance in patients with acute lung injury and increased intra-abdominal pressure: a pilot study looking at the effects of PAL-treatment

2012 ◽  
Vol 2 (Suppl 1) ◽  
pp. S15 ◽  
Author(s):  
Colin Cordemans ◽  
Inneke De laet ◽  
Niels Van Regenmortel ◽  
Karen Schoonheydt ◽  
Hilde Dits ◽  
...  
Keyword(s):  
Acute Lung Injury ◽  
Pilot Study ◽  
Lung Injury ◽  
Fluid Balance ◽  
Abdominal Pressure ◽  
Negative Fluid Balance

Withdrawal of life-sustaining therapies

2015 ◽  
pp. 463-472
Author(s):  
Margaret L. Campbell ◽  
Linda M. Gorman
Keyword(s):  
Quality Of Life ◽  
Mechanical Ventilation ◽  
Implantable Cardioverter Defibrillator ◽  
Organ Failure ◽  
Relative Frequency ◽  
Symptom Distress ◽  
Improve Quality ◽  
Cardioverter Defibrillator ◽  
Cardiac Devices

Withdrawal of mechanical ventilation (MV), discontinuation of dialysis, and deactivation of cardiac devices are procedures that occur with relative frequency. The benefits of these therapies, when initiated, are to replace failing organs, extend life, and improve quality of life by relieving symptom distress associated with organ failure. When the burdens exceed the benefits, or when the patient is near death or unresponsive, decisions may be made to cease these therapies. In some cases, such as implantable cardioverter defibrillator (ICD) deactivation, no distress is anticipated. In others, such as discontinuing dialysis or withdrawing MV, measures to palliate anticipated distress must be applied. A peaceful death after cessation of life-prolonging therapies can be provided.

scholarly journals Intra-Abdominal Pressure as a Marker of Enteral Nutrition Intolerance in Critically Ill Patients. The PIANE Study

Nutrients ◽  
2019 ◽  
Vol 11 (11) ◽  
pp. 2616
Author(s):  
M Bordejé ◽  
Juan Montejo ◽  
M Mateu ◽  
Manuel Solera ◽  
Jose Acosta ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Enteral Nutrition ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Urinary Catheter ◽  
Abdominal Pressure ◽  
Icu Patients ◽  
Group A ◽  
Group B ◽  
Low Sensitivity

To determine whether elevated intra-abdominal pressure (IAP) is associated with a higher rate of enteral nutrition-related gastrointestinal (GI) complications; to assess the value of IAP as a predictor of enteral nutrition (EN) intolerance. Intensive Care Unit (ICU) patients on mechanical ventilation requiring at least 5 days of EN were recruited for a prospective, observational, non-interventional, multicenter study. EN was performed and GI complications were managed with an established protocol. IAP was determined via a urinary catheter. Patients who developed any GI complications were considered as presenting EN intolerance. Variables related to EN, IAP and GI complications were monitored daily. Statistical analysis compared patients without GI complications (group A) vs. GI complications (group B). 247 patients were recruited from 28 participating ICUs (group A: 119, group B: 128). No differences between groups were recorded. Patients in group B (p < 0.001) spent more days on EN (8.1 ± 8.4 vs. 18.1 ± 13.7), on mechanical ventilation (8.0 ± 7.7 vs. 19.3 ± 14.9) and in the ICU (12.3 ± 11.4 vs. 24.8 ± 17.5). IAP prior to the GI complication was (14.3 ± 3.1 vs. 15.8 ± 4.8) (p < 0.003). The best IAP value identified for EN intolerance was 14 mmHg but it had low sensitivity and specificity. Although a higher IAP was associated with EN intolerance, IAP alone did not emerge as a good predictor of EN intolerance in critically ill patients.

Lung Organ Failure Score (LOFS): Probability of severe pulmonary organ failure after multiple injuries including chest trauma

Injury ◽  
2012 ◽  
Vol 43 (9) ◽  
pp. 1507-1512 ◽  
Author(s):  
Sebastian Wutzler ◽  
Arasch Wafaisade ◽  
Marc Maegele ◽  
Helmut Laurer ◽  
Emanuel V. Geiger ◽  
...  
Keyword(s):  
Organ Failure ◽  
Chest Trauma ◽  
Multiple Injuries ◽  
Organ Failure Score

scholarly journals Expiratory flow limitation in intensive care: prevalence and risk factors

Critical Care ◽  
2019 ◽  
Vol 23 (1) ◽  
Author(s):  
Carlo Alberto Volta ◽  
Francesca Dalla Corte ◽  
Riccardo Ragazzi ◽  
Elisabetta Marangoni ◽  
Alberto Fogagnolo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Fluid Balance ◽  
Adverse Outcomes ◽  
Small Airways ◽  
Flow Limitation ◽  
Expiratory Flow Limitation ◽  
Expected Length ◽  
Expiratory Flow

Abstract Background Expiratory flow limitation (EFL) is characterised by a markedly reduced expiratory flow insensitive to the expiratory driving pressure. The presence of EFL can influence the respiratory and cardiovascular function and damage the small airways; its occurrence has been demonstrated in different diseases, such as COPD, asthma, obesity, cardiac failure, ARDS, and cystic fibrosis. Our aim was to evaluate the prevalence of EFL in patients requiring mechanical ventilation for acute respiratory failure and to determine the main clinical characteristics, the risk factors and clinical outcome associated with the presence of EFL. Methods Patients admitted to the intensive care unit (ICU) with an expected length of mechanical ventilation of 72 h were enrolled in this prospective, observational study. Patients were evaluated, within 24 h from ICU admission and for at least 72 h, in terms of respiratory mechanics, presence of EFL through the PEEP test, daily fluid balance and followed for outcome measurements. Results Among the 121 patients enrolled, 37 (31%) exhibited EFL upon admission. Flow-limited patients had higher BMI, history of pulmonary or heart disease, worse respiratory dyspnoea score, higher intrinsic positive end-expiratory pressure, flow and additional resistance. Over the course of the initial 72 h of mechanical ventilation, additional 21 patients (17%) developed EFL. New onset EFL was associated with a more positive cumulative fluid balance at day 3 (103.3 ml/kg) compared to that of patients without EFL (65.8 ml/kg). Flow-limited patients had longer duration of mechanical ventilation, longer ICU length of stay and higher in-ICU mortality. Conclusions EFL is common among ICU patients and correlates with adverse outcomes. The major determinant for developing EFL in patients during the first 3 days of their ICU stay is a positive fluid balance. Further studies are needed to assess if a restrictive fluid therapy might be associated with a lower incidence of EFL.

Elevated intra-abdominal pressure correlates with frequency of organ failure and outcome in severe acute pancreatitis

Pancreatology ◽  
2013 ◽  
Vol 13 (3) ◽  
pp. S65-S66
Author(s):  
Mihailo Bezmarevic ◽  
Darko Mirkovic ◽  
Ivan Soldatovic ◽  
Milan Jovanovic
Keyword(s):  
Acute Pancreatitis ◽  
Organ Failure ◽  
Severe Acute Pancreatitis ◽  
Abdominal Pressure
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