Advanced Age May Limit the Survival Benefit of Open Abdominal Decompression

2011 ◽  
Vol 77 (7) ◽  
pp. 856-861 ◽  
Author(s):  
Michael L. Cheatham ◽  
Karen Safcsak ◽  
Creighton Fiscina ◽  
Christopher Ducoin ◽  
Howard G. Smith ◽  
...  
Keyword(s):  
Survival Benefit ◽  
Patient Survival ◽  
Survival Rates ◽  
Age Groups ◽  
Fascial Closure ◽  
Temporary Abdominal Closure ◽  
Abdominal Hypertension ◽  
Abdominal Decompression ◽  
Abdominal Compartment ◽  
Eighth Decade

Open abdominal decompression (OAD) and temporary abdominal closure (TAC) are widely performed for the treatment of intra-abdominal hypertension and/or abdominal compartment syndrome. During 2005 to 2009, 405 consecutive patients required OAD/TAC (trauma 68%, surgery 24%, medicine 5%, burn 3%). Overall patient survival to hospital discharge was 65 per cent regardless of age and was significantly decreased among patients older than 70 years of age ( P < 0.0001). Survival by decade of life exceeded 50 per cent through the eighth decade but decreased to 19 per cent for the ninth decade (older than 80 years of age). Survival varied significantly by service (trauma 72%, surgical 56%, burns 55%, medical 33%) ( P < 0.0001). Successful definitive fascial closure rates (range, 75 to 100%) were equivalent among all age groups ( P = 0.78). Survival after OAD/TAC varies by decade of life and mechanism of injury/illness. Age alone should not negate the use of OAD/TAC. Reasonable survival rates may be expected for patients younger than 80 years of age.

scholarly journals Abdominal Decompression in Children

2012 ◽  
Vol 2012 ◽  
pp. 1-11
Author(s):  
J. Chiaka Ejike ◽  
Mudit Mathur
Keyword(s):  
Medical Management ◽  
Patient Survival ◽  
Management Strategies ◽  
Critically Ill Children ◽  
Abdominal Pressure ◽  
Risk Of Mortality ◽  
Abdominal Hypertension ◽  
Abdominal Decompression ◽  
Positive Effect ◽  
Abdominal Compartment

Abdominal compartment syndrome (ACS) increases the risk for mortality in critically ill children. It occurs in association with a wide variety of medical and surgical diagnoses. Management of ACS involves recognizing the development of intra-abdominal hypertension (IAH) by intra-abdominal pressure (IAP) monitoring, treating the underlying cause, and preventing progression to ACS by lowering IAP. When ACS is already present, supporting dysfunctional organs and decreasing IAP to prevent new organ involvement become an additional focus of therapy. Medical management strategies to achieve these goals should be employed but when medical management fails, timely abdominal decompression is essential to reduce the risk of mortality. A literature review was performed to understand the role and outcomes of abdominal decompression among children with ACS. Abdominal decompression appears to have a positive effect on patient survival. However, prospective randomized studies are needed to fully understand the indications and impact of these therapies on survival in children.

scholarly journals Overview on Temporary Abdominal Closure Techniques: A Review

2021 ◽  
pp. 68-74
Author(s):  
Hashem Bark Awadh Abood ◽  
Sadeel Fahad Daghistani ◽  
Nouf Hashem Koshak ◽  
Yazid Ali Alghamdi ◽  
Sahad sami Ghamri ◽  
...  
Keyword(s):  
Open Abdomen ◽  
Fascial Closure ◽  
Temporary Abdominal Closure ◽  
Advantages And Disadvantages ◽  
Abdominal Closure ◽  
Abdominal Hypertension ◽  
Fluid Regulation ◽  
Abdominal Compartment ◽  
Emergency Abdominal Surgery ◽  
The Ideal

Open abdomen (OA) is becoming more common, primarily to prevent intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) following emergency abdominal surgery. The purpose of temporary abdominal closure (TAC) techniques is no longer just abdomen coverage; fluid regulation and early fascial closure are now important considerations. TAC techniques for leaving the abdomen open are numerous. The ideal one should be simple to apply and remove, allow for quick access to a surgical second opinion, drain secretions, ease primary closure with acceptable morbidity and mortality, allow for easy nursing, and, finally, be readily available and inexpensive. Over the years, several TAC methods have been proposed. In this review, we overview different techniques for temporary abdominal closure and its advantages and disadvantages.

Linea Alba Fasciotomy: A Novel Alternative in Trauma Patients with Secondary Abdominal Compartment Syndrome

2010 ◽  
Vol 76 (3) ◽  
pp. 312-316 ◽  
Author(s):  
Juan C. Duchesne ◽  
Meghan P. Howell ◽  
Calvin Eriksen ◽  
Georgia M. Wahl ◽  
Kelly V. Rennie ◽  
...  
Keyword(s):  
Compartment Syndrome ◽  
Abdominal Compartment Syndrome ◽  
Volume Index ◽  
Trauma Patients ◽  
Linea Alba ◽  
Physiological Variables ◽  
Abdominal Hypertension ◽  
Polytrauma Patients ◽  
Abdominal Decompression ◽  
Abdominal Compartment

Polytrauma patients needing aggressive resuscitation can develop intra-abdominal hypertension (IAH) with subsequent secondary abdominal compartment syndrome (SACS). After patients fail medical therapy, decompressive laparotomy is the surgical last resort. In patients with severe pancreatitis SACS, the use of linea alba fasciotomy (LAF) is an effective intervention to lower IAH without the morbidity of laparotomy. A pilot study of LAF was designed to evaluate its benefit in patients with SACS polytrauma. We conducted an observational study of blunt injury polytrauma patients undergoing LAF. Variables measured before and after LAF included intra-abdominal pressure (IAP, mmHg), abdominal perfusion pressure (APP, mmHg), right ventricular end diastolic volume index (RVEDVI, mL/m2), and ejection fraction. Of the five trauma patients with SACS, the mean age was 36 ± 17, four (80%) male with an Injury Severity Score of 27 ± 9. Pre- and post-LAF, IAP was 20.6 ± 4.7 and 10.6 ± 2.7 ( P < 0.0001), APP 55.2 ± 5.5 and 77.6 ± 7.1 ( P < 0.0001), RVEDVI 86.4 ± 9.3 and 123.6 ± 11.9 ( P < 0.0001), and EF 27.6 ± 4.2 and 40.8 ± 5 ( P < 0.0001), respectively. One patient needed full decompression for bile ascites from unrecognized liver injury. Linea alba fasciotomy, as a first-line intervention before committing to full abdominal decompression in patients with SACS trauma, improved physiological variables without mortality Consideration for LAF as a bridge before full abdominal decompression needs further evaluation in patients with polytrauma SACS.

Comparison of Intra Abdominal Pressure Monitoring Techniques and the Effects of the Abdominal Compartment Syndrome

2021 ◽  
Vol 15 (9) ◽  
pp. 2298-2301
Author(s):  
Salman A. Shah ◽  
Saeedah Asaf
Keyword(s):  
Blood Flow ◽  
Compartment Syndrome ◽  
Renal Blood Flow ◽  
Abdominal Compartment Syndrome ◽  
Porcine Model ◽  
Bladder Pressure ◽  
Fascial Closure ◽  
Pressure Measurements ◽  
Abdominal Hypertension ◽  
Abdominal Compartment

Background: Abdominal compartment syndrome (ACS) is a life-threatening condition that develops in the setting of increasing and uncontrolled intra-abdominal hypertension (IAH), leading to cardiovascular, respiratory, neurologic and/or renal dysfunction. Aims: To establish a porcine model for the evaluation of the effects of IAH on renal blood flow (RBF) and to determine if IVC pressure and/or Camino fiberoptic direct intraabdominal pressure measurements can accurately predict IAPs that have been derived using bladder pressure measurements. Methods: Abdominal laparotomy, placement of IAP and RBF measuring devices, and fascial closure were performed on six adult feeder pigs with a mean body weight of 25 +/- 5 kg. A Transonic Doppler flow probe, a suprapubic bladder catheter, a Camino fiberoptic probe, and a triple lumen central venous catheter were placed and then baseline measurements were taken of renal blood flow, bladder pressure, direct intra-peritoneal Camino pressure and IVC pressure, respectively. Normal saline was then infused into the abdomen to simulate increasing IAP. Following a 5–10-minute stabilization period, all measurements were again taken. Results: The correlation between IVC pressure and bladder pressure was 0.98, with a mean bias of -0.5 (SD 2.0; 95% CI: -0.9, -0.2). The correlation between direct IAP readings by Camino probe and bladder pressure was 0.91, with a mean bias of -3.9 (SD 4.3; 95% CI: -4.6, -3.2). There was a strong negative correlation (-0.95) between RBF and bladder pressure. At an IAP of 20 mmHg, RBF reduced by an average of 45.4% (95% CI: 40%, 50.8%). Upon abdominal decompression, RBF returned to 66.6% (95% CI: 54.3%, 78.9%) of its baseline value. Conclusions: A porcine model is effective in accurately measuring changes in real time RBF. RBF progressively declines as IAP increases, however upon decompression, it fails to achieve complete recovery. IVC pressure measurements correlate well with, and therefore may substitute, the gold standard bladder pressure measurements as representatives of IAP. Keywords: Abdominal Compartment syndrome, renal blood flow, intrabdominal hypertension, bladder pressure

Compartment Syndrome

2017 ◽  
Author(s):  
Basem Attum ◽  
William Obremskey ◽  
Bradley Dennis ◽  
Richard Miller
Keyword(s):  
Compartment Syndrome ◽  
Abdominal Compartment Syndrome ◽  
Clinical Signs ◽  
Skin Closure ◽  
Temporary Abdominal Closure ◽  
Diagnosis And Management ◽  
Abdominal Closure ◽  
Decompressive Laparotomy ◽  
Abdominal Hypertension ◽  
Abdominal Compartment

Compartment syndrome is a process that can develop anywhere skeletal muscle or abdominal organs are encased by a rigid fascial layer. This review describes the different aspects of these conditions, including the epidemiology, pathophysiology, diagnosis, and management of compartment syndrome in the extremities and abdomen. Diagnosis is expanded on further to describe clinical signs in the alert patient and the different methods of compartment measurement in the obtunded patient or when a physical examination is inconclusive. The anatomy of the leg, thigh, buttocks, forearm, and arm is described, along with surgical techniques for fasciotomy. Postoperative care, the different methods of wound management and skin closure, and diagnostic criteria for the diagnosis and management of abdominal compartment syndrome are discussed. Treatment of abdominal compartment syndrome with decompressive laparotomy and temporary abdominal closure is also described. Figures depict various fasciotomies and an algorithmic approach to management. Tables show the contents and function of the compartments of the leg and forearm. Key words: abdominal compartment syndrome, compartment syndrome, decompressive laparotomy, extremity, fasciotomy, intra-abdominal hypertension, intra-abdominal pressure, temporary abdominal closure, tibia fracture

Compartment Syndrome

2017 ◽  
Author(s):  
Basem Attum ◽  
William Obremskey ◽  
Bradley Dennis ◽  
Richard Miller
Keyword(s):  
Compartment Syndrome ◽  
Abdominal Compartment Syndrome ◽  
Clinical Signs ◽  
Skin Closure ◽  
Temporary Abdominal Closure ◽  
Diagnosis And Management ◽  
Abdominal Closure ◽  
Decompressive Laparotomy ◽  
Abdominal Hypertension ◽  
Abdominal Compartment

Compartment syndrome is a process that can develop anywhere skeletal muscle or abdominal organs are encased by a rigid fascial layer. This review describes the different aspects of these conditions, including the epidemiology, pathophysiology, diagnosis, and management of compartment syndrome in the extremities and abdomen. Diagnosis is expanded on further to describe clinical signs in the alert patient and the different methods of compartment measurement in the obtunded patient or when a physical examination is inconclusive. The anatomy of the leg, thigh, buttocks, forearm, and arm is described, along with surgical techniques for fasciotomy. Postoperative care, the different methods of wound management and skin closure, and diagnostic criteria for the diagnosis and management of abdominal compartment syndrome are discussed. Treatment of abdominal compartment syndrome with decompressive laparotomy and temporary abdominal closure is also described. Figures depict various fasciotomies and an algorithmic approach to management. Tables show the contents and function of the compartments of the leg and forearm. Key words: abdominal compartment syndrome, compartment syndrome, decompressive laparotomy, extremity, fasciotomy, intra-abdominal hypertension, intra-abdominal pressure, temporary abdominal closure, tibia fracture

scholarly journals Does kidney transplantation with a standard or expanded criteria donor improve patient survival? Results from a Belgian cohort

2021 ◽  
Vol 36 (5) ◽  
pp. 918-926
Author(s):  
Rachel Hellemans ◽  
Anneke Kramer ◽  
Johan De Meester ◽  
Frederic Collart ◽  
Dirk Kuypers ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Survival Benefit ◽  
Age Groups ◽  
Deceased Donor ◽  
Risk Levels ◽  
Improve Patient Survival ◽  
Expanded Criteria Donor ◽  
Expanded Criteria ◽  
Deceased Donor Kidney Transplant ◽  
Dialysis Outcomes

Abstract Background Changes in recipient and donor factors have reopened the question of survival benefits of kidney transplantation versus dialysis. Methods We analysed survival among 3808 adult Belgian patients waitlisted for a first deceased donor kidney transplant from 2000 to 2012. The primary outcome was mortality during the median waiting time plus 3 years of follow-up after transplantation or with continued dialysis. Outcomes were analysed separately for standard criteria donor (SCD) and expanded criteria donor (ECD) kidney transplants. We adjusted survival analyses for recipient age (20–44, 45–64 and ≥65 years), sex and diabetes as the primary renal disease. Results Among patients ≥65 years of age, only SCD transplantation provided a significant survival benefit compared with dialysis, with a mortality of 16.3% [95% confidence interval (CI) 13.2–19.9] with SCD transplantation, 20.5% (95% CI 16.1–24.6) with ECD transplantation and 24.6% (95% CI 19.4–29.5) with continued dialysis. Relative mortality risk was increased in the first months after transplantation compared with dialysis, with equivalent risk levels reached earlier with SCD than ECD transplantation in all age groups. Conclusions The results of this study suggest that older patients might gain a survival benefit with SCD transplantation versus dialysis, but any survival benefit with ECD transplantation versus dialysis may be small.

scholarly journals Partial pulpotomy without age restriction: a retrospective assessment of permanent teeth with carious pulp exposure

2021 ◽  
Author(s):  
Florin Eggmann ◽  
Thomas J. W. Gasser ◽  
Hanjo Hecker ◽  
Mauro Amato ◽  
Roland Weiger ◽  
...  
Keyword(s):  
Survival Rates ◽  
Age Groups ◽  
Permanent Teeth ◽  
Eligibility Criteria ◽  
Presumptive Diagnosis ◽  
Tooth Discoloration ◽  
Significant Difference ◽  
Pulp Exposure ◽  
The Mean

Abstract Objectives This study aimed to retrospectively evaluate clinical and radiographic outcomes of partial pulpotomy performed in permanent teeth with carious pulp exposure. Materials and methods Records of patients undergoing treatment at an undergraduate dental clinic between 2010 and 2019 were screened for partial pulpotomies in teeth with a presumptive diagnosis of normal pulp or reversible pulpitis. The follow-up had to be ≥ 1 year. Patient data were retrieved and analyzed using Mantel-Cox chi square tests and Kaplan–Meier statistics. The level of significance was set at α = 0.05. Results Partial pulpotomy was performed in 111 cases, of which 64 (58%) fulfilled the eligibility criteria. At the time of partial pulpotomy, the mean age was 37.3 (± 13.5) years (age range 18–85). The mean observation period was 3.1 (± 2.0) years. Two early failures (3.1%) and five late failures (7.7%) were recorded. The overall success rate of maintaining pulp vitality was 89.1%, with 98.4% tooth survival. The cumulative pulp survival rates of partial pulpotomy in patients aged < 30 years, between 30 and 40 years, and > 40 years were 100%, 75.5%, and 90.5%, respectively, with no significant difference between the age groups (p = 0.225). At follow-up, narrowing of the pulp canal space and tooth discoloration were observed in 10.9% and 3.1% of cases, respectively. Conclusions Across age groups, partial pulpotomy achieved favorable short and medium-term outcomes in teeth with carious pulp exposure. Clinical relevance Adequate case selection provided, partial pulpotomy is a viable operative approach to treat permanent teeth with deep carious lesions irrespective of patients’ age.

MO704THE PROGNOSTIC IMPACT OF WEIGHT GAIN AFTER PERITONEAL DIALYSIS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Win Hlaing Than ◽  
Jack K C Ng ◽  
Gordon C K Chan ◽  
Winston Fung ◽  
Cheuk Chun Szeto
Keyword(s):  
Weight Loss ◽  
Body Weight ◽  
Peritoneal Dialysis ◽  
Weight Gain ◽  
Clinical Outcomes ◽  
Patient Survival ◽  
Survival Rates ◽  
Overweight And Obesity ◽  
Technique Survival ◽  
Technique Failure

Abstract Background and Aims The prevalence of obesity has increased over the past decade in patients with End Stage Kidney Disease (ESKD). Obesity at the initiation of peritoneal dialysis (PD) was reported to adversely affect clinical outcomes. However, there are few studies on the prognostic relevance of weight gain after PD. Method We reviewed the change in body weight of 954 consecutive PD patients from the initiation of dialysis to 2 years after they remained on PD. Clinical outcomes including patient survival, technique survival, and peritonitis rate in the subsequent two years were reviewed. Results The mean age was 60.3 ± 12.2 years; 535 patients (56.1%) were men and 504 (52.8%) had diabetes. After the first 2 years on PD, the average change in body weight was 1.2± 5.1 kg; their body weight was 63.0 ± 13.3 kg; body mass index (BMI) 24.4 ± 4.4 kg/m2. The patient survival rates in the subsequent two years were 64.9%, 75.0%, and 78.9% (log rank test, p = 0.008) for patients with weight loss ≥3 kg during the first 2 years of PD weight change between -3 and +3 kg, and weight gain ≥3 kg, respectively. The corresponding technique survival rates in the subsequent two years were 93.1%, 90.1%, 91.3%, respectively (p = 0.110), and the peritonitis rates were 0.7±1.5, 0.6±1.7, and 0.6±1.1 episodes per patient-year, respectively (p = 0.3). When the actual BMI after the first 2 years of PD was categorized into underweight, normal weight, marginal overweight, overweight, and obesity groups, the patient survival rates in the subsequent two years were 77.3%, 75.2%, 73.3%, 74.3%, and 75.9%, respectively (p= 0.005), and technique survival 98.0%, 91.9%, 88.0%, 92.8%, and 81.0%, respectively (p= 0.001). After adjusting for confounding clinical factors by multivariate Cox regression models, weight gain ≥ 3kg during the first 2 years of PD was an independent protective factor for technique failure (adjusted hazard ratio [AHR] 0.049; 95% confidence interval [CI] 0.004-0.554, p = 0.015), but was an adverse predictor of patient survival (AHR 2.338, 95%CI 1.149-4.757, p = 0.019). In contrast, weight loss ≥ 3kg during the first 2 years of PD did not predict subsequent patient or technique survival. Conclusion Weight gain during the first 2 years of PD confers a significant risk of subsequent mortality but appears to be associated with a lower risk of technique failure. The mechanism of this discordant risk prediction deserves further study.

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