scholarly journals Continuous intra-gastral monitoring of intra-abdominal pressure in critically ill children: a validation study

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
T. Kaussen ◽  
M. Gutting ◽  
F. Lasch ◽  
D. Boethig ◽  
A. von Gise ◽  
...  
Keyword(s):  
Water Column ◽  
Critically Ill ◽  
Tertiary Care ◽  
Critically Ill Children ◽  
Abdominal Pressure ◽  
Abdominal Hypertension ◽  
Gastric Pressure ◽  
Abdominal Compartment

Abstract Background In critically ill children, detection of intra-abdominal hypertension (IAH > 10 mmHg) and abdominal compartment syndrome (ACS = IAH + organ dysfunction) is paramount and usually monitored through intra-vesical pressures (IVP) as current standard. IVP, however, carries important disadvantages, being time-consuming, discontinuous, with infection risk through observer-dependent manipulation, and ill-defined for catheter sizes. Therefore, we sought to validate air-capsule-based measurement of intra-gastric pressure (ACM-IGP). Methods We prospectively compared ACM-IGP with IVP both in vivo and in vitro (water column), according to Abdominal-Compartment-Society validation criteria. We controlled for patient age, admission diagnosis, gastric filling/propulsive medication, respiratory status, sedation levels and transurethral catheters, all influencing intra-abdominal pressure (IAP). Results In tertiary care PICU setting, finally, n = 97 children were enrolled (median age, 1.3 years [range 0 days–17 years], LOS-PICU 8.0 [1–332] days, PRISM-III-Score 13 [0–35]). In n = 2.770 measurements pairs, median IAP was 6.7 [0.9–23.0] mmHg, n = 38 (39%) children suffered from IAH > 10 mmHg, n = 4 from ACS. In vitro against water column, ACM-IGP correlated perfectly (r2 0.99, mean bias − 0.1 ± 0.5 mmHg, limits of agreement (LOA) − 1.1/+ 0.9, percentage error [PE] 12%) as compared with IVP (r2 0.98, bias + 0.7 ± 0.6 mmHg, LOA − 0.5/+ 1.9, PE 15%). With larger IVP catheters at higher pressure levels, IVP underestimated pressures against water column. In vivo, agreement between either technique was strong (r2 0.95, bias 0.3 ± 0.8 mmHg, LOA − 1.3/+ 1.9 mmHg, PE 23%). No impact of predefined control variables on measurement agreement was observed. Conclusions In a large PICU population with high IAH prevalence, ACM-IGP agreed favourably with IVP. More widespread usage of ACM-IGP may improve detection rates of ACS in critically ill children. Trial registration WHO-ICTRP-No. DRKS00006556 (German Clinical Trial Register). Registered 12th September 2014, URL: https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00006556

Continuous Intra-Gastral Monitoring of Intra-Abdominal Pressure in Critically ill Children – A Validation Study

2020 ◽  
Author(s):  
Torsten Kaussen ◽  
Miriam Gutting ◽  
Florian Lasch ◽  
Dietmar Boethig ◽  
Alexander von Gise ◽  
...  
Keyword(s):  
Water Column ◽  
Critically Ill ◽  
Tertiary Care ◽  
Critically Ill Children ◽  
Abdominal Pressure ◽  
Abdominal Hypertension ◽  
Gastric Pressure ◽  
Abdominal Compartment

Abstract Background: In critically ill children, detection of intra-abdominal hypertension (IAH, >10mmHg) and abdominal compartment syndrome (ACS, =IAH + organ dysfunction) is paramount and usually monitored through intra-vesical pressures (IVP) as current standard. IVP however carries important disadvantages, being time-consuming, discontinuous, with infection risk through observer-dependent manipulation, and ill-defined for catheter sizes. Therefore, we sought to validate air-capsule-based measurement of intra-gastric pressure (ACM-IGP).Methods: We prospectively compared ACM-IGP with IVP both in-vivo and in-vitro (water-column), according to Abdominal-Compartment-Society validation criteria. We controlled for patient age, admission diagnosis, gastric filling/propulsive medication, respiratory status, sedation levels and transurethral catheters, all influencing intra-abdominal pressure (IAP).Results: In tertiary care PICU setting, finally, n=97 children were enrolled (median age, 1.3 years [range, 0 days -17 years], LOS-PICU 8.0 [1-332] days, PRISM-III-Score 13 [0-35]). In n=2.770 measurements pairs, median IAP was 6.7 [0.9 -23.0] mmHg. n=38 (39%) children suffered from IAH>10mmHg, n=4 from ACS. In-vitro against water-column, ACM-IGP correlated perfectly (r² 0.99, mean bias -0.1±0.5 mmHg, limits-of-agreement (LOA) -1.1/+0.9, percentage error [PE] 12%) as compared with IVP (r² 0.98, bias +0.7±0.6 mmHg, LOA -0.5/+1.9, PE 15%). With larger IVP catheters at higher pressure levels, IVP underestimated pressures against water-column. In-vivo, agreement between either technique was strong (r² 0.95, bias 0.3±0.8 mmHg, LOA -1.3/+1.9mmHg, PE 23%). No impact of predefined control variables on measurement agreement was observed. Conclusions: In a large PICU population with high IAH prevalence, ACM-IGP agreed favourably with IVP. More wide-spread usage of ACM-IGP may improve detection rates of ACS in critically ill children. Trial registration: WHO-ICTRP-No. DRKS00006556 (German Clinical Trial Register). Registeres 12th September 2014, URL: https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00006556

Incidence of Intra-Abdominal Hypertension and Abdominal Compartment Syndrome: A Systematic Review

2019 ◽  
Vol 36 (2) ◽  
pp. 197-202 ◽  
Author(s):  
Zaid Khot ◽  
Patrick B. Murphy ◽  
Nathalie Sela ◽  
Neil G. Parry ◽  
Kelly Vogt ◽  
...  
Keyword(s):  
Compartment Syndrome ◽  
Critically Ill ◽  
Abdominal Compartment Syndrome ◽  
Critically Ill Patients ◽  
Data Extraction ◽  
Common Finding ◽  
Abdominal Pressure ◽  
Abdominal Hypertension ◽  
Definition Of ◽  
Abdominal Compartment

Objective: To determine the contemporary prevalence of intra-abdominal hypertension (IAH) and abdominal compartment syndrome in critically ill patients. Data Sources: Medline, Embase, and Central databases. Study Selection: Studies reporting on the prevalence of IAH in consecutively admitted critically ill patients using the World Society of Abdominal Compartment Syndrome (WSACS) consensus guidelines for intra-abdominal pressure (IAP) measurement. Data Extraction: Duplicate independent review and data abstraction. Data Synthesis: The search identified 2428 titles with 6 eligible studies (n = 1965). Reported prevalence ranged from 30% to 49%. Despite abiding by the WSACS guidelines for IAP measurement, studies varied in their definition of IAH, frequency and duration of IAP measurement, and reporting of outcomes. Three of 6 studies reported that IAH, especially at higher grades, was an independent predictor of mortality. Conclusions: Intra-abdominal hypertension is a common finding in critically ill patients and may be associated with increased mortality, especially at higher grades. Further prospective research is required to examine the effect of screening and treatment of IAH on patient outcomes.

scholarly journals Non-Invasive Intra-Abdominal Pressure Measurement by Means of Transient Radar Method: In Vitro Validation of a Novel Radar-Based Sensor

Sensors ◽  
2021 ◽  
Vol 21 (18) ◽  
pp. 5999
Author(s):  
Salar Tayebi ◽  
Ali Pourkazemi ◽  
Manu L.N.G. Malbrain ◽  
Johan Stiens
Keyword(s):  
Abdominal Wall ◽  
Pressure Gauge ◽  
Urethral Injury ◽  
Abdominal Pressure ◽  
P Value ◽  
Radar Method ◽  
Abdominal Hypertension ◽  
Tract Infections ◽  
Abdominal Compartment

Intra-abdominal hypertension, defined as an intra-abdominal pressure (IAP) equal to or above 12 mmHg is one of the major risk-factors for increased morbidity (organ failure) and mortality in critically ill patients. Therefore, IAP monitoring is highly recommended in intensive care unit (ICU) patients to predict development of abdominal compartment syndrome and to provide a better care for patients hospitalized in the ICU. The IAP measurement through the bladder is the actual reference standard advocated by the abdominal compartment society; however, this measurement technique is cumbersome, non-continuous, and carries a potential risk for urinary tract infections and urethral injury. Using microwave reflectometry has been proposed as one of the most promising IAP measurement alternatives. In this study, a novel radar-based method known as transient radar method (TRM) has been used to monitor the IAP in an in vitro model with an advanced abdominal wall phantom. In the second part of the study, further regression analyses have been done to calibrate the TRM system and measure the absolute value of IAP. A correlation of –0.97 with a p-value of 0.0001 was found between the IAP and the reflection response of the abdominal wall phantom. Additionally, a quadratic relation with a bias of −0.06 mmHg was found between IAP obtained from the TRM technique and the IAP values recorded by a pressure gauge. This study showed a promising future for further developing the TRM technique to use it in clinical monitoring.

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 “INTRAABDOMINAL HYPERTENSION AND ABDOMINAL COMPARTMENT SYNDROME IN EMERGENCY LAPAROTOMY PATIENTS IN TERTIARY CARE RURAL HOSPITAL”

2019 ◽  
Vol 3 (9) ◽  
Author(s):  
Dr. Rohit B Patil ◽  
Dr. Tushar M. Parmeshwar ◽  
Dr. Dilip Gupta
Keyword(s):  
Compartment Syndrome ◽  
Abdominal Compartment Syndrome ◽  
Tertiary Care ◽  
Total Mortality ◽  
Rural Hospital ◽  
Abdominal Pressure ◽  
Emergency Laparotomy ◽  
Abdominal Hypertension ◽  
Study Population ◽  
Abdominal Compartment

Background: Although initially recognized over 150 years ago, the patho-physiologic implications of elevated intra-abdominal pressure (IAP) have essentially been rediscovered only within the past two decades. The aim of the study was to evaluate the incidence, morbidity and mortality of intra abdominal hypertension and abdominal compartment syndrome in emergency laparotomy patients in tertiary care rural hospital. Method:  IAP measurement was done in all patients undergoing emergency laparotomy with manometry technique (U tube technique) using per- urethral foley's catheterization. Results: Our study population was a group of patients who underwent laparotomy for various indications which included traumatic as well as non-traumatic causes. In total, 104 patients, with 30 females and 74 males were included in the study population who fulfilled the study criteria. The mean ± SD age in our study were 40.2±13 years with 20-30yrs being the most common age group. Most of the studies on IAH and ACS analyse either trauma or ICU patients. Little has been reported on ACS in general surgical population. Our study population was a group of patients who underwent laparotomy for various indications which included traumatic as well as non traumatic causes, hence a predominance of general surgical patients. Conclusions: Findings suggest that the incidence of ACS in our study is 3.84 % and found to be more common in trauma patients. There is significant association between increased Intra-abdominal pressure at 6 and 24 hours after laparotomy and organ dysfunction. The total mortality rate in ACS group was 75%. There is significant association between increased Intra-abdominal pressure and mortality.

scholarly journals Intra-abdominal hypertension and abdominal compartment syndrome in critically ill patients: A narrative review of past, present, and future steps

2021 ◽  
pp. 145749692110301
Author(s):  
Marije Smit ◽  
Matijs van Meurs ◽  
Jan G. Zijlstra
Keyword(s):  
Compartment Syndrome ◽  
Critically Ill ◽  
Abdominal Compartment Syndrome ◽  
Critically Ill Patients ◽  
Open Abdomen ◽  
Surgical Decompression ◽  
Abdominal Pressure ◽  
Pressure Monitoring ◽  
Abdominal Hypertension ◽  
Abdominal Compartment

Background and objective: Intra-abdominal hypertension is frequently present in critically ill patients and is an independent predictor for mortality. In this narrative review, we aim to provide a comprehensive overview of current insights into intra-abdominal pressure monitoring, intra-abdominal hypertension, and abdominal compartment syndrome. The focus of this review is on the pathophysiology, risk factors and outcome of intra-abdominal hypertension and abdominal compartment syndrome, and on therapeutic strategies, such as non-operative management, surgical decompression, and management of the open abdomen. Finally, future steps are discussed, including propositions of what a future guideline should focus on. Conclusions: Pathological intra-abdominal pressure is a continuum ranging from mild intra-abdominal pressure elevation without clinically significant adverse effects to substantial increase in intra-abdominal pressure with serious consequences to all organ systems. Intra-abdominal pressure monitoring should be performed in all patients at risk of intra-abdominal hypertension. Although continuous intra-abdominal pressure monitoring is feasible, this is currently not standard practice. There are a number of effective non-operative medical interventions that may be performed early in the patient’s course to reduce intra-abdominal pressure and decrease the need for surgical decompression. Abdominal decompression can be life-saving when abdominal compartment syndrome is refractory to non-operative treatment and should be performed expeditiously. The objectives of open abdomen management are to prevent fistula and to achieve delayed fascial closure at the earliest possible time. There is still a lot to learn and change. The 2013 World Society of Abdominal Compartment Syndrome guidelines should be updated and multicentre studies should evaluate the effect of intra-abdominal hypertension treatment on patient outcome.

scholarly journals Sedative and Analgesic Pharmacokinetics During Pediatric ECMO

2020 ◽  
Vol 25 (8) ◽  
pp. 675-688
Author(s):  
Kanecia O. Zimmerman ◽  
Samantha H. Dallefeld ◽  
Christoph P. Hornik ◽  
Kevin M. Watt
Keyword(s):  
Drug Metabolism ◽  
Extracorporeal Membrane Oxygenation ◽  
Critically Ill ◽  
Critically Ill Children ◽  
Ecmo Circuit ◽  
Therapeutic Benefits ◽  
Target Organs ◽  
Life Threatening

Sedatives and analgesics are often administered to critically ill children supported by extracorporeal membrane oxygenation (ECMO) to facilitate comfort and to decrease risks of life-threatening complications. Optimization of sedative and analgesic dosing is necessary to achieve desired therapeutic benefits and must consider interactions between the circuit and patient that may affect drug metabolism, clearance, and impact on target organs. This paper reviews existing in vitro and pediatric in vivo literature concerning the effects of the ECMO circuit on sedative and analgesic disposition and offers dosing guidance for the management of critically ill children receiving these drugs.

Effects of Ofloxacin Administration on the Reliability of Urine Glucose Testing

1996 ◽  
Vol 30 (5) ◽  
pp. 469-472
Author(s):  
Tsong-Mei Tsai ◽  
Brian F Shea ◽  
Paul F Souney ◽  
Fred G Volinsky ◽  
Joseph M Scavone ◽  
...  
Keyword(s):  
Phase I ◽  
Phase Ii ◽  
Tertiary Care ◽  
Urine Samples ◽  
Care Hospital ◽  
Open Label ◽  
Urine Glucose ◽  
Glucose Testing

OBJECTIVE: TO study the effects of ofloxacin on the reliability of urine glucose testing. DESIGN: Open-label, nonrandomized. SETTING: A university-affiliated tertiary care hospital, ambulatory clinic. PARTICIPANTS: Ten healthy volunteers (8 men and 2 women) aged 22-39 years. MAIN OUTCOME MEASURES: Phase I (in vitro) involved the addition of selected amounts of ofloxacin to a set of standard 50-mL urine samples prepared to simulate glycosuria. Phase II (in vivo) involved the oral administration of ofloxacin 400 mg to 10 subjects. Urine was collected: (1) immediately predose, (2) pooled 0–4 hours postdose, and (3) pooled 4–8 hours postdose. Known glucose concentrations were then added to these samples. Clinitest and Diastix tests were performed on all samples. The accuracy of these tests in determining glucose concentrations was compared among urine samples taken before and after ofloxacin dosing. RESULTS: None of the ofloxacin concentrations in phase I (0,25,50, 100, 200,400, and 800 μg/mL) influenced these testing methods at the urine glucose concentrations of 0.0%, 0.5%, 1%, and 2%. Likewise, the accuracy of these two tests was unaffected by ofloxacin administration in phase II. CONCLUSIONS: In single-dose administration, ofloxacin does not interfere with Clinitest or Diastix for determining urine glucose concentrations. Supported by a grant from the RW Johnson Pharmaceutical Research Institute. Presented in abstract form at the American College of Clinical Pharmacy 1994 Winter Practice and Research Forum, February 6–9, 1994, San Diego. CA.

scholarly journals Abdominal compartment syndrome in severe acute pancreatitis (review of literature)

2020 ◽  
Vol 179 (2) ◽  
pp. 73-78
Author(s):  
L. A. Otdelnov ◽  
A. S. Mukhin
Keyword(s):  
Acute Pancreatitis ◽  
Compartment Syndrome ◽  
Abdominal Compartment Syndrome ◽  
Severe Acute Pancreatitis ◽  
Medical Management ◽  
Abdominal Pressure ◽  
Decompressive Laparotomy ◽  
Russian Science Citation Index ◽  
Abdominal Hypertension ◽  
Abdominal Compartment

The study was performed for analysis of current understanding of intra-abdominal hypertension and abdominal compartment syndrome in patients with severe acute pancreatitis.The English and Russian articles about intra-abdominal hypertension and abdominal compartment syndrome in patients with severe acute pancreatitis were analyzed. The articles were found in «Russian Science Citation Index» and «PubMed».There is a pathogenetic relationship between increased intra-abdominal pressure and the development of severe acute pancreatitis.For today, it was shown that intra-abdominal hypertension in patients with severe acute pancreatitis is associated with significantly higher APACHE-II and MODS score, prevalence of pancreatic and peripancreatic tissue lesions, early infection of pancreatic necrosis and higher mortality.The article considers various variants of decompressive interventions such as decompressive laparotomy, fasciotomy and percutaneous catheter drainage. For today, there are no randomized studies devoted to researching effectiveness of different decompressive interventions.The study showed that it is necessary to regularly monitor intra-abdominal pressure in patients with severe acute pancreatitis. Patients with intra-abdominal hypertension require emergency medical management to reduce intra-abdominal pressure. Inefficiency of the medical management and development of abdominal compartment syndrome are indications for surgery. The effectiveness of different decompressive interventions requires further studies.

Pathophysiology and Management of Abdominal Compartment Syndrome

2003 ◽  
Vol 12 (4) ◽  
pp. 367-371 ◽  
Author(s):  
Jeffrey Walker ◽  
Laura M. Criddle
Keyword(s):  
Compartment Syndrome ◽  
Abdominal Compartment Syndrome ◽  
Oxygen Free Radicals ◽  
Abdominal Pressure ◽  
Decompressive Laparotomy ◽  
Abdominal Hypertension ◽  
Translocation Of Bacteria ◽  
Serial Measurements ◽  
Abdominal Compartment ◽  
Multiorgan Dysfunction Syndrome

Abdominal compartment syndrome is a potentially lethal condition caused by any event that produces intra-abdominal hypertension; the most common cause is blunt abdominal trauma. Increasing intra-abdominal pressure causes progressive hypoperfusion and ischemia of the intestines and other peritoneal and retroperitoneal structures. Pathophysiological effects include release of cytokines, formation of oxygen free radicals, and decreased cellular production of adenosine triphosphate. These processes may lead to translocation of bacteria from the gut and intestinal edema, predisposing patients to multiorgan dysfunction syndrome. The consequences of abdominal compartment syndrome are profound and affect many vital body systems. Hemodynamic, respiratory, renal, and neurological abnormalities are hallmarks of abdominal compartment syndrome. Medical management consists of urgent decompressive laparotomy. Nursing care involves vigilant monitoring for early detection, including serial measurements of intra-abdominal pressure.

Sign in / Sign up

Export Citation Format

Share Document