abdominal pressure
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2022 ◽  
Vol 8 ◽  
Author(s):  
Ling Ding ◽  
Cong He ◽  
Xueyang Li ◽  
Xin Huang ◽  
Yupeng Lei ◽  
...  

Aims: We investigated whether faecal microbiota transplantation (FMT) decreases intra-abdominal pressure (IAP) and improves gastrointestinal (GI) dysfunction and infectious complications in acute pancreatitis (AP).Methods: In this first randomised, single-blind, parallel-group, controlled study, we recruited and enrolled consecutive patients with AP complicated with GI dysfunction. Eligible participants were randomly assigned to receive faecal transplant (n = 30) or normal saline (n = 30) via a nasoduodenal tube once and then again 2 days later. The primary endpoint was the rate of IAP decline; secondary endpoints were GI function, infectious complications, organ failure, hospital stay and mortality. Analyses were based on intention to treat.Results: We enrolled 60 participants and randomly assigned them to the FMT (n = 30) or control (n = 30) group. Baseline characteristics and disease severity were similar for both groups. IAP decreased significantly 1 week after intervention in both groups, with no difference in the IAP decline rate between FMT and Control group [0.1 (−0.6, 0.5) vs. 0.2 (−0.2, 0.6); P = 0.27]. Normal gastrointestinal failure (GIF) scores were achieved in 12 (40%) patients in the FMT group and 14 (47%) in the control group, with no significant difference (P = 0.60). However, D-lactate was significantly elevated in the FMT group compared to the control group, as calculated by the rate of decline [−0.3 (−3.7, 0.8) vs. 0.4 (−1.1, 0.9); P = 0.01]. Infectious complications occurred in 15 (50%) and 16 (53.33%) patients in the FMT and control groups, respectively (P = 0.80). However, interleukin-6 (IL-6) was significantly elevated in the FMT group compared to the control group, as calculated by the rate of decline [0.4 (−3.6, 0.9) vs. 0.8 (−1.7, 1.0); P = 0.03]. One participant experienced transient nausea immediately after FMT, but no serious adverse events were attributed to FMT.Conclusion: FMT had no obvious effect on IAP and infectious complications in AP patients, though GI barrier indictors might be adversely affected. Further multi-centre studies are needed to confirm our findings. The study was registered at https://clinicaltrials.gov (NCT02318134).


2021 ◽  
pp. 90-95
Author(s):  
O. L. Tkachuk ◽  
R. L. Parakhoniak ◽  
S. V. Melnyk ◽  
O. O. Tkachuk-Hryhorchuk

Pneumoperitoneum is one of the most critical components of laparoscopic surgery, which has a negative effect on gas exchange and stress to circulatory buffering system. One of the top priorities of laparoscopic technologies is to minimize the impact on the respiratory and cardiovascular systems, metabolic dynamics and compensatory abilities of homeostasis. The main goal of this research work is to compare the effects of carboxyperitoneum and argonoperitoneum on the intraoperative dynamics of CO2 concentration as well as cardiovascular and respiratory characteristics in patients undergoing laparoscopic cholecystectomy for various forms of cholelithiasis. Materials and methods. Four experimental groups involved patients based on their nosological form of cholelithiasis and the gas used to induce pneumoperitoneum. All patients underwent laparoscopic cholecystectomy by means of standard procedure. Either medical carbon dioxide or medical argon was used to induce pneumoperitoneum. Intraoperative monitoring of blood carbon dioxide levels PaCO2 was performed by taking venous blood every 15 minutes. Capnometry was performed by means of mainstream analysis using “BIOMED” BM1000C modular patient monitor by recording the discrete values of PetCO2 every 15 minutes, as well as by analyzing photocopies of capnography curves every 15 minutes. Intraoperative echocardiography was performed to identify the mean arterial pressure (MAP), heart rate (HR) and cardiac output (CO) in order to assess the effects of different types of pneumoperitoneum on the cardiovascular system. Results. The obtained data confirm the expected difference in the indices of cardiorespiratory functions between patients with acute cholecystitis and cholelithiasis without signs of inflammation. The investigation revealed that under the influence of pneumoperitoneum, heart rate and mean arterial pressure increase, while the cardiac output decreases. The respiratory pressure marker depends more on the intra-abdominal pressure and presumably the patient’s body type than on the presence of inflammatory syndrome. Argon insufflation has a slight negative impact on the cardiovascular system. Particularly, the mean arterial pressure and heart rate increase, while the cardiac output marker is less decreased as compared to the use of carbon dioxide. Abdominal pressure has a significant effect on the cardiovascular and respiratory systems regardless of the used type of gas. The combination of high intra-abdominal pressure with the elevated head end of the operating table, which is a common practise during cholecystectomy, has especially great influence on cardiovascular and respiratory functions. Operation which is carried out at decreased pressure allows reducing the deviations of practically all indices. Conclusions. Thus, the cardiovascular and respiratory systems adapt under the influence of pneumoperitoneum, providing compensation for the negative effects of mechanical and resorptive-metabolic character. Compensatory-adaptive abilities of the cardiovascular and respiratory systems increase with the decrease of intra-abdominal pressure. The use of argon as a working gas for insufflation into the abdominal cavity during laparoscopy reduces the negative impact of pneumoperitoneum on the cardiovascular and respiratory systems, providing a greater reserve of homeostatic and buffer systems of the body.


2021 ◽  
Vol 12 ◽  
pp. 628
Author(s):  
Nobuya Murakami ◽  
Ai Kurogi ◽  
Yoshihisa Kawakami ◽  
Yushi Noguchi ◽  
Makoto Hayashida ◽  
...  

Background: Terminal myelocystocele (TMC) is an occult spinal dysraphism characterized by cystic dilatation of the terminal spinal cord in the shape of a trumpet (myelocystocele) filled with cerebrospinal fluid (CSF), which herniates into the extraspinal subcutaneous region. The extraspinal CSF-filled portion of the TMC, consisting of the myelocystocele and the surrounding subarachnoid space, may progressively enlarge, leading to neurological deterioration, and early untethering surgery is recommended. Case Description: We report a case of a patient with TMC associated with OEIS complex consisting of omphalocele (O), exstrophy of the cloaca (E), imperforate anus (I), and spinal deformity (S). The untethering surgery for TMC had to be deferred until 10 months after birth because of the delayed healing of the giant omphalocele and the respiration instability due to hypoplastic thorax and increased intra-abdominal pressure. The TMC, predominantly the surrounding subarachnoid space, enlarged during the waiting period, resulting in the expansion of the caudal part of the dural sac. Although untethering surgery for the TMC was uneventfully performed with conventional duraplasty, postoperative CSF leakage occurred, and it took three surgical interventions to repair it. External CSF drainage, reduction of the size of the caudal part of the dural sac and use of gluteus muscle flaps and collagen matrix worked together for the CSF leakage. Conclusion: Preoperative enlargement of the TMC, together with the surrounding subarachnoid space, can cause the refractory CSF leakage after untethering surgery because the expanded dural sac possibly increases its own tensile strength and impedes healing of the duraplasty. Early untethering surgery is recommended after recovery from the life-threatening conditions associated with OEIS complex.


2021 ◽  
Vol 6 (6) ◽  
pp. 33-43
Author(s):  
О. V. Shapoval ◽  
◽  
N. А. Komaromi ◽  
M. M. Patsatsyia

The aim. The article is devoted to the methods used in combustiology practice to assess the condition of patients and predict general and local complications. Results. With severe thermal trauma, there is a risk of developing life-threatening conditions in the victims, in particular, sepsis and multiple organ failure. Informative for assessing the course of burn disease is a modified scale of physiological disorders, which takes into account the syndrome of systemic inflammatory response, endogenous intoxication during periods of toxemia and septicotoxemia, and concomitant pathology. The development of intoxication in severe burn injuries requires determining the degree of severity of the process and its assessment in dynamics. The toxicity of blood plasma is studied by the resistance of red blood cell membranes in the acid hemolysis reaction, indicators of the red blood cell intoxication index, and the content of universal markers of intoxication, in particular, medium-weight molecules. Methods for biosensor indication of cytotoxic factors have also been developed. Assessment of the severity of the condition of victims with burns and monitoring the effectiveness of therapy is carried out taking into account the level of procalcitonin and presepsin. To determine the effect of the wound process on the formation of early sepsis in patients with burns in the capillary zone of thermal damage, the content of homocysteine, endothelin and nitric oxide is studied. To assess the severity of the condition of burn patients and predict the development of complications, the values of integral hematological indices are informative. Reliable data on the depth of a burn wound are obtained using thermotopometry and pH measurement of burn wounds, the method of magnetic resonance imaging. In order to assess violations and dynamics of blood supply restoration in the area of thermal damage, the method of laser Doppler flowmetry and optical tissue oximetry is used. Determination of interstitial pressure in burns of the extremities and intra-abdominal pressure in common burns is a way to predict the development of compartment syndrome. To monitor the patient's glycemic status, it is proposed to determine the level of glycosylated hemoglobin. Microbiological research data is used to predict the risk of developing general complications of burn disease, as well as – together with cytological data and methods for determining the maturity of granulation tissue – to assess the readiness of granulating wounds for autodermoplasty. Conclusion. The development of new effective ways to predict and prevent the development of complications in burns is promising


2021 ◽  
Vol 11 (1) ◽  
pp. 25
Author(s):  
Beatriz Arranz-Martín ◽  
Patricia García-Gallego ◽  
Helena Romay-Barrero ◽  
Beatriz Navarro-Brazález ◽  
Carlos Martínez-Torres ◽  
...  

This study described the response of the bladder base (BB) by transabdominal ultrasound in primiparous women during movements that activate the abdominopelvic cavity musculature and cause variations in intra-abdominal pressure (IAP). A descriptive cross-sectional study was conducted in 64 primiparous women at eight weeks after uncomplicated delivery. BB displacement was measured using a 5-MHz convex transducer in a suprapubic position. Participants were asked to perform the isolated contraction of pelvic floor musculature (PFM) and transverse abdominis (TrA), cough at high lung volume and trunk flexion with and without maximal voluntary contraction of PFM. PFM contraction elevated the BB in all but one participant, whereas TrA contraction caused the BB to ascend in 56% of the women and descend in the rest; their combined contraction rose the BB in 65% of the women although the effect was greater with only PFM contraction (p < 0.01). The BB descended in all participants during coughing and trunk flexion although the descent was inferior with the joint maximal voluntary contraction of PFM (p < 0.01). In conclusion, TrA contraction must be assessed individually in puerperal women since its effect on the BB varies among subjects. During movements increasing IAP, such as coughing or curl-ups, the anticipatory contraction of PFM reduces bladder descent although not sufficiently to counteract bladder displacement.


2021 ◽  
Vol 17 (6) ◽  
pp. 33-41
Author(s):  
B. Küçüköztaş ◽  
L. İyilikçi ◽  
S. Ozbilgin ◽  
M. Ozbilgin ◽  
T. Ünek ◽  
...  

Objectives. Inspiratory, hemodynamic and metabolic changes occur in laparoscopic surgery depending on pneumoperitoneum and patient position. This study aims to evaluate the effects of intra-abdominal pressure increase based on CO2 pneumoperitoneum in laparoscopic operations on hemodynamic parameters and respiratory dynamics and satisfaction of surgeon and operative view.Materials and Methods. A total of 116 consecutive, prospective, ASA class I–III cases aged 18–70 years undergoing laparoscopic cholecystectomy were enrolled in this study. Data of 104 patients were analysed. Patients were divided into two groups as the group Low Pressure (<12 mmHg) (Group LP) (n=53) and the group Standard Pressure (>13 mmHg) (Group SP) (n=51). In this study administration of general anesthesia used total intravenous anaesthesia in both groups. All groups had standard and TOF monitorization applied. The anaesthesia methods used in both groups were recorded. Before, during and after peritoneal insufflation, the peroperative ventilation parameters and hemodynamic parameters were recorded. The adequacy of pneumoperitoneum, gastric and the operative view were evaluated by the operating surgeon and recorded.Results. The peripheral oxygen saturation showed no significant difference between the low and standard pressure pneumoperitoneum in view of tidal volume, respiratory rate, end tidal CO2, mean and peak inspiratory pressure, and minute ventilation values. In terms of hemodynamics, when values just after intubation and before extubation were compared, it was observed that in the LP group systolic, diastolic and mean blood pressure values were higher. In terms of heart rate, no significant difference was observed in determined periods between groups. There was no significant difference between the groups in terms of surgical satisfaction and vision.Conclusion. Low pressure pneumoperitoneum provides effective respiratory mechanics and stable hemodynamics for laparoscopic cholecystectomy. It also provides the surgeon with sufficient space for hand manipulations. Anaesthetic method, TIVA and neuromuscular blockage provided good surgery vision with low pressure pneumoperitoneum.


2021 ◽  
Vol 50 (1) ◽  
pp. 269-269
Author(s):  
Phillip Jenkins ◽  
Patrick Beer ◽  
James Cranford ◽  
Gul Sachwani-Daswani ◽  
Dean Kristl ◽  
...  
Keyword(s):  

2021 ◽  
Vol 12 (3) ◽  
pp. 38-46
Author(s):  
N. S. Morozova ◽  
A. A. Mamedov ◽  
D. Y. Lakomova ◽  
L. D. Maltseva ◽  
O. L. Morozova

Aim. To establish the effect of experimental intra-abdominal hypertension (IAH) on the teeth-jaw system of rats in the long-term period based on the study of pro-inflammatory cytokines and morphological analysis of the elements of the temporomandibular joint (TMJ) and salivary glands.Materials and methods. The experiment was carried out on 60 newborn rats; IAH was modelled by injecting collagen into the abdominal cavity to a predetermined level of intra-abdominal pressure. The rats were evenly (n = 20) divided into 3 groups: 1st - control; 2nd and 3rd - with light and severe IAH, respectively. Serum levels of IL-18, MCP-1, NGAL were determined by multiplex analysis after 10 and 120 days, VEGF-C - after 10 days - by ELISA. The morphological examination of the TMJ and salivary glands was performed using a Leica DM2000 microscope after 120 days.Results. After 10 days and 120 days, blood serum levels of NGAL, IL-18 and MCP-1 were statistically significantly increased in groups 2 and 3 compared to the control; the concentration of MCP-1 increased in proportion to the severity of the IAH with the maximum values in group 3. After 10 days, the level of VEGF was significantly increased in group 2 compared to the control group (p < 0.02). Inflammation of the TMJ was observed significantly more often in groups 2 and 3 than in the control group (p = 0.0002). In group 3, circulatory disorders and bone marrow degeneration of the TMJ, as well as inflammation, circulatory disorders and hyperplasia of the lymphoid tissue of the salivary glands were statistically significantly more often compared to groups 1 and 2.Conclusion. In the long term, experimental IAH showed an increase in the levels of markers of inflammation and hypoxia in the blood serum of rats; the severity of synovitis and sialadenitis grew with an increase in the level of intra-abdominal pressure; the maximum deviations in inflammation markers and morphological changes in the TMJ and salivary glands of rats were observed in the group with severe IAH.


2021 ◽  
Vol 12 ◽  
Author(s):  
Marijan Tepes ◽  
Slaven Gojkovic ◽  
Ivan Krezic ◽  
Helena Zizek ◽  
Hrvoje Vranes ◽  
...  

Recently, the stable gastric pentadecapeptide BPC 157 was shown to counteract major vessel occlusion syndromes, i.e., peripheral and/or central occlusion, while activating particular collateral pathways. We induced abdominal compartment syndrome (intra-abdominal pressure in thiopental-anesthetized rats at 25 mmHg (60 min), 30 mmHg (30 min), 40 mmHg (30 min), and 50 mmHg (15 min) and in esketamine-anesthetized rats (25 mmHg for 120 min)) as a model of multiple occlusion syndrome. By improving the function of the venous system with BPC 157, we reversed the chain of harmful events. Rats with intra-abdominal hypertension (grade III, grade IV) received BPC 157 (10 µg or 10 ng/kg sc) or saline (5 ml) after 10 min. BPC 157 administration recovered the azygos vein via the inferior–superior caval vein rescue pathway. Additionally, intracranial (superior sagittal sinus), portal, and caval hypertension and aortal hypotension were reduced, as were the grossly congested stomach and major hemorrhagic lesions, brain swelling, venous and arterial thrombosis, congested inferior caval and superior mesenteric veins, and collapsed azygos vein; thus, the failed collateral pathway was fully recovered. Severe ECG disturbances (i.e., severe bradycardia and ST-elevation until asystole) were also reversed. Microscopically, transmural hyperemia of the gastrointestinal tract, intestinal mucosa villi reduction, crypt reduction with focal denudation of superficial epithelia, and large bowel dilatation were all inhibited. In the liver, BPC 157 reduced congestion and severe sinusoid enlargement. In the lung, a normal presentation was observed, with no alveolar membrane focal thickening and no lung congestion or edema, and severe intra-alveolar hemorrhage was absent. Moreover, severe heart congestion, subendocardial infarction, renal hemorrhage, brain edema, hemorrhage, and neural damage were prevented. In conclusion, BPC 157 cured primary abdominal compartment syndrome.


Author(s):  
ATHIRA ROY ◽  
KRISHNA RAVI ◽  
REEJA T REJI

A hernia is a disease wherein organs or tissues, like the bowel, bulge through the abdominal wall. The etiological, as well as precipitating factors for hernia include abdominal pressure, pre-existing weakness of abdominal muscles, gender, obesity, age, diet, lack of regular exercise, and smoking. Swelling, stiffness, and discomfort seem to be the most prevalent hernia symptoms, particularly while straining, moving, or bending down. Open and laparoscopic techniques are mainly used for hernia repair, both use mesh to counterbalance the abdominal wall flaws and provide a tension-free restoration.


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