Clinical study of intra-abdominal pressure in the acute surgical abdomen
DOI:
https://doi.org/10.18203/2349-2902.isj20173385Keywords:
Abdominal compartment syndrome, Intra-abdominal pressure, Intra-abdominal hypertension, Intra-vascular pressureAbstract
Background: Intra-abdominal pressure (IAP) is the steady-state pressure concealed within the abdominal cavity. Early recognition of rising abdominal pressure is critically important, because it allows prompt intervention which will prevent Abdominal compartment syndrome (ACS) from developing, leading to a much better prognosis for the patient. This prospective case-control study was aimed at characterisation of this entity in the commonly encountered acute surgical abdomen i.e. perforation peritonitis, intestinal obstruction and the blunt abdominal trauma. The stress was laid upon the detection of the intra-abdominal pressure in the patients and the effect of this entity upon the routinely available clinical and laboratory parameters of organ functions. The organ systems studied were the renal, cardiovascular and the pulmonary systems. The clinical outcome was also analysed.
Methods: This is a prospective study conducted in Rajendra Institute of Medical Sciences, Ranchi, Jharkhand over a period of one and half year (January 2014 to June 2015). A total of 120 patients were studied, including 30 as controls. The intra-vesicular pressure was measured in all the subjects, which indirectly gives intraabdominal pressure.
Results: Initial intra-abdominal pressure ranged from 0-31 cm of saline with the mean of 13.77±8.46. The mean values of the intra-abdominal pressure in the study groups i.e acute surgical cases were found to be significantly higher, as compared to that of the control group (p<0.01). Highest mortality was observed in the IAP range of >25 cm of saline (33.33%, 4 out of 12).
Conclusions: Raised intraabdominal pressure significantly affects outcome and increases mortality.
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References
Malbrain ML, Cheatham ML, Kirkpatrick A, Sugrue M. Results from the International Conference of Experts on Intra-abdominal Hypertension and Abdominal Compartment Syndrome. I. Definitions. Intensive Care Med. 2006;32:1722-32.
Pelosi P, Croci M, Ravagnan I, Cerisara M, Vicardi P, Lissoni A. Respiratory system mechanics in sedated, paralyzed, morbidly obese patients. J Appl Physiol. 1997;82:811-8.
Hering R, Wrigge H, Vorwerk R, Brensing KA, Schröder S, Zinserling J. The effects of prone positioning on intra-abdominal pressure and cardiovascular and renal function in patients with acute lung injury. Anesth Analg. 2001;92:1226-31.
Malbrain ML, Chiumello D, Pelosi P, Bihari D, Innes R, Ranieri VM. Incidence and prognosis of intra-abdominal hypertension in a mixed population of critically ill patients: a multiple-center epidemiological study. Crit Care Med. 2005;33:315-22.
Cheatham ML, Malbrain ML, Kirkpatrick A, Sugrue M. Results from the International Conference of Experts on Intra-abdominal Hypertension and Abdominal Compartment Syndrome. II. Recommendations. Intensive Care Med. 2007;33:951-62.
Malbrain ML, Chiumello D, Pelosi P, Wilmer A. Prevalence of intra-abdominal hypertension in critically ill patients: a multicentre epidemiological study. Intens Care Med. 2004;30:822-9.
Vidal MG, Ruiz Weisser J, Gonzalez F, Toro MA, Loudet C. Incidence and clinical effects of intra-abdominal hypertension in critically ill patients. Crit Care Med. 2008;36:1823-31.
Schein M, Wittmann DH, Aprahamian CC, Condon RE. The abdominal compartment syndrome: The physioloqical and clinical consequences of elevated intra- abdominal pressure. J Am Coll Surg. 1995;180:745-53.
Kron IL, Harman PK, Nolan SP. The measurement of intra-abdominal pressure as a criterion for abdominal re-exploration. Ann Surg. 1984;199:28-30.
Iberti TJ, Kelly KM, Gentili DR, Hirsch S, Benjamin E. A simple technique to accurately determine Intra-abdominal pressure. Crit Care Med. 1987;15:1140-2.
Burch JM, Moore EE, Moore FA. The abdominal compartment syndrome. Surg Clin North Am. 1996;76:833-42.
Meldrum DR, Moore FA, Moore EE. Prospective characterization and selective management of the abdominal compartment syndrome. Am J Surg. 1997;174:667-2.
Malbrain ML, De laet I, Cheatham M. Consensus conference definitions and recommendations on intra-abdominal hypertension (IAH) and the abdominal compartment syndrome (ACS): The long road to the final publications, how did we get there? Acta Clin Belg Suppl. 2007;(1):44-59.
Reed SF, Britt RC, Collins J. Aggressive surveillance and early catheter-directed therapy in the management of intraabdominal hypertension. J Trauma. 2006;61:1359-63.
Leppaniemi A, Johansson K, De Waele JJ. Abdominal compartment syndrome and acute pancreatitis. Acta Clin Belg Suppl. 2007;(1):131-5.
Reckard JM, Chung MH, Varma MK. Management of intraabdominal hypertension by percutaneous catheter drainage. J Vasc Interv Radiol. 2005;16:1019-21.
Tuggle D, Skinner S, Garza J. The abdominal compartment syndrome in patients with burn injury. Acta Clin Belg Suppl. 2007;(1):136-40.
Corcos AC, Sherman HF. Percutaneous treatment of secondary abdominal compartment syndrome. J Trauma. 2001;51:1062-4.
Lacey SR, Bruce J, Brooks SP. The relative merits of various methods of indirect measurement of intra-abdominal pressure as a guide to closure of abdominal wall defects. J Pediatr Surg. 1987;22:1207-11.
Simon RJ, Friedlander MH, Ivatury RR, DiRaimo R, Machiedo GW. Hemorrhage lowers the threshold for intra-abdominal hypertension-induced pulmonary dysfunction. J Trauma. 1997;42(3):398-405.
Gaffney FA, Thal ER, Taylor WF. Hemodynamic effects of medical anti-shock trousers (MAST Garments). J Trauma. 1981;21:931.
Meldrum DR, Moore FA, Moore EE, Franciose RJ, Sauaia A, Burch JM. prospective characterisation and selective management of the abdominal compartment syndrome. Am J Surg. 1997;174:667-73.
Greenhalgh DG, Warden GD. The importance of intra- abdominal pressure measurements in burned children. J Trauma. 1994;36(5):685-90.
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