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Query: UMLS:C0020538 (hypertension)
170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Bladder pressure measurement through a foley catheter is the current standard in monitoring for intraabdominal hypertension (IAH) and abdominal compartment syndrome (ACS). Accurate pressure transduction requires a continuous fluid column with a small volume of transducing medium at the tip of the catheter. Infusing excessive fluid volume can falsely elevate the measured intra-abdominal pressure (IAP) due to bladder overdistention and can lead to intrinsic muscular contraction. This effect can be seen with volumes as low as 60 mL. Recent expert consensus has recommended 25 mL as the maximal infusion volume; however, 50 mL is the most commonly cited volume of infusion in the literature. The purpose of this analysis was to determine the variance between IAP values using a range of volume infusions between 10 and 60 mL. Eighteen adult, surgical intensive care unit (SICU) patients who were undergoing IAP measurement for IAH or clinically indicated monitoring were enrolled in a prospective, nontreatment study. Intra-abdominal pressure measurements were obtained with stepwise increases of injectate volume from 10 to 60 mL (in 10 mL increments). Bland-Altman analyses and receiver operating characteristic (ROC) curves were used for analysis. After analysis accounting for data correlation within patients, means and standard deviations were generated for differences between 50 mL and 10, 20, 30, 40, and 60 mL bladder infusion volumes. Bland-Altman analyses showed good agreement between measurements and no significant difference in variance (mean < or =1.35 mm Hg) between volume comparisons. The ROC curve generated for each test volume using a diagnostic pressure value for IAH (!12 mm Hg) showed that a value between 11 and 12 mm Hg gave the best combination of sensitivity and specificity for all test volumes. In SICU patients, with a clinical indication for IAP monitoring, bladder infusion volumes between 10 mL and 60 mL provide consistent IAP measurements.
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PMID:A comparison of infusion volumes in the measurement of intra-abdominal pressure. 1961 30

Patients who undergo open repair of ruptured abdominal aortic aneurysms (rAAA) may require delayed abdominal wound closure to prevent the adverse consequences of intra-abdominal hypertension and abdominal compartment syndrome. However, surgeons may be reticent to use delayed abdominal closure techniques due to concern that such management may increase the risk of graft infection. We retrospectively reviewed our patient experience with rAAA and other vascular catastrophes in which vacuum-pack abdominal wound management with delayed closure was used between 2000 and 2007. Eighteen of 23 patients treated with delayed closure survived (78%). In five early deaths, graft infection was not clinically suspected. Sixteen of 20 rAAA patients survived, with abdominal wound closure achieved at a mean of 4 days. Mean follow up was 53 months, the longest among comparable series. Graft infection has not been encountered in this group. Our results suggest that the potential risk of graft infection should not outweigh the benefits of vacuum-pack temporary abdominal wound management with delayed closure in critically ill patients at high risk for intra-abdominal hypertension and abdominal compartment syndrome after major abdominal vascular procedures.
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PMID:Vacuum-pack temporary abdominal wound management with delayed-closure for the management of ruptured abdominal aortic aneurysm and other abdominal vascular catastrophes: absence of graft infection in long-term survivors. 1965 99

Well leg compartment syndrome is rare after laparoscopic radical prostatectomy. We report a 68-year-old man that developed compartment syndrome after laparoscopic radical prostatectomy for prostate cancer. There are several circumstantial risk factors associated with LRP that, when combined, may potentially predispose to the development of compartment syndrome, including: obesity, evidence of peripheral vascular disease (advanced age, hypertension, hyperlipidemia, and diabetes mellitus), thromboembolism prophylaxis with compressive leg wraps together with intermittent pneumatic devices, combined general-spinal anesthesia, prolonged operative time in Trendelenburg position, and systemic hypotension due to intraoperative bleeding. The pathogenesis of this serious complication is discussed and preventive measures are highlighted.
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PMID:[Combined risk factors leading to well-leg compartment syndrome after laparoscopic radical prostatectomy]. 1990 Mar 89

Intra-abdominal hypertension (IAH) and abdominal compartment syndrome are increasingly observed in patients with severe acute pancreatitis (SAP). The aim of this study was to investigate the effects of IAH on pancreatic histology and ultrastructure in a porcine model. We examined 16 intubated and anesthetized domestic pigs with a mean body weight of 50.6 (SD, 3.8) kg. Using a CO2 pneumoperitoneum, the intra-abdominal pressure was increased to 30 mmHg for an investigation period of 6 or 12 h (each study group n = 6). In the control group, the intra-abdominal pressure remained 3.9 (SD, 5.4) mmHg for 12 h. Additional Ringer's solution was infused to maintain cardiac output at the level of controls. After the observation period, specimens were taken for histological and ultrastructural analysis, and animals were killed. Cardiac output did not change when compared with control. Histologically, mild- to moderate-grade necrosis was observed after 12 h of IAH. In the ultrastructural analysis, leukocyte infiltration and swelling of endothelial cells were found. In the acinar cells of the exocrine pancreas, endoplasmic reticulum was dilated, and necrosis was noticed. Mitochondrial damage manifested as cisternal destruction with formation of large vacuoles. In this porcine model, 6 and 12 h of IAH resulted in light-microscopical and ultrastructural changes comparable to pancreatitis in humans. As SAP is often accompanied by IAH, the finding of the underlying study suggests a vicious cycle in which IAH may worsen pancreatitis. Ultimately, these findings are in favor of a decompression in patients with SAP and IAH.
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PMID:Histomorphologic and ultrastructural lesions of the pancreas in a porcine model of intra-abdominal hypertension. 1994 Aug 13

Intra-abdominal hypertension (IAH) after damage control laparotomy (DCL) is not unusual and because of this, patients are treated with open-abdomen techniques to prevent abdominal compartment syndrome (ACS). The occurrence of recurrent ACS (R-ACS) after abdominal wall closure under tension in patients managed with DCL can be a trigger factor for second hit syndrome. Outcomes in this subset have not been previously described. In this 1-year retrospective study of severely injured patients in a Level I trauma center managed with DCL and sequential abdominal wall closure, 26 patients were identified. After attempted abdominal wall closure, 13 (50%) patients had R-ACS and 13 (50%) non-R-ACS. R-ACS patients had a statistically significant higher incidence of multisystem organ failure, acute respiratory distress syndrome, and sepsis as well as requiring longer ventilator support and longer hospital length of stay. We concluded that failure to recognize and treat IAH with development of R-ACS after tension abdominal wall closure in patients with DCL will trigger the second hit syndrome with increased risk of morbidity. Institution of a management algorithm with intra-abdominal pressure/abdominal perfusion pressure surveillance at the time of abdominal wall closure can potentially ameliorate complications.
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PMID:Recurrent abdominal compartment syndrome: an inciting factor of the second hit phenomenon. 1999 11

We report for the first time a case of acute kidney injury associated with severe gastric distention after a laparoscopic Nissen-Rossetti fundoplication of the stomach for hiatal hernia. An abdominal compartment syndrome secondary to intra-abdominal hypertension was suspected. Naso-gastric tube decompression resulted in immediate resaturation of the diuresis and progressive recovery of renal function.
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PMID:Massive gastric dilatation and anuria resolved with naso-gastric tube decompression. 2004 Dec 95

Abdominal compartment syndrome is a lethal yet under appreciated complication of vascular surgery. The World Society of Abdominal Compartment Syndrome conference in 2004 culminated recent research to formulate the internationally accepted definitions and promote education, in an attempt to reduce a quoted 82% mortality. The syndrome has a broad aetiology, many of which are pertinent to vascular surgery and particularly to ruptured aortic aneurysms. It is defined as an intra-abdominal pressure greater than 12 mm Hg or an abdominal perfusion pressure less than 60mm Hg, in the presence of end organ dysfunction and ultimately leads to multi-organ failure. The physiological derangements which occur in all major organ systems are generally well documented and an understanding of them paramount to early recognition. Numerous methods have been devised to measure intra-abdominal pressure and ideally, measurements utilising a catheter and pressure transducer should be taken in high risk patients yet very few clinicians have measured it. This is essential for diagnosis and also allows grading of the hypertension as clinical and radiological examination does not provide any conclusive information. Appropriate post operative wound closure has an important role in prevention of the syndrome, which would otherwise be treated by surgical decompression. Negative pressure dressings appear to be most beneficial but further prospective trials are required to clarify this.
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PMID:Abdominal compartment syndrome in vascular surgery - A review. 2007 77

Postoperative intra-abdominal hypertension (IAH) is a frequent occurrence in critically ill patients operated on for severe abdominal trauma, secondary peritonitis or ruptured abdominal aortic aneurysm. IAH may progress to abdominal compartment syndrome (ACS) with new-onset organ dysfunction. Early recognition of IAH and interventions that prevent the development of ACS may preserve vital organ functions and increase the probability of survival. The best method to prevent postoperative ACS is to leave the abdomen open during the operation. The decision to leave the abdomen open is usually based on the surgeon's judgment without intra-abdominal pressure (IAP) measurements during the operation. Because significant morbidity and mortality are associated with the open abdomen, the measurement of IAP immediately after the fascial closure, when feasible, could offer an objective method for determining the optimal IAP threshold for leaving the abdomen open. The management of the open abdomen requires a temporary abdominal closure (TAC) system that would ideally prevent the development of ACS and facilitate later primary fascia closure. Among several TAC systems, the most promising are those that provide negative pressure to the wound or continuous fascial traction or both.
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PMID:Prophylactic open abdomen in patients with postoperative intra-abdominal hypertension. 1996 14

The main focus when discussing acute or chronic mesenteric ischemia is on occlusive disease, arterial or venous. This article reviews present knowledge on mesenteric nonocclusive hypoperfusion syndromes. The following three clinical entities are reviewed: (1) Intraabdominal hypertension (IAH), or abdominal compartment syndrome (ACS), is important after ruptured abdominal aortic aneurysm repair. IAH >20 mm Hg occurs in approximately 50% of patients after open repair and in 20% after endovascular repair of ruptured abdominal aortic aneurysm, but these patients are different and no randomized data exists yet. A consensus issued by the World Society of Abdominal Compartment Syndrome provides guidance. Early conservative treatment of IAH and, alternatively, abdominal closure devices for leaving the abdomen partially open temporarily are discussed and a treatment algorithm is suggested. (2) Colonic ischemia after abdominal aortic surgery, its risk factors, clinical presentation, and treatment are discussed. A significant number of such patients develop IAH and reducing the abdominal perfusion pressure affects the left colon, the sentinel organ in these patients. (3) Nonocclusive mesenteric ischemia (NOMI); most often such patients suffer from severe cardiac failure requiring massive inotropic support. The condition is difficult to define. Early diagnosis with multidetector row computed tomography is a worthwhile alternative when angiography presents difficulties. A stenosis of the superior mesenteric artery is frequently enough that it should be ruled out because endovascular treatment can be lifesaving. New knowledge on these three different mesenteric hypoperfusion syndromes is reviewed. Success in treating these difficult patients is benefited from a multidisciplinary approach.
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PMID:Nonocclusive mesenteric hypoperfusion syndromes: recognition and treatment. 2029 50

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.
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PMID:Linea alba fasciotomy: a novel alternative in trauma patients with secondary abdominal compartment syndrome. 2034 63


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