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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Intraabdominal hypertension and abdominal compartment syndrome are increasingly recognized as potential complications in patients who have significant intraabdominal trauma. Intraabdominal hypertension and abdominal compartment syndrome affect all body systems, most notably the cardiac, respiratory, renal, and neurologic systems. This complication also affects blood flow to various intraabdominal organs and may play a significant role in the sepsis and multiple organ failure syndrome seen in many trauma patients. Nursing knowledge of the risk factors and clinical signs of intraabdominal hypertension and abdominal compartment syndrome can reduce the morbidity and mortality associated with this syndrome.
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PMID:Intraabdominal hypertension and abdominal compartment syndrome in trauma: pathophysiology and interventions. 1034 91

Pathologic conditions affecting the abdomen are a significant cause of morbidity and mortality in the intensive care unit, but their importance is not widely recognized. This article presents several aspects of abdominal pathology that can occur in intensive care unit patients. This pathology may have a considerable impact on the prognosis and survival of the critically ill patient. The diagnostic contribution of laboratory tests and imaging is discussed. Conditions such as the abdominal compartment syndrome, acute mesenteric ischemia, gastrointestinal bleeding, diarrhea, abdominal sepsis, complications of entereal and parenteral nutrition, and ileus in critically ill patients are also reviewed.
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PMID:Gastrointestinal complications in the intensive care unit. 1038 60

Sepsis, cellulitis, and necrotizing fasciitis rarely have been described as causes of compartment syndrome. We report a case in which forearm compartment syndrome presented as the initial symptom of systemic infection. Vibrio vulnificus, the etiologic pathogen of the compartment syndrome, was isolated from wound and blood cultures. The patient was treated with systemic antibiotic treatment and multiple forearm fasciotomies. The infectious process progressed rapidly, however and due to underlying liver insufficiency, the patient died of hepatorenal syndrome. This case illustrates the nature of V. vulnificus infections, which are characterized by shellfish transmission, predilection for soft tissue seeding, and a fulminant course in the compromised host.
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PMID:Compartment syndrome of the forearm as the initial symptom of systemic Vibrio vulnificus infection. 1044 62

We present the case of a woman who had coagulopathy and sepsis and who developed compartment syndrome of the arm. We discuss recognition and treatment of arm compartment syndrome and review the literature regarding this condition.
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PMID:Compartment syndrome of the arm and disseminated intravascular coagulation. 1137 Sep 50

Pediatric trauma management requires both operative and nonoperative (supportive) care. Fewer than 15% of pediatric trauma patients require surgery (Children's Hospital of Michigan Registry Data, excluding fractures), and the primacy of closed head injury and the multisystem nature of pediatric trauma dictate assessment and therapy. Complications arise at every level, including fluid resuscitation (too much or too little), antibiotics (too late), or pain control (inadequate). The institution of mechanical ventilation that is usually life-saving carries its own risks including those associated with intubation (perforation, aspiration, pro longed endotracheal intubation (stricture, pneumonia), and barotrauma (ventilator-induced lung injury). Minor procedures, such as thoracentesis, chest tube insertion, and pericardiocentesis, can all be complicated by perforation and hemorrhage. Major interventions, including laparotomy and thoracotomy, can result in hemorrhage, air leak, abdominal compartment syndrome, phrenic nerve and thoracic duct injury, postoperative abscess, and septicemia. Transfusion, cardiopulmonary bypass, and invasive monitoring can result in coagulopathy and vascular injury. Prolonged resuscitation and operative explorations can cause hypothermia and coagulopathy and initiate a cascade of multiorgan failure and ARDS. There is no doubt that rapid evacuation, prompt resuscitation, and organized systems of pediatric trauma care have reduced the overall mortality of childhood trauma. The higher velocity of travel and an increasingly chaotic urban environment have resulted in more multitrauma cases and in injuries of higher severity requiring more sophisticated and complicated diagnostic and therapeutic modalities. Our ability to identify life-threatening injuries, to provide expedited and definitive care, and to reduce and detect the complications predicted by these injuries and their treatment will result in long-term improvements in survival and significant reductions in morbidity.
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PMID:Pulmonary and respiratory complications of pediatric trauma. 1158 5

A victim of a motor accident was referred to the Emergency Department. He was unconscious, breathing was rapid and shallow, and had a mean arterial pressure of 60 mmHg with a distended abdomen. A peritoneal lavage was positive for blood. An immediate laparotomy showed a massive hepatic injury with bilobar disruptions. After an unsuccessful hepatorrhaphy an extensive perhepatic gauze packing was done. During the operation the patient was massively transfused and high doses of dopamine were used. At the end a relative stability was reached, but a few hours later, due to the high risk of sepsis and abdominal compartment syndrome, a second laparotomy was performed. Despite efforts to reach a good hemostasis, it was decided to perform a total hepatectomy and portocaval shunt. The patient was put on the waiting list for a compatible liver. After 36 h in this anhepatic state, the patient received the new graft. The graft showed immediate recovery. In cases of severe and complex liver trauma, performing a total hepatectomy followed by liver transplantation is justified.
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PMID:A blunt complex abdominal trauma: total hepatectomy and liver transplantation. 1181 7

Abdominal Compartment Syndrome (ACS) has multiple causes, and decompressive laparotomy has been the most frequent modality to prevent worsening cardiovascular, respiratory, and renal function. This pilot study evaluated the utility of percutaneous drainage (PD) of peritoneal fluid compared with decompressive laparotomy in burn patients. A 26-month review was conducted. Nine of 13 (69%) study patients developed intra-abdominal hypertension (IAH) that progressed to abdominal compartment syndrome in 4 (31%). All were treated with PD using a diagnostic peritoneal lavage catheter. Peritoneal fluid analysis revealed a sterile plasma ultrafiltrate with electrolyte and other chemistries reflecting patient serum levels. Five patients underwent PD successfully, and their IAH did not progress to ACS. Four patients with greater than 80% TBSA and severe inhalation injury did not respond to PD and required decompressive laparotomy. There was no evidence of bowel edema, ischemia, or necrosis. All patients requiring decompressive laparotomies died either from sepsis or respiratory failure. Percutaneous decompression is a safe and effective method of decreasing IAH and preventing ACS in patients with less than 80% TBSA thermal injury.
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PMID:A pilot study comparing percutaneous decompression with decompressive laparotomy for acute abdominal compartment syndrome in thermal injury. 1203 69

Intraosseous (IO) puncture is considered for the administration of drugs and fluids when vascular access cannot be achieved rapidly. Adrenaline/epinephrine, adenosine, crystalloids, colloids and blood products can be applied and administered effectively using this route during resuscitation of children. This technique is relatively simple with complications of <1%. These may include tibial fracture, lower extremity compartment syndrome and osteomyelitis. A case is described in which a 3-month-old male infant presented for emergency resuscitation requiring IO infusion utilising both tibial bones. High doses of adrenaline (1:1000; 0.1 mg/kg) were administered in the right tibial epiphysis only after the standard initial concentration (1:10000; 0.01 mg/kg) had minimal effect. A local inflammatory reaction was noted 24 h later in the right tibial region, which developed into cutaneous necrosis, and was eventually resected. Radiologically, no osseous lesion could be demonstrated, however, a bone scintigram revealed osteomyelitis. Upon surgical revision, purulent destruction was evident requiring removal of the epiphysis and part of the metaphysis. Although osteomyelitis is a rare complication which may be caused by sepsis, or contamination during insertion, we speculate that adrenaline in high concentrations may promote the development of osteomyelitis and the drug should be applied cautiously in more diluted concentrations.
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PMID:Osteomyelitis at the injection site of adrenalin through an intraosseous needle in a 3-month-old infant. 1206 48

We report the case of a 55 year old woman who developed abdominal compartment syndrome [ACS] following total gastrectomy for caustic ingestion. Contributing factors for the development of ACS included peritonitis and massive fluid resuscitation for cardiovascular support of septic shock. The adverse cardiovascular and pulmonary effects of intra-abdominal hypertension [IAH] were reversed with pharmacological neuromuscular blockade [NMB]. Surgical decompression of ACS was, therefore, postponed, but the patient required re-operation for intra-abdominal sepsis several days later and subsequently died. Although medical management of ACS with NMB may lower IAH and reverse its negative cardiopulmonary effects, surgical decompression may still be required for definitive treatment.
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PMID:Medical management of abdominal compartment syndrome: case report and a caution. 1237 24

The First Surgical Clinic of the First Medical Faculty of Charles University and General Faculty Hospital in Prague made operations of the pancreas ever since 1971. In the work sooner or later all approaches to surgical treatment pancreatitis were reflected. The authors present a brief review of results and their own experience since 1994 when duodenum-sparing operations were introduced. Indications for surgical treatment were based on the diagnosis by US, CT and ERCP, in exceptional case MR, after evaluation by a pancreatologist, roentgenologist and surgeon. The group of patients with chronic pancreatitis was extended by 21 patients from a group operated because of preoperative suspicion of a malignant pancreatic tumour not confirmed during and after surgery. In those Whipple's operation was preformed. The same operation was performed in three patients with chronic pancreatitis with serious changes in the area of the head of the pancreas. In 123 patients a drainage and duodenum sparing operation was preformed, of these in 57 according to Beger, 19 according to Frey, 37 Partington-Rochelle's procedure. The authors record two sepsis postoperative complications after the classical Beger operation and the hospital stay was on average by five days shorter as compared with the classical method of Whipple. When evaluating postoperative complaints and problems (pain, malnutrition, physical constitution and social position) the authors recorded equally favourable results as after non-complicated duodenopancreatectomy. They varied, depending on the patients co-operation round 84-87% while authors consider Beger's operation logical because of the removal of the main tissue mass of the head of the pancreas, responsible for pain, complications caused by fibrosis in the area round the bile duct and duodenum, responsible for the deteriation of the compartment syndrome in the left half of the gland. Its result is destruction of the remainder of exocrine and endocrine tissue. Of 187 operated patients one patient with decompensated diabetes died postoperatively. Based on their own experience the authors do not consider repeated re-operations an absolute contraindication of Beger's operation when conditions permit. A problem is, in their opinion, fibrosis in the vicinity of the pancreas and portal overpressure.
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PMID:[Choice of surgical procedure in operations for chronic pancreatitis--personal experience]. 1268 39


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