Diagnosis and Choice of a Method of Treatment of Intraabdominal Hypertension and Abdominal Compartment Syndrome

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Abstract


BACKGROUND: Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) remain a complex problem of abdominal surgery. To date, the pathophysiological mechanisms, methods for determining intra-abdominal pressure (IAP) the frequency of its measurement, and the methods of conservative and surgical more and more researchers consider surgical decompression as a treatment. AIMS: Аnalysis of the results of the implementation of monitoring of intra-abdominal pressure and its impact on the outcomes of treatment of patients with severe acute pancreatitis and acute colon obstruction. MATERIALS AND METHODS: A study of 397 patients with emergency abdominal pathology including 197 with acute obstructive obstruction of the colon (AOOC), 200 severe acute pancreatitis (SAP) was performed. Patients (n=201) were included in the I (main) group, which was carried out using IAP as the main criterion for assessing the patient`s condition and when choosing a method of treatment, in II ― without taking then into account and monitoring. Measurement of IAP, blood lactate was determined primarily, then alternatively 4 to 6 hours. The survey included the study of biochemical indicators, endoscopic methods, visualization (ultrasound scanning, CT of the abdominal cavity organs). RESULTS: In the I group of IAH patients, I and II degrees were in 73.13%, in the II group — in 79.5% IAH III and IV degrees, respectively, in 26.87% and 21.5% (p>0.05). Measurement of IAP was carried out according to the I.L. Kron method, repeated measurement depending on the degree of IAH after 4−6 hours, simultaneously, as a predictor of internal ischemia, determined the level of lactate in blood and perfusion abdominal pressure. An algorithm for early diagnosis is suggested excess intraabdominal pressure. For I and II, the degree of IAH was treated with aggressive conservative therapy, with failure of intensive therapy III of IAH degree — surgical treatment, with IV degree IAH — emergency decompressive laparotomy. In the I group, the mortality was significantly lower than in the II group: IAH at III, with AOOC 27.7% and 50%, respectively (p>0.05), at SAP — 37.5% and 80% (p<0.01), respectively, at IV degree IAH — for AOOC — 75% and 90% (p>0.05), with SAP — 75% and 88,8% (p>0.05) respectively. CONCLUSIONS: The results of treatment of patients with IAH can be improved by its early diagnosis, intensive, aggressive therapy of IAH I−III degrees. At IAH I, II degrees conservative treatment is shown, persistent aggressive conservative treatment should be performed at IAH III degree, if it is unsuccessful and IV degree of IAH, an emergency decompressive laparotomy should be performed.


Vil M. Timerbulatov

Department of surgery Bashkir State Medical University

Email: timervil@yandex.ru
ORCID iD: 0000-0001-6410-9003

Russian Federation

MD, PhD, professor.

Ufa.

SPIN-код: 1682-1775

Shamil V. Timerbulatov

Department of surgery Bashkir State Medical University

Email: timersh@yandex.ru
ORCID iD: 0000-0002-4832-6363

Russian Federation

MD, PhD, professor.

Ufa.

SPIN-код: 7919-6659

Radik R. Fayazov

Department of surgery Bashkir State Medical University

Email: kaf-hirurg@yandex.ru
ORCID iD: 0000-0003-1890-2865

Russian Federation

MD, PhD, professor.

Ufa.

SPIN-код: 4886-8764

Mahmud V. Timerbulatov

Department of surgery Bashkir State Medical University

Email: timerm@yandex.ru
ORCID iD: 0000-0002-6664-1308

Russian Federation

MD, PhD, professor.

Ufa.

SPIN-код: 4941-3126

Elza N. Gaynullina

Department of surgery Bashkir State Medical University

Author for correspondence.
Email: ehl2368@yandex.ru
ORCID iD: 0000-0002-2320-9558

Russian Federation

MD.

Ufa.

SPIN-код: 8053-1433

Ruslan A. Smir

Department of surgery Bashkir State Medical University

Email: kaf-hirurg@yandex.ru
ORCID iD: 0000-0001-6709-9381

Russian Federation

MD, PhD.

Ufa.

SPIN-код: 9180-9392

  1. Malbrain ML, Chiumello D, Pelosi P, et al. Incidence and prognosis of intraabdominal hypertension in a mixed population of critically ill patients: a multiple-center epidemiological study. Crit Care Med. 2005;33(2):315–322. doi: 10.1097/01.ccm.0000153408.09806.1b.
  2. Meldrum DR, Moore FA, Moore EE, et al. Prospective characterization and selective management of the abdominal compartment syndrome. Am J Surg. 1997;174(6):667–672; discussion 672-673. doi: 10.1016/s0002-9610(97)00201-8.
  3. Ertel W, Oberholzer A, Platz A, et al. Incidence and clinical pattern of the abdominal compartment syndrome after “damage-control” laparotomy in 311 patients with severe abdominal and/or pelvic trauma. Crit Care Med. 2000;28(6):1747–1753. doi: 10.1097/00003246-200006000-00008.
  4. Toens C, Schachtrupp A, Hoer J, et al. A porcine model of the abdominal compartment syndrome. Shock. 2002;18(4):316–321. doi: 10.1097/00024382-200210000-00005.
  5. Kirkpatrick AW, Roberts DJ, De Waele J, et al. Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the world society of the abdominal compartment syndrome. Intensive Care Med. 2013;39(7):1190–1206. doi: 10.1007/s00134-013-2906-z.
  6. De Keulenaer BL, De Waele JJ, Malbrain ML. Nonoperative management of intra-abdominal hypertension and abdominal compartment syndrome: evolving concepts. Am Surg. 2011;77Suppl 1:S34–41.
  7. Sugrue M, Bauman A, Jones F, et al. Clinical examination is an inaccurate predictor of intra-abdominal pressure. World J. Surgery. 2002;26:1428–1431. doi: 10.1007/s00268-002-6411.
  8. Cheatham ML, Malbrain ML, Kirkpatrick A, et al. Results from the international conference of experts on intra-abdominal hypertension and abdominal compartment syndrome. II. Recommendations. Intensive Care Med. 2007;33(6):951–962. doi: 10.1007/s00134-007-0592-4.
  9. Kron IL, Harman PK, Nolan SP. The measurement of intra-abdominal pressure as a criterion for abdominal re-exploration. Ann Surg. 1984;199(1):28–30. doi: 10.1097/00000658-198401000-00005.
  10. Balogh Z, Caldwell E, Heetveld M, et al. Institutional practice guidelines on management of pelvic fracture-related hemodynamic instability: do they make a difference? J Trauma. 2005;58(4):778–782. doi: 10.1097/01.ta.0000158251.40760.b2.
  11. Simon RJ, Friedlander MH, Ivatury RR, et al. Hemorrhage lowers the threshold for intra-abdominal hypertension-induced pulmonary dysfunction. J Trauma. 1997;42(3):398−403; discussion 404–405. doi: 10.1097/00005373-199703000-00006.
  12. Balogh Z, McKinley BA, Holcomb JB, et al. Both primary and secondary abdominal compartment syndrome can be predicted early and are harbingers of multiple organ failure. J Trauma. 2003;54(5):848–859; discussion 859−861. doi: 10.1097/01.ta.0000070166.29649.f3.

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