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ABDOMINAL HYPERTENSION OVERVIEW

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Information about ABDOMINAL HYPERTENSION OVERVIEW
Education

Published on January 7, 2009

Author: kumbanad

Source: authorstream.com

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New Concepts in Management of ABDOMINAL TRAUMA : New Concepts in Management of ABDOMINAL TRAUMA Abbreviated Laparotomy Abdominal Hypertension Enteral Nutrition ANTIBIOTICS Hollow Viscus Suture Packing ABDOMINAL HYPERTENSION OVERVIEW : ABDOMINAL HYPERTENSION OVERVIEW DR.VIJAYASARATHY Abdominal Hypertension : Abdominal Hypertension “ The end result of a progressive unchecked increase in intra abdominal pressure from a myriad of disorders that eventually leads to multiorgan dysfunction” JOHN HUNT When do you say that there is abdominal hypertension ? : When do you say that there is abdominal hypertension ? GRADING : GRADING I 12 -15 mm of Hg ii 16-20 mm of Hg iii 21-25 mm of Hg iv > 25 mm of Hg None Oliguria,? in spo2 Anuria, ?ventilatory pressure 3+? p02 What happens when there is sustained pressure : What happens when there is sustained pressure The progression of pressure Induced end organ changes -ACS Abdominal Compartment Syndrome : Abdominal Compartment Syndrome “ is result of unrecognized INTRA ABDOMINAL HYPERTENSION. If left untreated IAH will result in ACS” Measurement : Measurement DIRECT INDIRECT Measurement of IAP : Measurement of IAP Direct-placing a catheter Indirect –Bladder & Gastric pressure ABDOMINAL COMPARTMENT SYNDROME : ABDOMINAL COMPARTMENT SYNDROME 50 mL of sterile saline is instilled into the bladder via the aspiration port of the Foley catheter with the drainage tube clamped. An 18-gauge needle attached to a pressure transducer is then inserted in the aspiration port, and the pressure is measured. The transducer should be zeroed at the level of the pubic symphysis. Curr Opin Crit Care 2005; 11:333 AbViser Intra-Abdominal Pressure Monitoring Kit : AbViser Intra-Abdominal Pressure Monitoring Kit Closed system in-line with the Foley catheter. Once attached it is left in place during entire time IAP is measured. 30 seconds to measure IAP IAHT and ACS : IAHT and ACS To exercise extreme caution in multivisceral and exanguinated patients Do minimal– Abbreviated laparotomy Shift patient to ICU Stabilize Planned Intervention Abdominal perfusion Pressure : Abdominal perfusion Pressure APP= MAP-IAP APP to be optimized Abdominal Compartment Syndrome : Abdominal Compartment Syndrome Retroperitoneal Intraperitoneal Abdominal wall Chronic Risk of ACS : Risk of ACS 30-50 % of all ICU cases 1 in 11 of all ICU cases Intra Abdominal Pressure monitoring : Intra Abdominal Pressure monitoring Bladder Pressure Management : Management Fluids Measures to optimize APP Drugs Decompressive celiotomy Prevent recurrence of IAHT and ACS Decompression cocktail : Decompression cocktail 1 litre crystalloid restores preload 2 amp NaHco3 buffer acid 25grams Mannitol IAH/ACS Management: Decompressive Laparotomy : IAH/ACS Management: Decompressive Laparotomy Rigid Abdomen in ACS Post decompressive laparotomy Decompressive Laparotomy : Decompressive Laparotomy Delay in abdominal decompression may lead to intestinal ischemia Decompress Early! Decompressive Laparotomy : Decompressive Laparotomy Post-operative dressing Several days post-op ABDOMINAL COMPARTMENT SYNDROME : ABDOMINAL COMPARTMENT SYNDROME OPERATIVE DECOMPRESSION Vacuum-assisted temporary abdominal closure device: thin plastic sheet, a sterile towel, closed suction drains, and a large adherent operative drape. This dressing system permits increases in intra-abdominal volume, without a dramatic elevation in IAP. ? To be answered : ? To be answered Is routine monitoring of abdominal pressure in ICU acceptable How often ? What pressure is ideal for APP? Ideal monitoring Studies : Studies Pancreatitis- 23 patients 18 had decompessive laparotomy,these pts improved within 5 hrs. Ivatury et al: 70 patient 25 had facial suture,about 52% had IAP of > 25 mm of Hg 39% died 45 patients had laparotomy ,22% had IAHT > 25 mmof Hg 10.6 % died Final Thought : Final Thought Do NOT wait for signs of ACS to be present before you decide to check IAP By then the patient has one foot in the grave! You have lost your opportunity for medical therapy Monitor ALL high risk patients early and often: TREND IAP like a vital sign Intervene early, before critical pressure develops IAH/ACS : IAH/ACS Prevent Find Fix Slide 27: THANK YOU

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