Abdominal Compartment Syndrome - R. Ivatury (Landes, 2006) WW

326 Pages·2006·18.76 MB·English

MEDICAL INTELLIGENCE UNIT

Rao R. Ivatury, Michael L. Cheatham,
Manu L. N. G. Malbrain and Michael Sugrue

Abdominal Compartment Syndrome

Abdominal Compartment
Syndrome

IVATURY • CHEATHAM
MALBRAIN • SUGRUE

MIU

MEDICAL INTELLIGENCE UNIT

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ISBN 1-58706-196-1

9 7 8 1 5 8 7 0 6 1 9 6 7

Rao R. Ivatury, M.D.
Division of Trauma, Critical Care and Emergency Surgery
Department of Surgery
Virginia Commonwealth University
VCU Reanimation Engineering Shock Center (VCURES)
Richmond, Virginia, U.S.A.

Michael L. Cheatham, M.D.
Department of Surgical Education
Orlando Regional Medical Center
Orlando, Florida, U.S.A.

Manu L. N. G. Malbrain, M.D.
Intensive Care Unit
ZiekenhuisNetwerk Antwerpen
Campus Stuivenberg
Antwerp, Belgium

Michael Sugrue, M.D.
Department of Trauma
Liverpool Hospital
Liverpool, Sydney, Australia

Abdominal Compartment
Syndrome

MEDICAL
INTELLIGENCE
UNIT

EUREKAH.COM
GEORGETOWN, TEXAS
U.S.A.

LANDES BIOSCIENCE
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U.S.A.

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ISBN: 1-58706-196-1

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and usage of equipment and devices, as set forth in this book, are in accord with current recommend-
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Library of Congress Cataloging-in-Publication Data

Abdominal compartment syndrome / [edited by] Rao R. Ivatury ... [et
al.].
p. ; cm. -- (Medical intelligence unit)
Includes bibliographical references and index.
ISBN 1-58706-196-1
1. Abdomen--Diseases. 2. Compartment syndrome. I. Ivatury,
Rao R. II. Series: Medical intelligence unit (Unnumbered : 2003)
[DNLM: 1. Abdomen--physiopathology. 2. Compartment Syndromes.
3. Hypertension. WI 900 A1334 2006]
RC944.A163 2006
617.5'5--dc22
2006012693

ABDOMINAL COMPARTMENT SYNDROME

To the memory of my parents and to my family:
Leela, Gautam and Arun. Your patience, love and support
is the greatest gift. I am forever grateful.
Rao R. Ivatury

To my wife Susie and my daughters, Kaitlin, Amelia,
Julianne and Melinda. Thank you for your unwavering
love and support.
To my father and mother. Thank you for the example
you have always been for me.
Michael L. Cheatham

To the memory of Dr. Hubert Malbrain, my inspiring father, colleague
and friend.
I'm in gratitude to my devoted wife Bieke, who experienced a husband
“never being there when needed most.”
To share my passion, success, failure and dreams with her
is still a pleasant never ending story to me.
I also thank my three sons, Jacco, Milan and Luca for always providing a
quiet writing environment.
I thank my parents who gave me the opportunity to study medicine and
to develop my talents.
Manu L. N. G. Malbrain

To my family: Pauline, Conor, Alan, Gavin and Ryan.
Thanks for being there and allowing me the time
to work on ACS.
Michael Sugrue

CONTENTS

Foreword ............................................................................................ xvii

Preface ................................................................................................ xix

1. Abdominal Compartment Syndrome: Historical Background ................1
Moshe Schein
What Is History? ................................................................................... 1
Early Rays of Light ................................................................................ 2
The Dark Age........................................................................................ 3
Dawn .................................................................................................... 4
Sunrise .................................................................................................. 4
Morning ................................................................................................ 5
High Noon ........................................................................................... 5

2. Definitions .............................................................................................8
David J. J. Muckart, Rao R. Ivatury, Ari Leppäniemi
and R. Stephen Smith
Historical Background........................................................................... 8
Consensus Definitions......................................................................... 11

3. Intra-Abdominal Pressure Measurement Techniques ...........................19
Manu L. N. G. Malbrain and Felicity Jones
What Is IAP? ....................................................................................... 19
Indications for IAP Monitoring ........................................................... 20
Clinical Evaluation .............................................................................. 20
Invasive Direct IAP Measurement (Gold Standard) ............................. 26
Noninvasive Indirect IAP Measurement (Gold Standard).................... 27
Different Indirect IAP Measuring Methods ......................................... 28
Cost-Effectiveness ............................................................................... 56
Reproducibility of IAP Measurement .................................................. 58

4. Abdominal Perfusion Pressure .............................................................69
Michael L. Cheatham and Manu L. N. G. Malbrain
Physiology ........................................................................................... 70
Theory ................................................................................................ 72
Clinical Studies ................................................................................... 73
Clinical Application ............................................................................ 77

5. Prevalence and Incidence of Intra-Abdominal Hypertension................82
Dries H. Deeren and Manu L. N. G. Malbrain
Definitions .......................................................................................... 82
To Compare Cats and Dogs ................................................................ 82
Prevalence Rate ................................................................................... 83
Cumulative Incidence.......................................................................... 83

6. Intra-Abdominal Hypertension and the Cardiovascular System ...........89
Michael L. Cheatham and Manu L. N. G. Malbrain
Physiology ........................................................................................... 90
Hemodynamic Monitoring ................................................................. 92

7. Intra-Abdominal Hypertension and the Respiratory System ..............105
Ingrid R. A. M. Mertens zur Borg, Serge J. C. Verbrugge
and Claudia I. Olvera
Pulmonary Dysfunction with Increased Abdominal Pressure ............. 106
Physiological Derangements Due to Pulmonary Dysfunction
in ACS .......................................................................................... 107
Physiological Derangements Caused by Mechanical Ventilation........ 107
Principles of Mechanical Ventilation in ARDS/ALI in ACS .............. 108
Modes of Positive-Pressure Ventilation.............................................. 109
Lung Function Monitoring ............................................................... 111
Cardiovascular Effects of Mechanical Ventilation in ACS.................. 112
Weaning and Extubation................................................................... 112

8. Intra-Abdominal Hypertension and the Kidney ................................. 119
Michael Sugrue, Ali Hallal and Scott D’Amours
Is There Supportive Evidence from Human Experiments?................. 120
Does It Make Physiological Sense? .................................................... 121
Pathophysiology of Renal Impairment and IAH ................................ 122
Is There a Strong Association That Is Consistent from Study
to Study? ....................................................................................... 124
Is the Temporal Relationship Right? ................................................. 124
Is There a Dose Response Relationship and Is It Reversible? ............. 125
Is the Association Independent of Other Confounding Factors? ........ 125
Is There Evidence from Human Experiments? .................................. 125

9. Intra-Abdominal Hypertension and the Splanchnic Bed .................... 129
Rao R. Ivatury and Lawrence N. Diebel
IAH and Splanchnic Flow ................................................................. 129
Laparoscopy and IAH........................................................................ 131
Inotropes and IAH-Induced Splanchnic Hypoperfusion.................... 132
IAH and Multi-Organ Dysfunction Syndrome (MODS) .................. 134

10. Intra-Abdominal Hypertension and the Liver .................................... 138
Julia Wendon, Gianni Biancofiore and Georg Auzinger
Intra-Abdominal Pressure (IAP) and Portosystemic
Visceral Dysfunction ..................................................................... 139
Pathophysiology of IAH in Acute Liver Failure ................................. 139

Intra-Abdominal Pressure in Liver Transplant Recipients:
Incidence and Clinical Relevance .................................................. 140
Haemodynamic Monitoring in Patients with Liver Disease
and IAH ........................................................................................ 141

11.
Intra-Abdominal Hypertension and the Central Nervous System.......144
Giuseppe Citerio and Lorenzo Berra
Animal Studies .................................................................................. 145
Clinical Studies ................................................................................. 149

12.
Abdominal Compartment Syndrome Provokes Multiple Organ
Failure: Animal and Human Supporting Evidence .............................157
Christopher D. Raeburn and Ernest E. Moore
Background ....................................................................................... 157
Association of ACS with MOF .......................................................... 158
ACS as a Cause of MOF.................................................................... 161

13.
Postinjury Secondary Abdominal Compartment Syndrome ...............170
Zsolt Balogh and Frederick A. Moore
Definition and Historical Perspectives ............................................... 170
Epidemiology .................................................................................... 170
Prediction.......................................................................................... 172
Diagnosis of Secondary ACS ............................................................. 175
Treatment ......................................................................................... 175
Prediction, Prevention and Surveillance............................................. 175
Future Directions .............................................................................. 176

14.
Secondary Abdominal Compartment Syndrome in Burns ..................178
Michael E. Ivy
The Burn Literature .......................................................................... 179
Fluid Resuscitation Issues .................................................................. 183

15.
Morbid Obesity and Chronic Intra-Abdominal Hypertension ...........189
Giselle G. Hamad and Andrew B. Peitzman
Morbid Obesity and Weight-Related Comorbidities ......................... 189
Hemodynamic Alterations in Obesity................................................ 190
Pseudotumor Cerebri ........................................................................ 191
Pulmonary Abnormalities and Obesity .............................................. 192
Gastroesophageal Reflux .................................................................... 193
Genitourinary System........................................................................ 193
Incisional Hernias ............................................................................. 193

16. Miscellaneous Conditions and Intra-Abdominal Hypertension ..........197
Ari Leppäniemi, Andrew Kirkpatrick, Anastazia Salazar, Davis Elliot,
Savvas Nicolaou and Martin Björck

Part A: Severe Acute Pancreatitis ........................................................197
Ari Leppäniemi
Prevalence ......................................................................................... 199
Time of the Development of ACS ..................................................... 199
ACS and Organ Dysfunction ............................................................ 200
Diagnosis .......................................................................................... 200
Treatment ......................................................................................... 200
Mortality ........................................................................................... 201

Part B: The Renal Allograft Compartment Syndrome in Perspective:
An Organ Specific Compartment Syndrome with Illustrative
Pathophysiology .................................................................................203
Andrew Kirkpatrick, Anastazia Salazar, Davis Elliot
and Savvas Nicolaou
The Renal Allograft Compartment Syndrome ................................... 203
Sonography of the Renal Allograft ..................................................... 204
Is There a Potential Utility in the Native Kidney Subjected
to Raised Intra-Abdominal Pressure? ............................................. 204
The Reality of the ACS Patient and Other Potential Technologies .... 205
Future Directions .............................................................................. 208

Part C: Abdominal Compartment Syndrome
after Aortoiliac Surgery ......................................................................210
Martin Björck
Incidence of ACS after Open Aortoiliac Surgery................................ 210
Incidence of IAH/ACS after Endovascular Repair of AAA ................. 212
The Onset of IAH/ACS .................................................................... 212
Controversial Issues ........................................................................... 215

17. Abdominal Compartment Syndrome in the Pediatric Patient ............ 217
M. Ann Kuhn and David W. Tuggle

18. Prevention of Abdominal Compartment Syndrome ...........................223
John C. Mayberry
Contributing Factors and Warning Signs .......................................... 223
Prevention by Surveillance................................................................. 225
Prevention by Limiting Resuscitation ................................................ 225
Prevention by Prophylactic Temporary Abdominal Closure .............. 226
Medical Prevention ........................................................................... 228

19.
Medical Management of Abdominal Compartment Syndrome ..........232
Michael J. A. Parr and Claudia I. Olvera
Specific Procedures to Reduce IAP and the Consequences of ACS .... 233
General Support (Intensive Care) of the Critically Ill Patient ............ 237
Optimisation after Surgical Decompression to Counteract Adverse
Effects Associated with Decompression and Prevent Recurrence ... 238

20.
Continuous Negative Abdominal Pressure .........................................240
Franco Valenza and Luciano Gattinoni
Does NEXAP Decrease Intra-Abdominal Pressure? ........................... 241
Are There Problems with NEXAP Application?................................. 243
Does NEXAP Alter General Hemodynamics, and to What Extent?... 243
Does NEXAP Alter Respiratory Mechanics? ...................................... 245
Is NEXAP Effect Different Before and After IAH? ............................ 247
Clinical Perspectives .......................................................................... 251

21.
Anesthetic Considerations in Abdominal Compartment Syndrome ...254
Ingrid R. A. M. Mertens zur Borg, Serge J. C. Verbrugge
and Karel A. Kolkman
Anesthetic Management .................................................................... 254
Mechanical Ventilation ..................................................................... 258
Fluid Management ............................................................................ 259
Laparotomy ....................................................................................... 261

22.
Surgical Management of Abdominal Compartment Syndrome ..........266
Zsolt Balogh, Frederick A. Moore, Claudia E. Goettler,
Michael F. Rotondo, C. William Schwab and Mark J. Kaplan

Part A: The Surgical Management of Abdominal
Compartment Syndrome
Zsolt Balogh and Frederick A. Moore
Temporary Abdominal Closure (TAC).............................................. 266
Towel Clip Closure ........................................................................... 267
Bogotá Bag ........................................................................................ 267
Mesh Closure .................................................................................... 267
Vacuum Assisted Wound Closure (VAWC) ...................................... 268
Our Approach ................................................................................... 268

Part B: Surgical Management of the Open Abdomen After Damage
Control or Abdominal Compartment Syndrome
Claudia E. Goettler, Michael F. Rotondo and C. William Schwab
Indications for Open Abdomen ......................................................... 271
Temporary Abdominal Containment ................................................ 272
Resuscitation Period (Damage Control Part 2) .................................. 273
Managing and Changing Temporary Closure.................................... 276
Transitional Closure .......................................................................... 277
Tubes and Stoma in the Open Abdomen .......................................... 279
Fistulae .............................................................................................. 279
Definitive Abdominal Wall Repair .................................................... 280

Part C: Surgical Approaches to the Open Abdomen
Mark J. Kaplan
Pathophysiology of the Open Abdomen ............................................ 284
Morbidity Associated with the Open Abdomen................................. 285
Intra-Abdominal Hypertension and the Open Abdomen .................. 285
Methods of Managing the Open Abdomen ....................................... 287
Skin Only Closure ............................................................................. 288
Bogotá Bag ........................................................................................ 288
Mesh Closure of the Open Abdomen ................................................ 290
VAC Pac Closure .............................................................................. 291
Negative Pressure Therapy (NPT) ..................................................... 291
Closure of the Open Abdomen.......................................................... 293

23. Epilogue: Options and Challenges for the Future...............................297
Michael L. Cheatham, Rao R. Ivatury, Manu L. N. G. Malbrain
and Michael Sugrue
Education .......................................................................................... 298
Consensus Definitions....................................................................... 299
Research ............................................................................................ 300
Technology Development ................................................................. 301
World Society on Abdominal Compartment Syndrome (WSACS).... 301

Index ..................................................................................................303