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Zhang Y, Wen S, Zhao G, Cui Y. Risk factors for peripancreatic and pancreatic infection of acute pancreatitis and the development of a clinical prediction model. Medicine (Baltimore) 2025; 104:e42595. [PMID: 40419919 DOI: 10.1097/md.0000000000042595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/28/2025] Open
Abstract
Infected necrotizing pancreatitis (INP) is a serious complication that can increase the length of hospital stay and the cost of treatment, and is the leading cause of death in patients with acute pancreatitis (AP). This article aimed to predict the possibility of pancreatic and peripancreatic infections by early clinical indicators of AP and construct a clinical prediction model. We retrospectively studied consecutive patients admitted to the Nankai Hospital for moderate severe AP and severe AP, which developed within 2 weeks. Logistic regression was used to evaluate potential factors that could lead to INP and to develop clinical prediction model. Persistent organ failure, pancreatic necrosis area, and procalcitonin account were risk factors for INP. A prediction model was constructed based on the risk factors. The results showed that the model had good predictive performance. We developed a clinical prediction model with good predictive results that can be helpful for clinicians to identify and prevent the development of INP at an early stage.
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Affiliation(s)
- Yu Zhang
- Tianjin NanKai Hospital, Tianjin Medical University, Tianjin, China
- Tianjin Key Laboratory of Acute Abdomen Disease Associated Organ Injury and ITCWM Repair, Tianjin, China
- Institute of Integrative Medicine for Acute Abdominal Diseases, Tianjin, China
| | - Shuaiyong Wen
- Tianjin NanKai Hospital, Tianjin Medical University, Tianjin, China
- Tianjin Key Laboratory of Acute Abdomen Disease Associated Organ Injury and ITCWM Repair, Tianjin, China
- Institute of Integrative Medicine for Acute Abdominal Diseases, Tianjin, China
| | - Guijie Zhao
- Tianjin NanKai Hospital, Tianjin Medical University, Tianjin, China
- Tianjin Key Laboratory of Acute Abdomen Disease Associated Organ Injury and ITCWM Repair, Tianjin, China
- Institute of Integrative Medicine for Acute Abdominal Diseases, Tianjin, China
| | - Yunfeng Cui
- Department of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, Tianjin, China
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Rajabaleyan P, Cuk P, Möller S, Qvist N, Ellebæk MB. Vacuum-assisted closure or primary closure with relaparotomy on-demand in patients with secondary peritonitis: a systematic review and meta-analysis. World J Emerg Surg 2025; 20:42. [PMID: 40399929 PMCID: PMC12096719 DOI: 10.1186/s13017-025-00615-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2024] [Accepted: 04/23/2025] [Indexed: 05/23/2025] Open
Abstract
BACKGROUND Secondary peritonitis is a serious condition with significant morbidity and mortality. Its management requires emergency laparotomy for source control. Vacuum-assisted closure (VAC) and primary abdominal closure (PAC) are the main strategies for managing the laparostomy after source control. Despite the increasing use of VAC, concerns persist regarding its complications and long-term outcomes compared with PAC. METHODS This systematic review followed PRISMA 2020 and MOOSE. The Cochrane Risk of Bias (RoB 2) tool, MINORS and GRADE framework assessed study quality and evidence certainty. The protocol was registered in PROSPERO (CRD42022304724). A comprehensive search of MEDLINE, Embase, and the Cochrane Library from January 2004 to August 2024 identified studies reporting postoperative outcomes following VAC or PAC after laparotomy for secondary peritonitis. The included studies had to report at least two key outcomes: mortality, postoperative complications, incisional hernia, secondary fascial closure, and hospital or intensive care unit (ICU) length of stay. RESULTS Thirty-three studies including 4,520 patients were analyzed. Mortality was 31.1% in VAC and 22.2% in PAC (p = 0.327). Postoperative complications were higher with VAC (71.0% vs. 39.3%, p = 0.001). Incisional hernia rates were similar (21.3% vs. 20.8%, p = 0.958). Secondary fascial closure rate was significantly lower with VAC (58.1% vs. 85.9%, p < 0.001). VAC patients had longer ICU stays (21.1 vs. 9.7 days, p = 0.04), while hospital stay did not differ. Most studies had a high risk of bias, and GRADE assessment showed low to very low evidence certainty. CONCLUSION VAC therapy was associated with more postoperative complications, a lower fascial closure rate, and a longer ICU length of stay compared with PAC. Thirty-day mortality rates did not differ between the approaches. However, most of studies included were subject to serious risk of bias and a low level of certainty in evidence.
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Affiliation(s)
- Pooya Rajabaleyan
- Research Unit for Surgery, Odense University Hospital, Odense, Denmark.
- University of Southern Denmark, Odense, Denmark.
- Department of Clinical Research, University of Southern Denmark, 5000, Odense C, Denmark.
| | - Pedja Cuk
- Research Unit for Surgery, Odense University Hospital, Odense, Denmark
- University of Southern Denmark, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, 5000, Odense C, Denmark
| | - Sören Möller
- Open Patient Data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark
| | - Niels Qvist
- Research Unit for Surgery, Odense University Hospital, Odense, Denmark
- University of Southern Denmark, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, 5000, Odense C, Denmark
| | - Mark Bremholm Ellebæk
- Research Unit for Surgery, Odense University Hospital, Odense, Denmark
- University of Southern Denmark, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, 5000, Odense C, Denmark
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Hostiuc M, Negoi I. Etiology and Risk Factors for Splanchnic Vein Thrombosis in Non-Cirrhotic, Non-Neoplastic Patients: A Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2025; 61:933. [PMID: 40428892 DOI: 10.3390/medicina61050933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2025] [Revised: 05/13/2025] [Accepted: 05/19/2025] [Indexed: 05/29/2025]
Abstract
Splanchnic vein thrombosis (SVT) is a heterogeneous group of disorders affecting the portal, mesenteric, splenic, and hepatic veins. While frequently associated with liver cirrhosis and malignancy, SVT also occurs in non-cirrhotic, non-neoplastic patients. This narrative review evaluates the epidemiology and risk factors for SVT in this population. The prevalence and incidence of SVT in non-cirrhotic, non-neoplastic patients remain incompletely characterized, with estimates varying widely across studies. The clinical significance of SVT relates to potential complications, including intestinal ischemia, portal hypertension, and a possible underlying systemic disorder. Risk factors for SVT can be categorized into local abdominal conditions, thrombophilias, and systemic disorders. Local factors include inflammatory bowel disease, pancreatitis, abdominal surgery, and trauma. Thrombophilias, both inherited and acquired, are significant contributors to SVT risk. Systemic conditions associated with SVT include autoimmune disorders, pregnancy, hematological diseases, and infections. The complex interplay of these risk factors highlights the need for a comprehensive evaluation of SVT patients. Early recognition and management of these conditions can prevent potentially life-threatening complications and guide decisions regarding anticoagulation and long-term follow-up.
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Affiliation(s)
- Mihaela Hostiuc
- Internal Medicine, Department 5, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Ionut Negoi
- General Surgery, Department 10, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
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Simon T, Thole T, Castelli S, Timmermann B, Jazmati D, Schwarz R, Fuchs J, Warmann S, Hubertus J, Schmidt M, Rogasch J, Körber F, Vokuhl C, Schäfer J, Schulte JH, Deubzer H, Rosswog C, Fischer M, Lang P, Langer T, Astrahantseff K, Lode H, Hero B, Eggert A. GPOH Guidelines for Diagnosis and First-line Treatment of Patients with Neuroblastic Tumors, update 2025. KLINISCHE PADIATRIE 2025; 237:117-140. [PMID: 40345224 DOI: 10.1055/a-2556-4302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2025]
Abstract
The clinical course of neuroblastoma is more heterogeneous than any other malignant disease. Many low-risk patients experience regression after limited or even no chemotherapy. However, more than half of high-risk patients die from disease despite intensive multimodal treatment. Precise disease characterization for each patient at diagnosis is key for risk-adapted treatment. The guidelines presented here incorporate results from national and international clinical trials to produce recommendations for diagnosing and treating neuroblastoma patients in German hospitals outside of clinical trials.
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Affiliation(s)
- Thorsten Simon
- Pediatric Oncology and Hematology, University of Cologne, Cologne, Germany
| | - Theresa Thole
- Pediatric Oncology and Hematology, Charité University Hospital Berlin, Berlin, Germany
| | - Sveva Castelli
- Pediatric Oncology and Hematology, Charité University Hospital Berlin, Berlin, Germany
| | - Beate Timmermann
- Westgerman Protontherapycenter Essen, University of Duisburg-Essen, Duisburg, Germany
| | - Danny Jazmati
- Department of Radiation Oncology, Heinrich Heine University Düsseldorf, Dusseldorf, Germany
| | | | - Jörg Fuchs
- Pediatric Surgery and Urology, University of Tübingen, Tübingen, Germany
| | - Steven Warmann
- Department of Pediatric Surgery, Charité University Hospital Berlin, Berlin, Germany
| | - Jochen Hubertus
- Department of Pediatric Surgery, Marien-Hospital Witten, Witten, Germany
| | | | - Julian Rogasch
- Nuclear Medicine, Charité University Hospital Berlin, Berlin, Germany
| | - Friederike Körber
- Institut und Poliklinik für Radiologische Diagnostik, Kinderradiologie, University of Cologne, Cologne, Germany
| | - Christian Vokuhl
- Pediatric Pathology, Institute for Pathology, University of Bonn, Bonn, Germany
| | - Jürgen Schäfer
- Diagnostic and Interventional Radiology, University of Tübingen, Tübingen, Germany
| | | | - Hedwig Deubzer
- Pediatric Oncology and Hematology, Charité University Hospital Berlin, Berlin, Germany
| | - Carolina Rosswog
- Pediatric Oncology and Hematology, University of Cologne, Cologne, Germany
- Experimental Pediatric Oncology, University of Cologne, Cologne, Germany
| | - Matthias Fischer
- Pediatric Oncology and Hematology, University of Cologne, Cologne, Germany
- Experimental Pediatric Oncology, University of Cologne, Cologne, Germany
| | - Peter Lang
- Pediatric Oncology and Hematology, University of Tübingen, Tübingen, Germany
| | - Thorsten Langer
- Childrens' Hospital, University Hospital Schleswig-Holstein Lübeck Campus, Lübeck, Germany
| | - Kathy Astrahantseff
- Pediatric Oncology and Hematology, Charité University Hospital Berlin, Berlin, Germany
| | - Holger Lode
- Pediatric Oncology and Hematology, University of Greifswald, Greifswald, Germany
| | - Barbara Hero
- Pediatric Oncology and Hematology, University of Cologne, Cologne, Germany
| | - Angelika Eggert
- Pediatric Oncology and Hematology, Charité University Hospital Berlin, Berlin, Germany
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Hörer TM, Abu-Zidan FM, McGreevy DT, Nilsson K, Djavani Gidlund K. Abdominal Compartment Syndrome After Endovascular Repair of Ruptured Abdominal Aortic Aneurysms: A Single-Center Experience of Total Endovascular Care for Ruptured Abdominal Aneurysms. J Endovasc Ther 2025:15266028251328494. [PMID: 40165640 DOI: 10.1177/15266028251328494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2025]
Abstract
OBJECTIVE Open repair of ruptured abdominal aortic aneurysms (rAAA) has been increasingly replaced by endovascular aortic repair (EVAR) in many centers. Despite being a minimally invasive procedure, EVAR is associated with a risk of abdominal compartment syndrome (ACS), which can lead to significant morbidity and mortality. This study examines the incidence and clinical manifestation of ACS in a consecutive cohort of rAAA patients treated exclusively with EVAR at Örebro University Hospital over a 12-year period. METHODS This is a retrospective analysis of prospectively collected data. We identified 139 patients who had presented to Örebro University Hospital with rAAA between October 2009 and September 2021. Patients with isolated iliac artery, thoracic and thoracoabdominal aortic ruptures, previous aortic interventions (open or endovascular), and patients receiving palliative treatment were excluded. Patients developing ACS after rAAA were compared with those who did not develop ACS. RESULTS A total of 100 patients treated using EVAR were included in this study. ACS was identified in 17 patients, and these were compared with 83 patients who did not develop ACS. Mortality at 30 days was 53% in the ACS group (9/17) and 22% in the No-ACS group (18/83, p = 0.015). Regression analysis showed that advanced age and ACS were independent risk factors for death, with ACS increasing the hazard 4-fold (HR 4.26, CI 1.99-9.10, p < 0.001) and age increasing the hazard by 6% for every year (HR 1.06, CI 1.06-1.1, p = 0.004). The use of aortic balloon occlusion was not independently associated with the development of ACS. CONCLUSIONS ACS is a life-threatening complication of rAAA treated using EVAR and a significant number of patients developed ACS with high mortality and complication rates. All rAAA patients treated using EVAR should be monitored closely for ACS and treatment with decompressive laparotomy should be initiated without delay.Clinical ImpactOpen repair of ruptured abdominal aortic aneurysms (rAAA) has been increasingly replaced by endovascular aortic repair (EVAR). Despite being a minimally invasive procedure, EVAR is associated with a risk of abdominal compartment syndrome (ACS), which can lead to significant morbidity and mortality This article investigates abdominal compartment syndrome (ACS) in a cohort of total endovascular treated rAAA in a single centre and the treatment as well as the results, and gives insight on ACS in this patient group and might contribute to better understanding how to treat them and avoid this life-threatening complication.
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Affiliation(s)
- Tal M Hörer
- Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Fikri M Abu-Zidan
- The Research Office, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE
| | - David T McGreevy
- Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Kristofer Nilsson
- Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Khatereh Djavani Gidlund
- Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Koh S, Kim S. Development and feasibility study of a piezoresistive pressure sensor-based automated system for monitoring and controlling gastric pressure in endoscopy. Med Biol Eng Comput 2025; 63:1101-1115. [PMID: 39627486 PMCID: PMC11946989 DOI: 10.1007/s11517-024-03254-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2024] [Accepted: 11/25/2024] [Indexed: 03/27/2025]
Abstract
Maintaining precise intragastric pressure during gastrointestinal endoscopy is critical for patient safety and diagnostic accuracy, yet current methods relying on manual adjustments pose risks of improper insufflation. This study aimed to develop an automated gastric pressure control system for flexible endoscopy, addressing these challenges with a piezoresistive pressure sensor that can be integrated into a 7.3 mm diameter flexible endoscope. The system, incorporating air and suction pumps controlled by a microcontroller, was calibrated in an acrylic chamber and validated through comprehensive testing in both an endoscopy simulator and a porcine specimen. Testing scenarios included normal breathing, coughing, belching, and combined events, assessing accuracy, stability, and real-time pressure regulation under conditions mimicking physiological responses. Results demonstrated high accuracy (R2 = 0.9999), minimal bias (0.23 mmHg), and strong agreement with reference standards, confirming effective pressure management. Simulated clinical scenarios in simulator and porcine specimen further showed the system's ability to maintain target pressure with minimal errors, indicating robustness under dynamic conditions. These findings suggest that the automated pressure control system significantly improves safety and procedural efficiency in endoscopy, with potential applicability to other minimally invasive procedures. Further animal model testing is recommended to validate the clinical performance under realistic physiological conditions.
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Affiliation(s)
- Sukgyu Koh
- Interdisciplinary Program in Bioengineering, Graduate School, Seoul National University, Seoul, South Korea
- MedInTech Inc., 60, Daehak-Ro, Jongno-Gu, Seoul, South Korea
| | - Sungwan Kim
- Interdisciplinary Program in Bioengineering, Graduate School, Seoul National University, Seoul, South Korea.
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, South Korea.
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Jiang R, Ma H, Song X, Hu X, Lui KY, Liang Y, Cai C. Increased intra-abdominal pressure linked to worse long-term prognosis among patients with orthotopic liver transplantation: a retrospective, observational study. BMC Gastroenterol 2025; 25:204. [PMID: 40148802 PMCID: PMC11951577 DOI: 10.1186/s12876-025-03772-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2024] [Accepted: 03/07/2025] [Indexed: 03/29/2025] Open
Abstract
OBJECTIVE To investigate the prognostic value of intra-abdominal pressure (IAP) among patients with orthotopic liver transplantation (OLT). PATIENTS We enrolled adult patients admitted in the Department of Critical Care Medicine of the First Affiliated Hospital of Sun Yat-sen University after undergoing liver transplantation from January 2018 to March 2022. METHODS AND RESULTS A total of 382 patients were included, with 73 patients who died within 1 year after admission. Intra-abdominal Hypertension (IAH) was defined as a sustained IAP ≥ 12 mmHg. The incidence of IAH among liver transplant patients was 46.2%. The IAP and sequential organ failure assessment (SOFA) scores were significantly lower in survivors than non-survivors (P < 0.05). Restricted cubic spline (RCS) analysis found that an IAP level above 16 mmHg was significantly associated with an elevated risk of 1-year mortality, and Kaplan-Meier survival curves further validated this finding (log-rank P < 0.001). Multivariate Cox proportional hazards regression model indicated that patients in IAH grade III (HR: 3.16, 95% CI: 1.31-7.62, P = 0.010) and IV (HR: 9.93, 95% CI: 2.84-34.7, P < 0.001) had significantly higher 1-year mortality risks adjusted by SOFA score classifications compared to individuals without IAH. Maximum IAP levels alone and a modified SOFA score incorporating IAH grade demonstrated satisfactory performance in predicting in-hospital mortality among OLT patients (AUC: 0.710, 0.834, respectively). CONCLUSIONS Elevated intra-abdominal pressure above 16 mmHg was significantly related with worse 1-year survival among OLT patients. Both maximum IAP alone and SOFA score incorporated with IAH components showed strong prognostic values for in-hospital mortality of these individuals.
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Affiliation(s)
- Rongjie Jiang
- Department of Critical Care Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, China
| | - Huan Ma
- Department of Critical Care Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, China
| | - Xiaodong Song
- Department of Critical Care Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, China
| | - Xiaoguang Hu
- Department of Critical Care Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, China
| | - Ka Yin Lui
- Department of Critical Care Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, China
| | - Yujun Liang
- Department of Critical Care Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, China
| | - Changjie Cai
- Department of Critical Care Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, China.
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Plešnik B, Djokić M, Djordjević S, Krašna S, Žumer J, Trotovšek B. Non-invasive and continuous intra-abdominal pressure assessment using MC sensors. Sci Rep 2025; 15:10775. [PMID: 40155446 PMCID: PMC11953365 DOI: 10.1038/s41598-025-95512-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2024] [Accepted: 03/21/2025] [Indexed: 04/01/2025] Open
Abstract
Monitoring intra-abdominal pressure (IAP) in critical care patients is crucial for preventing intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS), with their severe consequences. The muscle contraction sensor (MC) introduced in this study offers a novel, non-invasive method with promising accuracy based on previous findings. This study further evaluates the MC accuracy and reproducibility and examines its correlation with objective IAP measurements obtained through a CO2 insufflator. We enrolled 41 patients undergoing elective laparoscopic gallbladder removal under general anesthesia with complete muscle relaxation. Two MC sensors were placed on the right and left sides of the abdomen, and elevated IAP was induced by insufflating CO2 into the peritoneal cavity. IAP measurements from the MC sensors were compared to the randomized IAP values set on the CO2 insufflator. Data from both methods were analyzed to assess the accuracy and agreement with the insufflator measurements. The MC sensor provided continuous and accurate detection of IAP changes. A Pearson correlation coefficient of 0.963 indicated a strong positive linear correlation between the MC sensor readings and the IAP values set on the insufflator. The coefficient of determination (R2) was 0.927, showing that the model explains 92.7% of the variation in IAP values based on the MC sensor signals. Receiver operating characteristic analysis demonstrated that the MC sensor system performed exceptionally well in identifying both IAH and ACS cases, with an area under the curve of 0.996 for IAH and 0.981 for ACS. The study introduces a transcutaneous pressure measuring device as an innovative, non-invasive method for assessing IAP. The system strongly correlates with IAP values measured by CO2 insufflation, indicating its accuracy. It thus could present an alternative to conventional IAP measurement in the future. The MC capability to deliver real-time, continuous data holds substantial potential for proactive patient care. By incorporating advanced analytics like machine learning, the system could detect trends and provide early warnings of dangerous IAP changes, enabling timely, targeted interventions to enhance outcomes for critically ill patients.
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Affiliation(s)
- Boštjan Plešnik
- University Medical Centre Ljubljana, Zaloška cesta 7, Ljubljana, Slovenia.
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, Ljubljana, Slovenia.
| | - Mihajlo Djokić
- University Medical Centre Ljubljana, Zaloška cesta 7, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, Ljubljana, Slovenia
| | | | - Simon Krašna
- Faculty of Mechanical Engineering, University of Ljubljana, Aškerčeva cesta 6, Ljubljana, Slovenia
| | - Jan Žumer
- TMG-BMC Ltd, Štihova ulica 24, Ljubljana, Slovenia
| | - Blaž Trotovšek
- University Medical Centre Ljubljana, Zaloška cesta 7, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, Ljubljana, Slovenia
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Tolonen M, Vikatmaa P. Diagnosis and management of acute mesenteric ischemia: What you need to know. J Trauma Acute Care Surg 2025:01586154-990000000-00933. [PMID: 40107963 DOI: 10.1097/ta.0000000000004585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2025]
Abstract
ABSTRACT Acute mesenteric ischemia (AMI) is associated with high mortality rates. There are multiple challenges to establishing an accurate early diagnosis and providing state-of-the-art care for AMI patients. A high index of suspicion is key for early diagnosis. Once suspicion is raised, a triphasic computed tomography angiography is the essential diagnostic tool. Avoiding delays, using hybrid operating rooms and contemporary revascularization techniques for arterial occlusive AMI, can significantly improve the prognosis. Regional health care systems should be developed to direct AMI patients into centers with sufficient capabilities for providing all aspects of care at all hours. The acute care surgeon has a central role in performing laparotomies and bowel resections when needed and coordinating the management flow in close collaboration with vascular surgeons and interventional radiologists for prompt and effective revascularization. A significant share of patients with an arterial occlusive AMI can be managed by endovascular revascularization without the need for a laparotomy. There are no reliable tools for predicting transmural bowel necrosis, and individual assessment and clinical experience are very important in decision-making when choosing between laparotomy and close observation. During laparotomy, an atherosclerotic occlusion at the root of the superior mesenteric artery can be stented by using a retrograde open mesenteric or percutaneous approach, and surgical bypass is seldom needed. Using hospital-specific management pathways is very useful for the standardization of care in arterial occlusive AMI. In venous AMI, systemic anticoagulation is sufficient in most cases. In patients whose symptoms do not resolve, there are various options for endovascular and surgical revascularization. In nonocclusive mesenteric ischemia, prevention by maintaining sufficient abdominal perfusion pressure is key. High-level evidence is scarce, but with current knowledge, the prognosis of AMI patients has plenty of room for improvement.
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Affiliation(s)
- Matti Tolonen
- From the Department of Abdominal Surgery (M.T.), HUS Abdominal Center; and Department of Vascular Surgery (P.V.), Abdominal Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
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10
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Zheng Y, Xue Y, Li K, Zhang Z, Wan Z, Huang H, Xiong W, Li J. Incidence and clinical characteristics of occult inguinal hernias: a retrospective analysis of laparoscopic repair. Hernia 2025; 29:111. [PMID: 40069471 DOI: 10.1007/s10029-025-03298-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2024] [Accepted: 02/11/2025] [Indexed: 05/13/2025]
Abstract
BACKGROUND Occult inguinal hernia is a unique clinical challenge characterized by asymptomatic presentation and the absence of detectable signs on physical examination, leading to frequent misdiagnosis and underdiagnosis. The advancement of laparoscopic hernia surgery has facilitated the identification of occult hernias, yet effective diagnostic and predictive methods remain lacking. OBJECTIVE This study aims to evaluate the incidence and clinical characteristics of occult inguinal hernias detected during laparoscopic unilateral inguinal hernia repair and to provide evidence-based recommendations for their management. METHODS A retrospective analysis was conducted on 868 patients diagnosed preoperatively with unilateral inguinal hernia at the Guangdong Provincial Hospital of Traditional Chinese Medicine between January 2013 and December 2020. All patients underwent laparoscopic hernia repair surgery, during which both sides of the inguinal area were explored for occult hernias. Statistical analysis, including univariate and multivariate logistic regression, was performed to identify significant predictors of occult hernias. RESULTS Intraoperative detection of occult inguinal hernias was observed in 225 patients (25.92%). Patients with occult inguinal hernia had a higher median age of 68 (59, 76) years, compared to 63 (52, 73) years for those with unilateral inguinal hernia. The incidence was notably higher in females (34.61%) compared to males (25.37%). Stratified by hernia type, the prevalence of occult hernias was 23.84% among patients with indirect hernias (154/646) and 31.75% among those with direct hernias (60/189). Among the 225 patients with occult hernias, 129(57.33%) occult hernias cases occurred on the left side, and 142(63.11%) occult hernias cases were of the indirect type. Multivariate logistic regression analysis identified female gender, high age, and the presence of high-risk factors for intra-abdominal hypertension as independent and significant predictors of occult hernia development. CONCLUSION Occult inguinal hernia remains a diagnostic and therapeutic challenge. For older patients presenting with unilateral inguinal hernia and high-risk factors for intra-abdominal hypertension, we recommend TAPP exploration and simultaneous repair of contralateral occult hernias.
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Affiliation(s)
- Yansheng Zheng
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Jinan University, Jinan, China
| | - Yuling Xue
- The Second Clinical College of Guangzhou, University of Chinese Medicine, Guangzhou, China
| | - Keling Li
- The Second Clinical College of Guangzhou, University of Chinese Medicine, Guangzhou, China
| | - Zhe Zhang
- The Second Clinical College of Guangzhou, University of Chinese Medicine, Guangzhou, China
| | - Zhenhui Wan
- The Second Clinical College of Guangzhou, University of Chinese Medicine, Guangzhou, China
| | - Haipeng Huang
- Department of Gastrointestinal Surgery, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Wenjun Xiong
- Guangdong Clinical Research Academy of Chinese Medicine, Guangzhou, China.
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, No.16 Airport Road, Baiyun District, Guangzhou, Guangdong Province, China.
| | - Jin Li
- Guangdong Clinical Research Academy of Chinese Medicine, Guangzhou, China.
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, No.16 Airport Road, Baiyun District, Guangzhou, Guangdong Province, China.
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11
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Doudakmanis C, Makris D. Ventilator-Associated Pneumonia in Patients With Increased Intra-abdominal Pressure. Cureus 2025; 17:e81370. [PMID: 40291219 PMCID: PMC12034327 DOI: 10.7759/cureus.81370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2025] [Indexed: 04/30/2025] Open
Abstract
Increased intra-abdominal pressure (IAP) is a significant clinical concern, which has been proven to cause significant adverse events in patients. Respiratory infections are a high-yield problem in the intensive care unit (ICU). In this study, we reviewed available literature regarding the relationship between elevated IAP and the development of ventilator-associated pneumonia (VAP) in mechanically ventilated patients. Patients with prolonged mechanical ventilation are prone to develop VAP. Longer hospitalization, prior use of antibiotics, and comorbidities make these patients more susceptible to infections. Multidrug-resistant VAP poses a vast threat to critically ill patients, as it is characterized by a shift in the microbiological profile of the disease, as well as difficulties in its treatment options. Elevated IAP could adversely affect mechanically ventilated patients, as it is associated with an elevated risk of microaspirations and altered patency of the intestinal barrier, thus comprising an important factor for developing VAP. In addition, elevated IAP can deteriorate pulmonary function and hemodynamic condition of the patient, adding an extra risk for developing VAP. In such frail conditions, these patients have compromised immune function and are at risk of developing systematic infection, even resulting in the failure of multiple organs. As the microbiologic profile shifts toward multidrug-resistant bacteria, there is a need for comprehensive strategies in ICU settings to mitigate the risks associated with both elevated IAP and multidrug-resistant VAP. Timely intervention and proper management can prevent the risk of difficult-to-treat infections and life-threatening adverse events for patients.
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Affiliation(s)
- Christos Doudakmanis
- Department of Critical Care Medicine, University Hospital of Larissa, Larissa, GRC
- Second Propaedeutic Department of Surgery, Laiko General Hospital of Athens, Athens, GRC
| | - Demosthenes Makris
- Department of Critical Care Medicine, University Hospital of Larissa, Larissa, GRC
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12
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Takagi H. The hernia is mightier than the aorta. Eur Heart J Case Rep 2025; 9:ytaf122. [PMID: 40115620 PMCID: PMC11925006 DOI: 10.1093/ehjcr/ytaf122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2024] [Revised: 01/16/2025] [Accepted: 03/04/2025] [Indexed: 03/23/2025]
Affiliation(s)
- Hisato Takagi
- Department of Cardiovascular Surgery, Shizuoka Medical Center, 762-1 Nagasawa, Shimizu-cho, Sunto-gun, Shizuoka 411-8611, Japan
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13
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Deng L, Chen Z, Jin T, Cai F, He Y, Shen Y, Zhang S, Guo J, Yang X, Yang L, Lu H, Wang C, Tang W, Lin Z, Li L, Tan Q, Zhu P, Zhang X, Shi N, Hu C, Huang Z, Du D, Huang W, Zhang Z, Zhang S, Xia Q. Traditional Chinese medicine Chaiqinchengqi decoction for patients with acute pancreatitis: A randomized clinical trial. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2025; 138:156393. [PMID: 39879706 DOI: 10.1016/j.phymed.2025.156393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2024] [Revised: 12/26/2024] [Accepted: 01/12/2025] [Indexed: 01/31/2025]
Abstract
BACKGROUND Chaiqinchengqi decoction, a traditional Chinese medicine, has shown promising effects in in vitro, animal and preliminary small human studies for acute pancreatitis, but evidence of clinical practice is limited. PURPOSE To investigate whether Chaiqinchengqi decoction could improve clinical outcomes in patients with acute pancreatitis. STUDY DESIGN Prospective, pragmatic, randomized controlled trial. (Chictr.org.cn registration number: ChiCTR2000034325) METHODS: This trial was conducted at West China Hospital of Sichuan University, China. Patients with acute pancreatitis were randomly assigned to receive either Chaiqinchengqi decoction or placebo by oral and rectal enemas in addition to guideline-directed administrations using a 1:1 ratio. The intervention of Chaiqinchengqi and placebo was determined by the grading of acute gastrointestinal injury. Patients were assessed within 24 and 48 hours, and on 3, 5, and 7 days after admission, or organ failure normalized. Survivors were followed up at 1, 3, and 6 months after discharge. Primary outcome was the duration of respiratory failure to 28 days after enrollment. Secondary outcomes included other organ failure, local complications, 6-month all-cause mortality, inflammatory indicators, and related interventions. RESULTS Among 248 patients enrolled, Chaiqinchengqi decoction shortened the duration of respiratory failure compared with the placebo (median [IQR], 1.0 [0.0 to 5.0] vs 3.0 [1.0-8.0] days; median difference, -1.0; 95% CI, -2.0 to 0.0, P=.001). There were significant differences in the duration of circulatory failure, the incidence of new-onset respiratory and cardiovascular and failure, the incidence of new organ failure, severity, intensive care unit need, pain visual analogue scale, pancreatitis activity scoring system, and EQ-5D-5L. CONCLUSION Chaiqinchengqi decoction as an adjunctive therapy significantly reduced the duration of respiratory failure and improved 6-month clinical outcomes of acute pancreatitis in addition to guideline-directed treatments. Further study is needed to elucidate the mechanism of action.
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Affiliation(s)
- Lihui Deng
- West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, PR China..
| | - Zhiyao Chen
- West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, PR China..
| | - Tao Jin
- West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, PR China..
| | - Fei Cai
- West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, PR China..
| | - Yanqiu He
- West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, PR China..
| | - Yuxin Shen
- West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, PR China..
| | - Shihang Zhang
- West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, PR China..
| | - Jia Guo
- West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, PR China..
| | - Xiaonan Yang
- West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, PR China..
| | - Lin Yang
- Department of Clinical Pharmacology, West China Hospital, Sichuan University, Chengdu, PR China..
| | - Huimin Lu
- West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, PR China.; Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, PR China..
| | - Chunhui Wang
- West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, PR China.; Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, PR China..
| | - Wenfu Tang
- West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, PR China..
| | - Ziqi Lin
- West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, PR China..
| | - Lan Li
- West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, PR China..
| | - Qingyuan Tan
- West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, PR China..
| | - Ping Zhu
- West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, PR China.; Department of Clinical Research Management, West China Hospital, Sichuan University, Chengdu, PR China..
| | - Xiaoxin Zhang
- West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, PR China..
| | - Na Shi
- West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, PR China..
| | - Cheng Hu
- West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, PR China..
| | - Zixing Huang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, PR China..
| | - Dan Du
- Mass Spectrometry Platform, Frontiers Science Centre for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, PR China..
| | - Wei Huang
- West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, PR China..
| | - Zhongwei Zhang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, PR China..
| | - Shu Zhang
- Department of Emergency, West China Hospital, Sichuan University, Chengdu, PR China..
| | - Qing Xia
- West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, PR China..
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14
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Li Z, Lu F, Dong L, Dai Y, Bao R, Wu J, Rao Y, Wang H. Barriers and facilitators in implementing intra-abdominal pressure measurement by nurses in paediatric intensive care units: A qualitative study. Aust Crit Care 2025; 38:101136. [PMID: 39551653 DOI: 10.1016/j.aucc.2024.101136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 09/12/2024] [Accepted: 10/11/2024] [Indexed: 11/19/2024] Open
Abstract
BACKGROUND Intra-abdominal hypertension has been proven to be an independent risk factor for death in critically ill patients. Accurate monitoring of intra-abdominal pressure is of great significance for early identification and timely intervention of intra-abdominal hypertension to prevent further progression to abdominal compartment syndrome. Paediatric critical care nurses play an important role in constant observation and recognition of subtle and dynamic changes in intra-abdominal pressure of critically ill children. OBJECTIVES The objective of this study was to explore paediatric critical care nurses's views on the barriers and facilitators in clinical practice of intra-abdominal pressure measurement. METHODS A qualitative, open-ended, and exploratory study was conducted in the paediatric intensive care unit of a tertiary hospital in China. Semistructured interviews were conducted with nurses and nursing managers who were involved in the management of intra-abdominal pressure. The interview guide was developed using the Theoretical Domains Framework to explore the barriers and facilitators to intra-abdominal pressure measurement in the paediatric intensive care unit. Data analysis followed the framework approach, drawing on the Theoretical Domains Framework. RESULTS Fourteen participants (10 nurses and four nursing managers) were interviewed. We identified seven domains related to intra-abdominal pressure measurement mapping to six "barrier" domains and four "facilitator" domains. The six "barrier" domains were knowledge, social influences, behavioural regulation, beliefs about consequences, beliefs about capabilities, and environmental context and resources, and the four "facilitator" domains were social influences, beliefs about consequences, environmental context and resources, and social/professional role and identity. CONCLUSIONS The findings confirm the need for interventions to support paediatric critical care nurses in their intra-abdominal pressure measurement practices, with a particular focus on increasing knowledge, improving skills and measurement equipment, promoting nurse-physician interprofessional collaboration, providing a standardised measurement process, and establishing a supportive environment. Using the Theoretical Domains Framework will enhance the design of a targeted intervention, which should facilitate the standardised management of intra-abdominal pressure in the paediatric intensive care unit.
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Affiliation(s)
- ZhiRu Li
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - FangYan Lu
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China; Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Li Dong
- Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - YanHong Dai
- Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - RuiJie Bao
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - JingYun Wu
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - YuXin Rao
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - HuaFen Wang
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
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15
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Yin Z, Li L, Zhang Q, Zhang X, Shi R, Xia X, Wang Z, Li S, Ye M, Liu Y, Tan W, Chen Z. PerC B-Cells Activation via Thermogenetics-Based CXCL12 Generator for Intraperitoneal Immunity Against Metastatic Disseminated Tumor Cells. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2025; 37:e2411731. [PMID: 39865939 DOI: 10.1002/adma.202411731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2024] [Revised: 01/04/2025] [Indexed: 01/28/2025]
Abstract
During cancer peritoneal metastasis (PM), conventional antigen-presenting cells (dendritic cells, macrophages) promote tumorigenesis and immunosuppression in peritoneal cavity. While intraperitoneal immunotherapy (IPIT) has been used in clinical investigations to relieve PM, the limited knowledge of peritoneal immunocytes has hindered the development of therapeutic IPIT. Here, a dendritic cell-independent, next-generation IPIT is described that activates peritoneal cavity B (PerC B) cell subsets for intraperitoneal anti-tumor immunity via exogenous antigen presentation. The PerC B-cell-involved IPIT framework consists of an isotropic-porous, cell-fitting, thermogenetics-based CXCL12 generator. Such nanoscale thermal-confined generator can programmatically fine-tune the expression of CXCL12 to recruit disseminated tumor cells (DTCs) through CXCL12-CXCR4 axis while avoiding cytokine storm, subsequently release DTC-derived antigen to trigger PerC B-cell-involved immunity. Notably, antigen-presenting B-cell cluster, expressing the regulatory signaling molecules Ptpn6, Ms4a1, and Cd52, is identified playing the key role in the IPIT via single-cell RNA sequencing. Moreover, such IPIT availably assuages peritoneal effusion and PM in an orthotopic gastric cancer and metastatic model. Overall, this work offers a perspective on PerC B-cell-involved antigen-presenting in intraperitoneal immunity and provides a configurable strategy for activating anti-DTC immunity for next-generation IPIT.
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Affiliation(s)
- Zhiwei Yin
- Molecular Science and Biomedicine Laboratory (MBL), State Key Laboratory of Chemo/Biosensing and Chemometrics, College of Chemistry and Chemical Engineering, College of Environmental Science and Engineering, College of Biology, Aptamer Engineering Center of Hunan Province, Hunan University, Changsha, 410082, China
| | - Ling Li
- Molecular Science and Biomedicine Laboratory (MBL), State Key Laboratory of Chemo/Biosensing and Chemometrics, College of Chemistry and Chemical Engineering, College of Environmental Science and Engineering, College of Biology, Aptamer Engineering Center of Hunan Province, Hunan University, Changsha, 410082, China
- Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang, 310018, China
| | - Qiang Zhang
- Molecular Science and Biomedicine Laboratory (MBL), State Key Laboratory of Chemo/Biosensing and Chemometrics, College of Chemistry and Chemical Engineering, College of Environmental Science and Engineering, College of Biology, Aptamer Engineering Center of Hunan Province, Hunan University, Changsha, 410082, China
- Department of Chemistry, College of Sciences, Northeastern University, Shenyang, 110819, China
| | - Xiaoshen Zhang
- Department of Respiratory Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
| | - Rui Shi
- Molecular Science and Biomedicine Laboratory (MBL), State Key Laboratory of Chemo/Biosensing and Chemometrics, College of Chemistry and Chemical Engineering, College of Environmental Science and Engineering, College of Biology, Aptamer Engineering Center of Hunan Province, Hunan University, Changsha, 410082, China
| | - Xin Xia
- Molecular Science and Biomedicine Laboratory (MBL), State Key Laboratory of Chemo/Biosensing and Chemometrics, College of Chemistry and Chemical Engineering, College of Environmental Science and Engineering, College of Biology, Aptamer Engineering Center of Hunan Province, Hunan University, Changsha, 410082, China
| | - Zhaoxin Wang
- Molecular Science and Biomedicine Laboratory (MBL), State Key Laboratory of Chemo/Biosensing and Chemometrics, College of Chemistry and Chemical Engineering, College of Environmental Science and Engineering, College of Biology, Aptamer Engineering Center of Hunan Province, Hunan University, Changsha, 410082, China
| | - Shengkai Li
- Molecular Science and Biomedicine Laboratory (MBL), State Key Laboratory of Chemo/Biosensing and Chemometrics, College of Chemistry and Chemical Engineering, College of Environmental Science and Engineering, College of Biology, Aptamer Engineering Center of Hunan Province, Hunan University, Changsha, 410082, China
| | - Mao Ye
- Molecular Science and Biomedicine Laboratory (MBL), State Key Laboratory of Chemo/Biosensing and Chemometrics, College of Chemistry and Chemical Engineering, College of Environmental Science and Engineering, College of Biology, Aptamer Engineering Center of Hunan Province, Hunan University, Changsha, 410082, China
| | - Yanlan Liu
- Molecular Science and Biomedicine Laboratory (MBL), State Key Laboratory of Chemo/Biosensing and Chemometrics, College of Chemistry and Chemical Engineering, College of Environmental Science and Engineering, College of Biology, Aptamer Engineering Center of Hunan Province, Hunan University, Changsha, 410082, China
| | - Weihong Tan
- Molecular Science and Biomedicine Laboratory (MBL), State Key Laboratory of Chemo/Biosensing and Chemometrics, College of Chemistry and Chemical Engineering, College of Environmental Science and Engineering, College of Biology, Aptamer Engineering Center of Hunan Province, Hunan University, Changsha, 410082, China
- Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang, 310018, China
- Institute of Molecular Medicine (IMM), Renji Hospital, Shanghai Jiao Tong University School of Medicine and College of Chemistry and Chemical Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Zhuo Chen
- Molecular Science and Biomedicine Laboratory (MBL), State Key Laboratory of Chemo/Biosensing and Chemometrics, College of Chemistry and Chemical Engineering, College of Environmental Science and Engineering, College of Biology, Aptamer Engineering Center of Hunan Province, Hunan University, Changsha, 410082, China
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16
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Singh SP, Mallick B, Nath P. Pressure Mounts: Predictive Power of Intra-abdominal Hypertension in Patients with Severe Acute Pancreatitis. Dig Dis Sci 2025:10.1007/s10620-025-08931-1. [PMID: 40019585 DOI: 10.1007/s10620-025-08931-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2024] [Accepted: 02/14/2025] [Indexed: 03/01/2025]
Affiliation(s)
- Sukhraj Pal Singh
- Department of Gastroenterology & Hepatology, Kalinga Institute of Medical Sciences (KIMS), KIIT University, Bhubaneswar, 753024, India
| | - Bipadabhanjan Mallick
- Department of Gastroenterology & Hepatology, Kalinga Institute of Medical Sciences (KIMS), KIIT University, Bhubaneswar, 753024, India
| | - Preetam Nath
- Department of Gastroenterology & Hepatology, Kalinga Institute of Medical Sciences (KIMS), KIIT University, Bhubaneswar, 753024, India.
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17
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Alberti P, Ade-Ajayi N, Greenough A. Respiratory Support Strategies for Surgical Neonates: A Review. CHILDREN (BASEL, SWITZERLAND) 2025; 12:273. [PMID: 40150556 PMCID: PMC11941308 DOI: 10.3390/children12030273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2025] [Revised: 02/16/2025] [Accepted: 02/22/2025] [Indexed: 03/29/2025]
Abstract
Neonates with congenital conditions which require surgical management frequently experience respiratory distress. This review discusses the management of pulmonary complications and the respiratory support strategies for four conditions: oesophageal atresia-tracheoesophageal fistula (OA-TOF), congenital diaphragmatic hernia (CDH), congenital lung malformations (CLM), and anterior abdominal wall defects (AWD). Mechanical ventilation techniques which can reduce the risk of ventilator-induced lung injury (VILI) are discussed, as well as the use of non-invasive respiratory support modes. While advances in perioperative respiratory support have improved outcomes in infants with OA-TOF, managing respiratory distress in premature OA-TOF neonates remains a challenge. In CDH infants, a randomised trial has suggested that conventional ventilation may improve outcomes compared to high-frequency ventilation. Echocardiographic assessment is essential in the management of CDH infants with pulmonary hypertension. Lung-protective ventilation settings may lower the rate of postoperative complications in symptomatic CLM infants, but there remains debate regarding the choice of expectant versus surgical management in neonates with asymptomatic CLMs. Infants with AWDs can require ventilation due to pulmonary hypoplasia, but the effects of this on their long-term respiratory health are poorly understood. As surgical techniques continue to evolve and novel ventilation techniques become available, prospective multi-centre studies will be required to define the optimal respiratory support strategies for neonatal surgical conditions that affect lung function.
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Affiliation(s)
- Piero Alberti
- Department of Women and Children’s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London SE5 9RS, UK; (P.A.); (N.A.-A.)
| | - Niyi Ade-Ajayi
- Department of Women and Children’s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London SE5 9RS, UK; (P.A.); (N.A.-A.)
- Department of Paediatric Surgery, King’s College Hospital, Denmark Hill, London SE5 9RS, UK
| | - Anne Greenough
- Department of Women and Children’s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London SE5 9RS, UK; (P.A.); (N.A.-A.)
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18
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Muğlu H, İnan Kahraman E, Sünger E, Murt A, Bilici A, Görgülü N. Acute Kidney Injury Secondary to Abdominal Compartment Syndrome: Biomarkers, Pressure Variability, and Clinical Outcomes. MEDICINA (KAUNAS, LITHUANIA) 2025; 61:383. [PMID: 40142193 PMCID: PMC11943739 DOI: 10.3390/medicina61030383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2025] [Revised: 02/19/2025] [Accepted: 02/21/2025] [Indexed: 03/28/2025]
Abstract
Background and Objectives: Abdominal compartment syndrome (ACS) is a severe clinical condition caused by intra-abdominal hypertension (IAH), often observed in surgical and trauma patients. However, ACS can also develop in non-surgical patients with massive ascites, leading to acute kidney injury (AKI) due to renal hypoperfusion. This study investigates the association between intra-abdominal pressure (IAP) changes, renal biomarkers, and mortality in patients with ACS-related AKI. Materials and Methods: A prospective cohort study was conducted on 24 hospitalized patients with ascites due to malignancy, cirrhosis, or heart failure. IAP was measured via the trans-vesical method on the first and seventh days of hospitalization. Serum and urinary biomarkers, including kidney injury molecule-1 (KIM-1), neutrophil gelatinase-associated lipocalin (NGAL), and interleukin-6 (IL-6), were assessed for their correlation with IAP changes. The primary outcome was in-hospital mortality, and the secondary outcomes included AKI progression and the effect of paracentesis on IAP reduction. Results: The overall in-hospital mortality rate was 50%. Patients who survived had significantly lower IAP on the seventh day compared to those who died (14.9 ± 3.5 mmHg vs. 20.2 ± 5.6 mmHg, p = 0.01). A 25% reduction in IAP was associated with improved kidney function and increased survival (p < 0.001). Urinary KIM-1 and serum NGAL levels showed a moderate correlation with IAP (r = 0.55, p = 0.02 and r = 0.61, p = 0.018, respectively), while IL-6 levels were significantly higher in non-survivors (p = 0.03). Paracentesis was associated with improved survival outcomes (p = 0.04). Conclusions: ACS is a critical but often overlooked cause of AKI in non-surgical patients with massive ascites. Lowering IAP significantly improves renal function and reduces mortality. Urinary KIM-1 and serum NGAL may serve as useful biomarkers for monitoring IAP changes. The early identification and management of IAH through timely interventions such as paracentesis and volume control strategies could improve patient outcomes.
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Affiliation(s)
- Harun Muğlu
- Department of Medical Oncology, Medipol University Faculty of Medicine, Istanbul 34214, Turkey; (E.S.); (A.B.)
| | - Eslem İnan Kahraman
- Department of Internal Medicine, Bagcilar Training and Research Hospital, Istanbul 34200, Turkey;
| | - Erdem Sünger
- Department of Medical Oncology, Medipol University Faculty of Medicine, Istanbul 34214, Turkey; (E.S.); (A.B.)
| | - Ahmet Murt
- Department of Nephrology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul 34098, Turkey;
| | - Ahmet Bilici
- Department of Medical Oncology, Medipol University Faculty of Medicine, Istanbul 34214, Turkey; (E.S.); (A.B.)
| | - Numan Görgülü
- Department of Nephrology, Bagcilar Training and Research Hospital, Istanbul 34200, Turkey;
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19
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Pereira R, Lopes D, Machado SB, Val-Flores L, Caeiro F, Perdigoto R, Marcelino PA, Saliba F. Abdominal Hypoperfusion and Acute Kidney Injury in the Critically Ill Patient with Liver Cirrhosis: A Prospective Cohort Study. GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2025; 32:25-36. [PMID: 39906513 PMCID: PMC11790267 DOI: 10.1159/000538939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 04/13/2024] [Indexed: 02/06/2025]
Abstract
Background Reduced abdominal perfusion pressure (APP) is an underdiagnosed potential pathophysiological mechanism for acute kidney injury (AKI) in the patient with liver cirrhosis and ascites. This study aimed to analyze the prevalence of abdominal hypoperfusion (AhP) (APP <60 mm Hg) and the impact of APP on AKI in critically ill patients with liver cirrhosis. Methods This was a post hoc analysis from a prospective cohort study set in a general ICU at a tertiary university hospital. Patients were recruited between October 2016 and December 2021. Acute renal failure (ARF) was defined by stage 3 AKI according to the International Club of Ascites. Results Fifty-eight patients where included, with a mean age of 57 (±8.4) years, 79% were male, and 93% had acute-on-chronic liver failure at admission. The prevalence of AhP reached 75%, and 29% of cases had persisting AhP during the first week of ICU stay. Patients with baseline AhP had a higher 28-day mortality compared to those without AhP (respectively, 76% vs. 49%, p = 0.03). Acute renal failure developed in 48% of patients. Higher serum urea (aOR: 1.01, 95% CI: 1.00-1.02, p = 0.04) and white blood cell count (aOR: 1.1, 95% CI: 1.01-1.2, p = 0.02) at ICU admission, as well as low persisting APP (aOR: 0.9, 95% CI: 0.86-0.98, p = 0.02) were independent risk factors for ARF. Conclusion Critically ill patients with liver cirrhosis presented a high prevalence of ARF, independently associated with higher baseline serum urea and WBC, and lower persisting APP. A structured clinical approach to optimize APP may reduce renal dysfunction in high-risk patients with cirrhosis.
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Affiliation(s)
- Rui Pereira
- Unidade de Cuidados Intensivos Polivalente 7 (UCIP7), Hospital Curry Cabral, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - Diogo Lopes
- Unidade de Cuidados Intensivos Polivalente 7 (UCIP7), Hospital Curry Cabral, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - Sara Brandão Machado
- Unidade de Cuidados Intensivos Polivalente 7 (UCIP7), Hospital Curry Cabral, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - Luís Val-Flores
- Unidade de Cuidados Intensivos Polivalente 7 (UCIP7), Hospital Curry Cabral, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - Fernando Caeiro
- Serviço de Nefrologia, Hospital Curry Cabral, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - Rui Perdigoto
- Unidade de Transplantes, Hospital Curry Cabral, Centro Hospitalar Universitário Lisboa Central, Nova Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Paulo Alexandre Marcelino
- Unidade de Cuidados Intensivos Polivalente 4 (UCIP4), Hospital de Santa Marta, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - Faouzi Saliba
- AP-HP Hôpital Paul Brousse, Hepato-Biliary Center, INSERM Unit No 1193, Université Paris Saclay, Villejuif, France
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20
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Lubnow M, Koch CT, Malfertheiner MV, Foltan M, Philipp A, Lunz D, Schlitt HJ, Brennfleck F, Dietl B, Hamer OW, Stadlbauer A, Schmid C, Zeman F, Müller T, Fisser C. Prevalence, Predictors and Decompressive Laparotomy in Abdominal Compartment Syndrome in Patients Requiring Extracorporeal Membrane Oxygenation. J Clin Med 2025; 14:855. [PMID: 39941529 PMCID: PMC11818648 DOI: 10.3390/jcm14030855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2025] [Revised: 01/20/2025] [Accepted: 01/22/2025] [Indexed: 02/16/2025] Open
Abstract
Background: Critically ill patients requiring extracorporeal membrane oxygenation (ECMO) have several risk factors to suffer from abdominal compartment syndrome (ACS). Little is known about this subgroup. The aim of this study was to investigate the prevalence and associated factors for ACS in patients requiring ECMO to assess the effect of decompressive laparotomy (DL) and the impact on mortality. Methods: This retrospective observational study analyzed adult patients requiring ECMO in four intensive care units at the University Medical Center Regensburg between 01/2010 and 06/2020. Patients with clinically suspected ACS were screened by measuring intra-abdominal pressure (IAP) with the trans-bladder technique. ACS was defined as IAP > 20 mmHg and survival was defined as successful discharge from hospital. Results: The prevalence of ACS in non-ECMO ICU patients was 0.8% (291/36,795) and 2.9% (47/1643) in ECMO patients. In the subgroup of resuscitated ECMO patients, ACS was present in 4.2% (32/766). Procalcitonin was associated with ACS. ECMO patients with ACS receiving DL were significantly more ill compared to those without DL (SOFA score at ICU admission 18 [15; 20], vs. 16 [13; 17], p = 0.048). DL decreased IAP and significantly improved ventilation; vasopressor and lactate stabilized within 24 hours. Survival was comparable between the DL and the non-DL groups (11% [1/9] vs. 14% [1/7], p = 1.000). Conclusions: ECMO patients are at high risk of developing ACS, even more so for resuscitated patients. This and high procalcitonin may be taken into consideration when screening for ACS. Decompressive laparotomy did improve respiratory compliance and stabilized hemodynamic parameters with low rates of complication. Even though patients that received DL were significantly more ill, the mortality rates were not higher.
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Affiliation(s)
- Matthias Lubnow
- Department of Internal Medicine II, University Medical Center Regensburg, 93053 Regensburg, Germany; (M.L.); (T.M.)
| | - Chiara T. Koch
- Department of Internal Medicine II, University Medical Center Regensburg, 93053 Regensburg, Germany; (M.L.); (T.M.)
| | | | - Maik Foltan
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, 93053 Regensburg, Germany; (M.F.); (A.P.); (A.S.); (C.S.)
| | - Alois Philipp
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, 93053 Regensburg, Germany; (M.F.); (A.P.); (A.S.); (C.S.)
| | - Dirk Lunz
- Department of Anesthesiology, University Medical Center Regensburg, 93053 Regensburg, Germany;
| | - Hans J. Schlitt
- Department of Surgery, University Medical Center Regensburg, 93053 Regensburg, Germany;
| | - Frank Brennfleck
- Department of Surgery, Main-Kinzig-Kliniken Gelnhausen, 63571 Gelnhausen, Germany;
| | - Barbara Dietl
- Department of Radiotherapy, University Medical Center Regensburg, 93053 Regensburg, Germany;
| | - Okka W. Hamer
- Department of Radiology, University Medical Center Regensburg, 93053 Regensburg, Germany;
- Department of Radiology, Hospital Donaustauf, 93093 Donaustauf, Germany
| | - Andrea Stadlbauer
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, 93053 Regensburg, Germany; (M.F.); (A.P.); (A.S.); (C.S.)
| | - Christof Schmid
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, 93053 Regensburg, Germany; (M.F.); (A.P.); (A.S.); (C.S.)
| | - Florian Zeman
- Center for Clinical Studies, University Medical Center Regensburg, 93053 Regensburg, Germany;
| | - Thomas Müller
- Department of Internal Medicine II, University Medical Center Regensburg, 93053 Regensburg, Germany; (M.L.); (T.M.)
| | - Christoph Fisser
- Department of Internal Medicine II, University Medical Center Regensburg, 93053 Regensburg, Germany; (M.L.); (T.M.)
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21
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Liao CH, Spain DA, Chen CC, Cheng CT, Lin WC, Ho DR, Lin HF, Catena F. Feasibility and accuracy of continuous intraabdominal pressure monitoring with a capsular device in human pilot trial. World J Emerg Surg 2025; 20:7. [PMID: 39865273 PMCID: PMC11771060 DOI: 10.1186/s13017-024-00569-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2024] [Accepted: 11/26/2024] [Indexed: 01/28/2025] Open
Abstract
BACKGROUND Intrabdominal pressure (IAP) is an important parameter. Elevated IAP can reduce visceral perfusion, lead to intraabdominal hypertension, and result in life-threatening abdominal compartment syndrome. While ingestible capsular devices have been used for various abdominal diagnoses, their application in continuous IAP monitoring remains unproven. METHOD We conducted a prospective clinical trial to evaluate the feasibility of IAP measurement using a digital capsule PressureDOT, an ingestible capsule equipped with wireless transmission capability and a pressure sensor, then compared its reliability with conventional intravesical method. Patients undergoing laparoscopic or robotic surgeries were recruited. During surgery, we created pneumoperitoneum by inflating CO2 into the peritoneal cavity and IAP was simultaneously monitored using both the ingestible capsules and intravesical measurements from Foley catheter. We assessed the feasibility of signal transmission and the accuracy of pressure measurements. RESULTS Six patients were enrolled in this pilot study. No adverse events were reported, and the average first-intake time was within 24 h. All capsules were successfully expelled, with an average excretion time of 81 h. In the summarized data, the mean IAPdot is 0.6 mmHg lower than the IAPivp, with a standard deviation of 1.68 mmHg. However, capsule measurements showed excellent correlation with intravesical IAP measurements, with an intraclass correlation coefficient of 0.916 (95% CI: 0.8821-0.9320). CONCLUSION Our study demonstrates the feasibility and safety of using digital capsules for continuous IAP monitoring, providing the agreement between IAP measurements from digital capsules and conventional intravesical measurement within a near-normal pressure.
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Affiliation(s)
- Chien-Hung Liao
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - David A Spain
- Department of Surgery, Stanford University, Stanford, CA, USA
| | - Chih-Chi Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chi-Tung Cheng
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Wei-Cheng Lin
- Department of Electrical Engineering, Chang Gung University, Taoyuan, Taiwan
| | - Dong-Ru Ho
- Department of Surgery, Division of Urology, Chang Gung Memorial Hospital, Chang Gung University, Puzi City, Chiayi, Taiwan.
- School of Medicine, National Tsing Hua University, Hsinchu, Taiwan.
| | - Heng-Fu Lin
- Division of Trauma, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Graduate Institute of Medicine, Yuan Ze University, Taoyuan City, Taiwan
| | - Fausto Catena
- University of Bologna- Bufalini Hospital, Cesena, Italy
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22
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吴 雪, 李 兰, 石 佳, 李 洁, 李 紫, 林 子, 刘 婷, 金 涛, 夏 庆. [Clinical Manifestations of Early-Onset Capillary Leak Syndrome in Patients With Multiple Organ Failure Due to Severe Acute Pancreatitis]. SICHUAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF SICHUAN UNIVERSITY. MEDICAL SCIENCE EDITION 2025; 56:277-283. [PMID: 40109459 PMCID: PMC11914012 DOI: 10.12182/20250160609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2024] [Indexed: 03/22/2025]
Abstract
Objective To investigate the early dynamic changes of biomarkers associated with capillary leak syndrome (CLS) in patients with severe acute pancreatitis (SAP) and their correlation with multiple organ failure (MOF). Methods A total of 171 SAP patients admitted to the West China Centre of Excellence for Pancreatitis, West China Hospital, Sichuan University between September 1, 2019 and December 31, 2020 were enrolled for this study. The patients were divided into MOF and non-MOF groups based on the occurrence of MOF in the first 5 days of hospitalization, and were further divided into subgroups based on the presence of moderate-to-severe intra-abdominal hypertension (IAH). We performed dynamic monitoring of the blood biomarkers (hematocrit [HCT], blood urea nitrogen [BUN], and creatinine [Cr]), plasma proteins (albumin [Alb], total protein [TP], and non-albumin plasma proteins [NAPP]), and intra-abdominal pressure. Trends in these indicators across groups were analyzed comprehensively. Results No significant differences in baseline data between the two groups were observed. The baseline data of the 2 groups were comparable. The MOF group had significantly higher rates of persistent systemic inflammatory response syndrome (SIRS) lasting 48 hours (91.3% vs. 71.8%), ICU admission (70.4% vs. 17.6%), and length-of-stay ([32 ± 17.7] days vs. [19.0 ± 12.2] days) compared to those of the non-MOF group (P < 0.05). The incidences of respiratory, circulatory, and renal failures were higher in the MOF group than those in the non-MOF group, showing significant differences in circulatory failure (69% vs. 3.5%) and renal failure (65.5% vs. 3.5%) (P < 0.05). In the first 5 days of hospitalization, the MOF group showed significantly elevated BUN and Cr levels, while Alb and TP levels dropped rapidly upon admission and then gradually recovered. The NAPP level of the MOF group continued to decrease after admission, and on the third day after admission, the NAPP level was lower than that of the Non-MOF group, showing statistically significant difference (P < 0.001). The Alb/NAPP ratio of the MOF group decreased significantly on day 1 and then rapidly increased, showing significant differences between the groups on days 3 and 4 (P = 0.001). Subgroup analysis of MOF patients with moderate-to-severe IAH revealed similar trends in the dynamic changes and the overall changes in the indicators, and the difference was even more pronounced. The mixed linear model showed that the average levels of HCT, BUN, Alb/NAPP, and Alb/TP were higher and increased over time in the MOF combined with IAP subgroup (P < 0.001). Conclusion The CLS model of SAP patients is validated, confirming that CLS is a key factor in the progression from SIRS to MOF. The loss of NAPP is an early and important indicator of CLS persistence and progression to MOF. Additionally, moderate-to-severe IAH accelerates the deterioration of MOF. These findings provide valuable insights into the potential mechanisms of MOF and warrant further validation through large-scale prospective studies.
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Affiliation(s)
- 雪滢 吴
- 四川大学华西医院 中西医结合中心 胰腺炎中心 (成都 610041)West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 兰 李
- 四川大学华西医院 中西医结合中心 胰腺炎中心 (成都 610041)West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 佳华 石
- 四川大学华西医院 中西医结合中心 胰腺炎中心 (成都 610041)West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 洁 李
- 四川大学华西医院 中西医结合中心 胰腺炎中心 (成都 610041)West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 紫钰 李
- 四川大学华西医院 中西医结合中心 胰腺炎中心 (成都 610041)West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 子琦 林
- 四川大学华西医院 中西医结合中心 胰腺炎中心 (成都 610041)West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 婷婷 刘
- 四川大学华西医院 中西医结合中心 胰腺炎中心 (成都 610041)West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 涛 金
- 四川大学华西医院 中西医结合中心 胰腺炎中心 (成都 610041)West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 庆 夏
- 四川大学华西医院 中西医结合中心 胰腺炎中心 (成都 610041)West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
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23
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ŞARER EA, TAHTACI M, ERSOY UC, HONCA M. The abdominal compliance index and postoperative pain after laparoscopic gynecologic surgery: a preliminary observational cohort study. Turk J Med Sci 2025; 55:277-286. [PMID: 40129911 PMCID: PMC11931810 DOI: 10.55730/1300-0144.5969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2024] [Revised: 02/18/2025] [Accepted: 01/15/2025] [Indexed: 03/26/2025] Open
Abstract
Background/aim In gynecology, laparoscopic surgery has the advantages of reduced scarring, less postoperative pain, faster recovery, and lower risk of complications. Despite these advantages, shoulder pain still remains a major concern, affecting up to 90% of patients undergoing gynecologic laparoscopic surgery. Use of the abdominal compliance index (ACI) may offer the benefit of increased space for safer surgery and may prevent the drawback of high insufflation pressures. The aim of this study was to investigate the relationship between shoulder pain, abdominal pain, and analgesic use with the recently advised ACI, a surrogate index of abdominal expansion in patients undergoing gynecologic laparoscopic surgery. Materials and methods Thirty-one patients with American Society of Anesthesiologists scores of 1-3 who underwent elective gynecologic laparoscopic surgery were included. The insufflation pressure was set to 12 mmHg. ACI, defined as insufflated intraabdominal volume (L) per body surface area (m2), was used to estimate the relationship between abdominal compliance and postoperative pain. Results The 31 patients were separated into two groups based on median ACI level (range 1.37-2.73 L/m2), with those having values of 2.16 L/m2 or lower as group 1 and those with higher values as group 2. Abdominal visual analogue scale (VAS) scores at 30 min postoperative were significantly higher in group 2 than in group 1 (p < 0.001). Shoulder pain VAS scores at 24 h and 36 h postoperative were also significantly higher in group 2 than in group 1 (p = 0.021 and p = 0.002, respectively). The total amount of analgesic infusion and additional analgesic requirements were lower in group 1 than in group 2 (p = 0.049 and p = 0.001, respectively). ACI did not differ with patient demographic characteristics or history of abdominal/laparoscopic surgery, parity, abdominal drainage, and pneumoperitoneum time. Conclusion ACI, a surrogate index of abdominal expansion capacity, may be used to guide individualization of insufflation pressures by identifying female patients under risk of higher postoperative pain.
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Affiliation(s)
- Ebru Akgün ŞARER
- Department of Anesthesiology, Bilkent City Hospital, Ankara,
Turkiye
| | - Mustafa TAHTACI
- Department of Gastroenterology, Bilkent City Hospital, Yıldırım Beyazıt University, Ankara,
Turkiye
| | - Umut Cahit ERSOY
- Department of Anesthesiology, Bilkent City Hospital, Ankara,
Turkiye
| | - Mehtap HONCA
- Department of Anesthesiology, Bilkent City Hospital, Ankara,
Turkiye
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24
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Kamada T, Ohdaira H, Aida T, Yamagishi D, Takahashi J, Nakashima K, Ito E, Suzuki N, Hata T, Yoshida M, Yamanouchi E, Suzuki Y. Fluoroscopic balloon dilation is effective for anastomotic leakage caused by compression due to intraperitoneal hematoma after ileostomy closure: A case report. Medicine (Baltimore) 2025; 104:e41240. [PMID: 40184079 PMCID: PMC11709225 DOI: 10.1097/md.0000000000041240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2024] [Accepted: 12/19/2024] [Indexed: 04/05/2025] Open
Abstract
RATIONALE There have been no reports of delayed anastomotic leakage of the ileum caused by compression of an intra-abdominal hematoma due to postoperative bleeding after ileostomy closure. PATIENT CONCERNS We report the case of a 44-year-old man with delayed anastomotic leakage after ileostomy closure caused by the compression of an intra-abdominal hematoma that healed quickly after fluoroscopic balloon dilatation of the bowel stenosis area. DIAGNOSES Postoperative bleeding and hemorrhagic shock occurred on postoperative day 1 after ileostomy closure. Vital signs stabilized after blood transfusion, and computerized tomography-guided drainage was successfully performed to reduce the hematoma volume. However, residual hematoma compressed the ileum on the anal side of the anastomosis, leading to delayed anastomotic leakage. INTERVENTIONS/OUTCOMES Fluoroscopic balloon dilation of the stenotic area through the drain was successfully performed, and the anastomotic leakage healed quickly. LESSONS In cases of small intestinal anastomotic leakage after postoperative bleeding, compression of the intestinal tract due to a hematoma should be considered. Fluoroscopic balloon dilation through a drain is an effective procedure.
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Affiliation(s)
- Teppei Kamada
- Department of Surgery, International University of Health and Welfare Hospital, Nasushiobara, Tochigi, Japan
| | - Hironori Ohdaira
- Department of Surgery, International University of Health and Welfare Hospital, Nasushiobara, Tochigi, Japan
| | - Takashi Aida
- Department of Surgery, International University of Health and Welfare Hospital, Nasushiobara, Tochigi, Japan
| | - Daisuke Yamagishi
- Department of Surgery, International University of Health and Welfare Hospital, Nasushiobara, Tochigi, Japan
| | - Junji Takahashi
- Department of Surgery, International University of Health and Welfare Hospital, Nasushiobara, Tochigi, Japan
| | - Keigo Nakashima
- Department of Surgery, International University of Health and Welfare Hospital, Nasushiobara, Tochigi, Japan
| | - Eisaku Ito
- Department of Surgery, International University of Health and Welfare Hospital, Nasushiobara, Tochigi, Japan
| | - Norihiko Suzuki
- Department of Surgery, International University of Health and Welfare Hospital, Nasushiobara, Tochigi, Japan
| | - Taigo Hata
- Department of Surgery, International University of Health and Welfare Hospital, Nasushiobara, Tochigi, Japan
| | - Masashi Yoshida
- Department of Surgery, International University of Health and Welfare Hospital, Nasushiobara, Tochigi, Japan
| | - Eigoro Yamanouchi
- Department of Radiology, International University of Health and Welfare Hospital, Nasushiobara, Tochigi, Japan
| | - Yutaka Suzuki
- Department of Surgery, International University of Health and Welfare Hospital, Nasushiobara, Tochigi, Japan
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25
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Smith S, Priestap F, Parry N, Arntfield R, Murphy P, Vogt K, Ball I. Intraabdominal hypertension is less common than it used to be: A pilot step wedge trial. J Crit Care Med (Targu Mures) 2025; 11:95-100. [PMID: 40017480 PMCID: PMC11864065 DOI: 10.2478/jccm-2025-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2024] [Accepted: 12/19/2024] [Indexed: 03/01/2025] Open
Abstract
Objective This is a pilot study to determine the feasibility of a multicentre stepped wedge cluster randomized trial of implementing the 2013 World Society of the Intraabdominal Compartment Syndrome (WSACS) guidelines as an intervention to treat intraabdominal hypertension (IAH) and abdominal compartment syndrome (ACS) in critically ill patients. Design Single-centre before-and-after trial, with an observation / baseline period of 3 months followed by a 9-month intervention period. Setting A 35 bed medical-surgical-trauma intensive care unit in a tertiary level, Canadian hospital. Patients Recruitment from consecutively admitted adult intensive care unit patients. Intervention In the intervention period, treatment teams were prompted to implement WSACS interventions in all patients diagnosed with IAH. Measurements and Main Results 129 patients were recruited, 59 during the observation period and 70 during the intervention period. Only 17.0% and 12.9%, respectively, met diagnostic criteria for IAH. Many recruited patients did not have intraabdominal pressures measured regularly per study protocol. There was no difference in ICU mortality for patients in either cohort or between those with and without IAH. Conclusions The incidence of IAH in our patient population has decreased significantly since 2015. This is likely due to a significant change in routine care of critically ill patients, especially with respect to judicious goal-directed fluid resuscitation. Patient recruitment and protocol adherence in this study were low, exacerbated by other staffing and logistical pressures during the study period. We conclude that a larger multicentre trial is unlikely to yield evidence of a detectable treatment effect.
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Affiliation(s)
- Shane Smith
- Office of Academic Military Medicine, Western University, London, Ontario, Canada
- Department of Surgery, Western University, London, Ontario, Canada
- London Health Sciences Centre Trauma Program, London, Ontario, Canada
| | - Fran Priestap
- London Health Sciences Centre Trauma Program, London, Ontario, Canada
| | - Neil Parry
- Office of Academic Military Medicine, Western University, London, Ontario, Canada
- Department of Surgery, Western University, London, Ontario, Canada
- London Health Sciences Centre Trauma Program, London, Ontario, Canada
| | - Robert Arntfield
- Department of Medicine, Western University, London, Ontario, Canada
| | - Patrick Murphy
- Department of Surgery, Division of Trauma and Acute Care Surgery, Medical College of Wisconsin,Milwaukee, WI, USA
| | - Kelly Vogt
- Department of Surgery, Western University, London, Ontario, Canada
- London Health Sciences Centre Trauma Program, London, Ontario, Canada
| | - Ian Ball
- Office of Academic Military Medicine, Western University, London, Ontario, Canada
- London Health Sciences Centre Trauma Program, London, Ontario, Canada
- Department of Medicine, Western University, London, Ontario, Canada
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26
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Xu L, Zhao W, He J, Hou S, He J, Zhuang Y, Wang Y, Yang H, Xiao J, Qiu Y. Abdominal perfusion pressure is critical for survival analysis in patients with intra-abdominal hypertension: mortality prediction using incomplete data. Int J Surg 2025; 111:371-381. [PMID: 39166944 PMCID: PMC11745648 DOI: 10.1097/js9.0000000000002026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2024] [Accepted: 07/30/2024] [Indexed: 08/23/2024]
Abstract
BACKGROUND Abdominal perfusion pressure (APP) is a salient feature in the design of a prognostic model for patients with intra-abdominal hypertension (IAH). However, incomplete data significantly limits the size of the beneficiary patient population in clinical practice. Using advanced artificial intelligence methods, the authors developed a robust mortality prediction model with APP from incomplete data. METHODS The authors retrospectively evaluated the patients with IAH from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Incomplete data were filled in using generative adversarial imputation nets (GAIN). Lastly, demographic, clinical, and laboratory findings were combined to build a 7-day mortality prediction model. RESULTS The authors included 1354 patients in this study, of which 63 features were extracted. Data imputation with GAIN achieved the best performance. Patients with an APP <60 mmHg had significantly higher all-cause mortality within 7-90 days. The difference remained significant in long-term survival even after propensity score matching (PSM) eliminated other mortality risks between groups. Lastly, the built machine learning model for 7-day modality prediction achieved the best results with an AUC of 0.80 in patients with confirmed IAH outperforming the other four traditional clinical scoring systems. CONCLUSIONS APP reduction is an important survival predictor affecting the survival prognosis of patients with IAH. The authors constructed a robust model to predict the 7-day mortality probability of patients with IAH, which is superior to the commonly used clinical scoring systems.
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Affiliation(s)
- Liang Xu
- Department of General Surgery, The Second Affiliated Hospital of the Army Medical University
- Bio-Med Informatics Research Centre and Clinical Research Centre, The Second Affiliated Hospital of the Army Medical University
| | - Weijie Zhao
- Bioengineering College, Chongqing University
| | - Jiao He
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University
| | - Siyu Hou
- Bio-Med Informatics Research Centre and Clinical Research Centre, The Second Affiliated Hospital of the Army Medical University
| | - Jialin He
- Department of Gastroenterology, The Second Affiliated Hospital of the Army Medical University
| | - Yan Zhuang
- Medical Big Data Research Center, Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Ying Wang
- Department of General Surgery, The Second Affiliated Hospital of the Army Medical University
| | - Hua Yang
- Department of General Surgery, Chongqing General Hospital, Chongqing
| | - Jingjing Xiao
- Bio-Med Informatics Research Centre and Clinical Research Centre, The Second Affiliated Hospital of the Army Medical University
| | - Yuan Qiu
- Department of General Surgery, The Second Affiliated Hospital of the Army Medical University
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27
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Seo D, Lim S, Namgoong B, Uhm H, Hong H, Lee N, Kim I, Heo S, Kang JH, Kim C, Shin H, Her J, Kim MS. Assessment of changes in intra-abdominal pressure and cardiac output induced by liver compression in healthy anesthetized spontaneously breathing dogs. PLoS One 2024; 19:e0315491. [PMID: 39666706 PMCID: PMC11637381 DOI: 10.1371/journal.pone.0315491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2024] [Accepted: 11/26/2024] [Indexed: 12/14/2024] Open
Abstract
OBJECTIVE Liver compression (LC) has been proposed to predict fluid responsiveness in human pediatric patients. Because the evaluation of fluid responsiveness through LC depends on the mechanism of increased intra-abdominal pressure (IAP), understanding the impact of LC on IAP, cardiac output (CO), and respiratory parameters is essential. Thus, this study aimed to investigate the effects of LC on these parameters. METHODS The present study used six healthy beagles. All dogs were anesthetized with isoflurane and allowed to breathe spontaneously in dorsal recumbency. After instrumentation, LC was performed at four different pressures in a sequential, non-randomized manner: (1) 10 mmHg, approximately half of the minimum value within the range; (2) 22 mmHg, a commonly used pressure within the range; (3) 44 mmHg, twice the pressure of the minimum value within the range; and (4) 60 mmHg, twice the pressure of the maximum value within the range. At each pressure, CO via transthoracic echocardiography, IAP, and cardiorespiratory parameters were measured before, during, and after LC. RESULTS Overall, our results showed that the IAP was significantly increased at all pressures during LC (P < 0.001), yielding a linear correlation between LC pressure and IAP (P < 0.001; r² = 0.89). The maximum IAP during LC was 7 mmHg, and intra-abdominal hypertension was not induced. LC at 22 mmHg significantly increased the IAP by 1.7 mmHg, but did not significantly alter the CO or respiratory parameters. CONCLUSIONS This is the first study to evaluate the effects of LC on IAP, CO, and respiratory parameters in healthy, anesthetized, and spontaneously breathing dogs. Our findings indicate that applying LC with a commonly used pressure may have a low risk of inducing intra-abdominal hypertension and related complications. Further studies are required to explore the use of LC in various clinical settings.
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Affiliation(s)
- Daeyun Seo
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine and Research institute for Veterinary Science, Seoul National University, Seoul, South Korea
| | - Seongsoo Lim
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine and Research institute for Veterinary Science, Seoul National University, Seoul, South Korea
| | - Beomkwan Namgoong
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine and Research institute for Veterinary Science, Seoul National University, Seoul, South Korea
| | - Heesung Uhm
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine and Research institute for Veterinary Science, Seoul National University, Seoul, South Korea
| | - Hyeajeong Hong
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine and Research institute for Veterinary Science, Seoul National University, Seoul, South Korea
| | - Nanju Lee
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine and Research institute for Veterinary Science, Seoul National University, Seoul, South Korea
| | - Isong Kim
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine and Research institute for Veterinary Science, Seoul National University, Seoul, South Korea
| | - Seunghun Heo
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine and Research institute for Veterinary Science, Seoul National University, Seoul, South Korea
| | - Ji Hwan Kang
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine and Research institute for Veterinary Science, Seoul National University, Seoul, South Korea
| | - Cheyoun Kim
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine and Research institute for Veterinary Science, Seoul National University, Seoul, South Korea
| | - Hayoung Shin
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine and Research institute for Veterinary Science, Seoul National University, Seoul, South Korea
| | - Jiwoong Her
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, United States of America
| | - Min Su Kim
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine and Research institute for Veterinary Science, Seoul National University, Seoul, South Korea
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Niebuhr H, Wegner F, Dag H, Reinpold W, Woeste G, Köckerling F. Preoperative botolinum toxin A (BTA) and intraoperative fascial traction (IFT) in the management of complex abdominal wall hernias. Hernia 2024; 28:2273-2283. [PMID: 39269518 PMCID: PMC11530493 DOI: 10.1007/s10029-024-03156-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2024] [Accepted: 08/26/2024] [Indexed: 09/15/2024]
Abstract
INTRODUCTION Preoperative botolinum toxin A (BTA) administration to the lateral abdominal wall has been widely used since its introduction for treating complex abdominal wall defects and loss of domain (LOD) hernias. Intraoperative fascial traction (IFT) is an established technique for complex abdominal wall hernias exceeding a width of 10 cm and has also shown auspicious results. We present our single center data including 143 consecutive cases combining both techniques from 2019 to 2023. Aim of the study was to develop an algorithm for a tailored approach for very large and complex ventral abdominal wall hernias. METHODS Consecutive patients treated with preoperative BTA and IFT from August 2019 to December 2023 were identified in our prospectively maintained database and reviewed retrospectively. Metrics included intraoperative findings and short-term (30 days) postoperative outcomes. RESULTS 143 patients were included in our retrospective analysis. The mean age was 58.9 years and 99% of all patients had an ASA Score of II or III with a mean body mass index of 32.4 kg/m2. The mean intraoperative reduction of fascia-to-fascia after BTA and IFT was 9.81 cm. 14 patients either had a lateral defect or a combination of a midline and lateral hernia. An additional uni- or bilateral transverse abdominis release (TAR) was necessary in 43 cases (30.1%). The overall surgical site occurrence rate (SSO) was 30.1% of which 13.8% were surgical site infections (SSI). Re-operation and SSO rates were significantly higher if an additional TAR was performed (both p = 0.001; α = 0.05). CONCLUSIONS IFT in combination with BTA is a transformative and clinically proven tool in the surgeons' toolbox. It might be an easier, and less invasive alternative to other available techniques in many cases, but it should not be looked at as an ultimate stand-alone method to treat all complex W3 hernias.
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Affiliation(s)
| | - Felix Wegner
- Agaplesion Bethesda Hospital Bergedorf, Hamburg, Germany
| | - Halil Dag
- Hamburg Hernia Center, Hamburg, Germany
| | | | - Guido Woeste
- Agaplesion Elisabethenstift Darmstadt, Darmstadt, Germany
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Zhang J, Song L, Ma Z, Sun L, Wang X, Liu D, Huang F, Man Y. Intra-abdominal pressure and residual renal function decline in peritoneal dialysis: a threshold-based investigation. Ren Fail 2024; 46:2312535. [PMID: 38321869 PMCID: PMC10851793 DOI: 10.1080/0886022x.2024.2312535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/27/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND The potential impact of elevated intra-abdominal pressure (IAP) on residual renal function (RRF) has not been determined. The objective of this study was to investigate the relationship between IAP and the rate of RRF decline in newly initiated peritoneal dialysis (PD) patients, and to identify the optimal IAP threshold value for delaying the deterioration of RRF. METHODS A cohort of 62 newly initiated PD patients who completed both 6- and 12-month follow-up evaluations was obtained using the Durand method. A logistic regression model was used to identify variables associated with a rapid decline in RRF. Receiver operating characteristic (ROC) curves were generated to determine the optimal threshold value. Another retrospective cohort analysis was performed to validate the identified critical value. RESULTS For each 1 cmH2O increase in IAP, the risk of a rapid decline in the RRF increased by a factor of 1.679. Subsequent analysis revealed that patients in the high IAP group had more significant decreases in residual renal estimated glomerular filtration rate (eGFR) (Z = -3.694, p < 0.001) and urine volume (Z = -3.121, p < 0.001) than did those in the non-high IAP group. Furthermore, an IAP ≥15.65 cmH2O was a robust discriminator for the prediction of the rate of RRF decline. CONCLUSION Patients in the high IAP group experienced a more rapid decline in RRF. Additionally, an optimal critical pressure of 15.65 cmH2O was identified for predicting the rate of RRF decline. IAP, as one of the factors contributing to the rapid decline in RRF in the first year of PD, should be given due attention.
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Affiliation(s)
- Jingjing Zhang
- Graduate School of Jinzhou Medical University, Jinzhou, PR China
- Department of Nephrology, Linyi People’s Hospital, Linyi, PR China
| | - Lei Song
- Department of Nephrology, Linyi People’s Hospital, Linyi, PR China
| | - Zhongwei Ma
- Department of Nephrology, Linyi People’s Hospital, Linyi, PR China
| | - Lina Sun
- Department of Nephrology, Linyi People’s Hospital, Linyi, PR China
| | - Xiaoqing Wang
- Department of Nephrology, Linyi People’s Hospital, Linyi, PR China
| | - Duanyan Liu
- Department of Nephrology, Linyi People’s Hospital, Linyi, PR China
| | - Feng Huang
- Department of Nephrology, Linyi People’s Hospital, Linyi, PR China
| | - Yulin Man
- Department of Nephrology, Linyi People’s Hospital, Linyi, PR China
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30
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Ockenga J, Fromhold-Treu S, Löser C, Madl C, Martignoni M, Meier R, Rubin D, Schütte K, Stang K, Török HP, Wehle L, Weimann A. S3-Leitlinie Klinische Ernährung bei
Pankreaserkrankungen. AKTUELLE ERNÄHRUNGSMEDIZIN 2024; 49:451-475. [DOI: 10.1055/a-2328-6190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
Abstract
ZusammenfassungSowohl die akute als auch die chronische Pankreatitis sind häufige Erkrankungen,
die ein erhebliches Risiko für eine Mangelernährung mit sich bringen und eine
Ernährungstherapie erfordern können. In ca. 20% der akuten Pankreatitiden tritt
eine nekrotisierende Pankreatitis auf, die mit einer erhöhten Morbidität und
Mortalität verbunden ist. Hier ist oftmals eine Ernährungstherapie mittels einer
enteralen oder parenteralen Ernährung notwendig, die neben medikamentösen,
endoskopischen, radiologischen oder chirurgischen Maßnahmen eine etablierte
Säule der multimodalen Therapie darstellt.Bei der chronischen Pankreatitis handelt es sich um eine chronische Entzündung
der Bauchspeicheldrüse mit Entwicklung einer Fibrose und langfristig Atrophie
des Organs. Bauchschmerzen, die zu einer verminderten oralen Aufnahme von
Nährstoffen führen, sowie exokrines und endokrines Versagen sind häufige
Komplikationen der Krankheit. All diese Faktoren stellen Risikofaktoren für eine
Unter- bzw. Mangelernährung dar. Daher sollten Patienten mit chronischer
Pankreatitis als ernährungsmedizinische Risikopatienten betrachtet, untersucht
und entsprechend behandelt werden. Darüber hinaus sollte bei Patienten mit
chronischer Pankreatitis auf Osteoporose und ein erhöhtes Frakturrisiko geachtet
werden, und entsprechende Präventivmaßnahmen erwogen werden.
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Affiliation(s)
- Johann Ockenga
- Medizinische Klinik II, Klinikum Bremen-Mitte, Gesundheit Nord gGmbH,
Bremen, Deutschland
| | - Sophie Fromhold-Treu
- Abteilung für Gastroenterologie, Endokrinologie und
Stoffwechselkrankheiten, Zentrum für Innere Medizin, Universitätsmedizin
Rostock, Rostock, Deutschland
| | - Christian Löser
- Medizinische Klinik, DRK-Kliniken Nordhessen, Kassel,
Deutschland
| | - Christian Madl
- Zentrum für Gastroenterologische und Hepatologische Erkrankungen und
Gastrointestinale Endoskopie, Krankenanstalt Rudolfstiftung, Wien,
Österreich
| | - Marc Martignoni
- Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar,
Technische Universität München, Deutschland
| | - Rémy Meier
- Arztpraxis MagenDarm Basel AG, Basel, Schweiz
| | - Diana Rubin
- Zentrum für Ernährungsmedizin, Vivantes Klinikum Spandau, Berlin,
Deutschland
| | - Kerstin Schütte
- Klinik für Allgemeine Innere Medizin und Gastroenterologie,
Niels-Stensen-Kliniken Marienhospital Osnabrück, Osnabrück,
Deutschland
| | | | - Helga Paula Török
- Medizinische Klinik und Poliklinik II, Campus Innenstadt, Klinikum der
Ludwig-Maximilians-Universität München, München, Deutschland
| | - Lena Wehle
- Deutsche Gesellschaft für Ernährungsmedizin e.V., Berlin,
Deutschland
| | - Arved Weimann
- Abteilung für Allgemein-, Viszeral- und Onkologische Chirurgie,
Klinikum St. Georg gGmbH, Leipzig, Deutschland
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31
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Nasa P, Wise RD, Smit M, Acosta S, D'Amours S, Beaubien-Souligny W, Bodnar Z, Coccolini F, Dangayach NS, Dabrowski W, Duchesne J, Ejike JC, Augustin G, De Keulenaer B, Kirkpatrick AW, Khanna AK, Kimball E, Koratala A, Lee RK, Leppaniemi A, Lerma EV, Marmolejo V, Meraz-Munoz A, Myatra SN, Niven D, Olvera C, Ordoñez C, Petro C, Pereira BM, Ronco C, Regli A, Roberts DJ, Rola P, Rosen M, Shrestha GS, Sugrue M, Velez JCQ, Wald R, De Waele J, Reintam Blaser A, Malbrain MLNG. International cross-sectional survey on current and updated definitions of intra-abdominal hypertension and abdominal compartment syndrome. World J Emerg Surg 2024; 19:39. [PMID: 39609850 PMCID: PMC11605967 DOI: 10.1186/s13017-024-00564-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2024] [Accepted: 11/02/2024] [Indexed: 11/30/2024] Open
Abstract
BACKGROUND The Abdominal Compartment Society (WSACS) established consensus definitions and recommendations for the management of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) in 2006, and they were last updated in 2013. The WSACS conducted an international survey between 2022 and 2023 to seek the agreement of healthcare practitioners (HCPs) worldwide on current and new candidate statements that may be used for future guidelines. METHODS A self-administered, online cross-sectional survey was conducted under the auspices of the WSACS to assess the level of agreement among HCPs over current and new candidate statements. The survey, distributed electronically worldwide, collected agreement or disagreement with statements on the measurement of intra-abdominal pressure (IAP), pathophysiology, definitions, and management of IAH/ACS. Statistical analysis assessed agreement levels, expressed in percentages, on statements among respondents, and comparisons between groups were performed according to the respondent's education status, base specialty, duration of work experience, role (intensivist vs non-intensivist) and involvement in previous guidelines. Agreement was considered to be reached when 80% or more of the respondents agreed with a particular statement. RESULTS A total of 1042 respondents from 102 countries, predominantly physicians (73%), of whom 48% were intensivists, participated. Only 59% of HCPs were aware of the 2013 WSACS guidelines, and 41% incorporated them into practice. Despite agreement in most statements, significant variability existed. Notably, agreement was not reached on four new candidate statements: "normal intra-abdominal pressure (IAP) is 10 mmHg in critically ill adults" (77%), "clinical assessment and estimation of IAP is inaccurate" (65.2%), "intragastric can be an alternative to the intravesical route for IAP measurement" (70.4%), and "measurement of IAP should be repeated in the resting position after measurement in a supine position" (71.9%). The survey elucidated nuances in clinical practice and highlighted areas for further education and standardization. CONCLUSION More than ten years after the last published guidelines, this worldwide cross-sectional survey collected feedback and evaluated the level of agreement with current recommendations and new candidate statements. This will inform the consensus process for future guideline development.
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Affiliation(s)
- Prashant Nasa
- Department of Anaesthesia and Critical Care Medicine, The Royal Wolverhampton NHS Trust, New Cross Hospital, Wolverhampton, WV10 0QP, UK.
| | - Robert D Wise
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), 1050, Brussels, Belgium
- Discipline of Anesthesiology and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, 4001, South Africa
- Adult Intensive Care, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 9DU, UK
| | - Marije Smit
- Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Stefan Acosta
- Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden
| | - Scott D'Amours
- Trauma and Acute Care Surgery Unit, Liverpool Hospital, Sydney, Australia
- The University of New South Wales- South West Clinical School, Sydney, Australia
| | - William Beaubien-Souligny
- Department of Medicine, Nephrology Division, Centre Hospitalier de L'Université de Montréal, Université de Montréal, Montreal, Canada
| | - Zsolt Bodnar
- Department of Surgery, Letterkenny University Hospital, Donegal, Ireland
| | - Federico Coccolini
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy
| | - Neha S Dangayach
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Wojciech Dabrowski
- First Department of Anesthesiology and Intensive Therapy, Medical University of Lublin, Lublin, Poland
| | - Juan Duchesne
- Division Chief Trauma/Acute Care and Critical Care Department of Surgery, Tulane University, New Orleans, LA, USA
| | - Janeth C Ejike
- Department of Pediatrics, Downey Medical Center, Southern California Permanente Medical Group, 9333 Imperial Highway, Downey, CA, 90242, USA
- Kaiser Permanente Bernard J. Tyson School of Medicine, 98 S. Los Robles, 2nd Floor, Pasadena, CA, 91101, USA
| | - Goran Augustin
- Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Bart De Keulenaer
- Department of Intensive Care, Fiona Stanley Hospital, Murdoch, Australia
- Department of Surgery, The University of Western Australia, Perth, WA, Australia
| | - Andrew W Kirkpatrick
- Department of Surgery and Critical Care Medicine, Regional Trauma Services Foothills Medical Centre, Calgary, AB, T2N 2T9, Canada
| | - Ashish K Khanna
- Department of Anesthesiology, Section On Critical Care Medicine, Wake Forest School of Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
- Outcomes Research Consortium, Houston, TX, USA
| | - Edward Kimball
- Department of Surgery, University of Utah, 50 N Medical Drive, Salt Lake City, UT, USA
| | - Abhilash Koratala
- Division of Nephrology Froedtert & Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rosemary K Lee
- Baptist Health South Florida, Coral Gables, Florida, USA
| | - Ari Leppaniemi
- Department of Abdominal Surgery, Meilahti Hospital, University of Helsinki, Haartmaninkatu 4, PO Box 340, 00029, Helsinki, Finland
| | - Edgar V Lerma
- Department of Medicine, Advocate Christ Medical Center, University of Illinois at Chicago, Oak Lawn, IL, USA
| | | | - Alejando Meraz-Munoz
- Division of Nephrology, St. Boniface Hospital and The University of Manitoba, Winnipeg, MB, Canada
| | - Sheila N Myatra
- Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Daniel Niven
- Departments of Critical Care Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Claudia Olvera
- The American British Cowdray Medical Center, Universidad Anahuac, Mexico City, Mexico
| | - Carlos Ordoñez
- Division of Trauma and Acute Care Surgery, Department of Surgery, Fundación Valle del Lili, Cra 98 No. 18-49, 760032, Cali, Colombia
- Sección de Cirugía de Trauma y Emergencias, Universidad del Valle - Hospital Universitario del Valle, Cl 5 No. 36-08, 760032, Cali, Colombia
| | - Clayton Petro
- Department of General Surgery, Center for Abdominal Core Health, Cleveland Clinic, Cleveland, OH, USA
| | - Bruno M Pereira
- University of Vassouras, Rio de Janeiro, Brazil
- General Surgery Residency Program, Santa Casa de Campinas, Rio de Janeiro, Brazil
| | - Claudio Ronco
- Department of Nephrology and the International Renal Research Institute (IRRIV), San Bortolo Hospital, Vicenza, Italy
- University of Padova, Padua, Italy
| | - Adrian Regli
- Department of Intensive Care, Fiona Stanley Hospital, Perth, WA, Australia
- Medical School, The Notre Dame University, Fremantle, WA, Australia
- Medical School, The University of Western Australia, Perth, WA, Australia
| | - Derek J Roberts
- Departments of Surgery and Community Health Sciences, University of Calgary, Calgary, AB, T2N 5A1, Canada
| | - Philippe Rola
- Intensive Care, Santa Cabrini Hospital, Montreal, QC, Canada
| | - Michael Rosen
- Department of General Surgery, Center for Abdominal Core Health, Cleveland Clinic, Cleveland, OH, USA
| | - Gentle S Shrestha
- Department of Critical Care Medicine, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
| | | | | | - Ron Wald
- Division of Nephrology, Department of Medicine, St. Michael's Hospital, Toronto, Canada
- Department of Nephrology and Hypertension, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Jan De Waele
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Annika Reintam Blaser
- Clinic of Anesthesiology and Intensive Care, University of Tartu, Puusepa 8, 51014, Tartu, Estonia
- Department of Intensive Care Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Manu L N G Malbrain
- First Department of Anesthesiology and Intensive Therapy, Medical University of Lublin, Lublin, Poland
- Medical Data Management, Medaman, Geel, Belgium
- International Fluid Academy, Lovenjoel, Belgium
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Shi L, Shao J, Luo Y, Liu G, OuYang M. The incidence and risk factors of gastrointestinal dysfunction during enteral nutrition in mechanically ventilated critically ill patients. Nurs Open 2024; 11:e2247. [PMID: 39474999 PMCID: PMC11523002 DOI: 10.1002/nop2.2247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/06/2023] [Accepted: 06/12/2024] [Indexed: 11/02/2024] Open
Abstract
AIM To assess the occurrence and risk factors of gastrointestinal (GI) dysfunction during enteral nutrition (EN) in critically ill patients supported with mechanical ventilation. DESIGN Prospective observational study. METHODS Totally 252 patients admitted at a mixed medical-surgical ICU were enrolled. GI symptoms and the potential risk variables were recorded during the first 14 days of EN. RESULTS The incidence of GI dysfunction was 65.5%, and the incidence of diarrhoea, constipation, abdominal distension, and upper GI intolerance was 28.2%, 18.3%, 6.7% and 12.3%, respectively. The median onset days of constipation, diarrhoea, abdominal distension and UDI was 3, 5, 5 and 6 days, respectively. Multivariable Cox regression analysis showed a significant relationship between GI dysfunction and age (HR = 2.321, 95% CI: 1.024-5.264, p = 0.004), APACHE-II score at ICU admission (HR = 7.523, 95% CI: 4.734-12.592, p = 0.018), serum albumin level (HR = 0.594, 95% CI: 0.218-0.889, p = 0.041), multidrug-resistant bacteria-positive culture (HR = 6.924, 95% CI: 4.612-10.276, p<0.001), negative fluid balance (HR = 0.725, 95% CI: 0.473-0.926, p = 0.037), use of vasopressor drugs (HR = 1.642, 95% CI: 1.297-3.178, p<0.001), EN way (HR = 6.312, 95% CI: 5.143-11.836, p<0.001), infusion rate (HR = 1.947, 95% CI: 1.135-3.339, p<0.001), and intra-abdominal hypertension (HR = 3.864, 95% CI: 2.360-5.839, p<0.001). CONCLUSION Critically ill patients supported with mechanical ventilation are at a high risk of GI dysfunction. Interventions such as the use of laxatives or prokinetic agents, control of EN infusion rate, and maintaining a normal state of hydration, might be beneficial for the prevention of GI dysfunction in critically ill patients. PATIENT OR PUBLIC CONTRIBUTION No.
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Affiliation(s)
- Ling Shi
- Huizhou Central People's HospitalHuizhouGuangdongChina
| | - Jianmei Shao
- The First Affiliated Hospital of Guangzhou Medical UniversityGuangzhouGuangdongChina
| | - Yuxia Luo
- Huizhou Central People's HospitalHuizhouGuangdongChina
| | - Guiyan Liu
- Huizhou Central People's HospitalHuizhouGuangdongChina
| | - Miao OuYang
- Huizhou Central People's HospitalHuizhouGuangdongChina
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33
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Lopez-Monclus J, Gómez-Cruz A, Munoz-Rodriguez JM, Catalina García-Perrote S, Román García de León L, Blazquez-Hernando LA, Robin Valle De Lersundi Á, Santos-González M, Lucena de la Poza JL, Garcia-Urena MA. Sequential Fasciotomies for Managing Abdominal Compartment Syndrome: Porcine Experimental Study. J Surg Res 2024; 303:761-771. [PMID: 39471760 DOI: 10.1016/j.jss.2024.09.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 08/17/2024] [Accepted: 09/14/2024] [Indexed: 11/01/2024]
Abstract
INTRODUCTION Abdominal compartment syndrome (ACS) poses a significant clinical challenge, with high morbidity and mortality rates. Conventional treatment via decompressive laparotomy with open abdomen and temporary closure presents significant drawbacks. This experimental study evaluates the efficacy of open minimally invasive sequential fasciotomy in managing simulated ACS in a porcine model. METHODS Ten adult pigs were included in this prospective experimental investigation, wherein a mechanical model of abdominal hypertension was induced by pneumoperitoneum via a Veres needle. Open minimally invasive sequential fasciotomy, involving bilateral external oblique muscles (EOMs) and linea alba (LA), was performed. Physiological parameters were recorded preprocedure and postprocedure. RESULTS In our study, 70% of pigs completed the fasciotomy sequence. Unilateral EOM fasciotomy significantly reduced intravesical pressure and femoral venous pressure by 18% and 16%, respectively. Bilateral EOM fasciotomies led to a 35.7% decrease in both parameters. Following re-establishment of intra-abdominal pressure to 20 mmHg, LA fasciotomy resulted in a 47% drop in intravesical pressure and femoral venous pressure. Significant increases in tidal volume and abdominal perimeter were observed after each fasciotomy. CONCLUSIONS This study establishes that open minimally invasive sequential fasciotomy of bilateral EOM and LA is an effective strategy for managing simulated ACS in a porcine model. Each fasciotomy resulted in a significant reduction in intra-abdominal pressure. These findings suggest that sequential fasciotomy techniques offer a promising alternative to decompressive laparotomy in ACS management. Further research is essential to validate these outcomes in human subjects.
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Affiliation(s)
- Javier Lopez-Monclus
- Division of Complex Abdominal Wall Surgery, Department of Surgery, Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain; Department of Surgery, Faculty of Medicine, Autónoma de Madrid University, Madrid, Spain
| | | | - Joaquin M Munoz-Rodriguez
- Division of Complex Abdominal Wall Surgery, Department of Surgery, Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain; Department of Surgery, Faculty of Medicine, Autónoma de Madrid University, Madrid, Spain.
| | | | - Laura Román García de León
- Division of Complex Abdominal Wall Surgery, Department of Surgery, Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain; Department of Surgery, Faculty of Medicine, Autónoma de Madrid University, Madrid, Spain
| | - Luis A Blazquez-Hernando
- Division of Complex Abdominal Wall Surgery, Department of Surgery, Ramón y Cajal University Hospital, Madrid, Spain; Department of Surgery, Faculty of Medicine, Alcala de Henares University, Alcala de Henares, Madrid, Spain
| | - Álvaro Robin Valle De Lersundi
- Division of Complex Abdominal Wall Surgery, Department of Surgery, Henares University Hospital, Madrid, Spain; Complex Abdominal Wall Research Group from Francisco de Vitoria University, Madrid, Spain
| | - Martin Santos-González
- Division of Medical and Surgical Research, Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain
| | - José Luis Lucena de la Poza
- Department of Surgery, Faculty of Medicine, Autónoma de Madrid University, Madrid, Spain; Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain
| | - Miguel A Garcia-Urena
- Division of Complex Abdominal Wall Surgery, Department of Surgery, Henares University Hospital, Madrid, Spain; Complex Abdominal Wall Research Group from Francisco de Vitoria University, Madrid, Spain
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Chiu CH, Lu CW, Lin TY, Chen PF. Abdominal compartment syndrome during intraoperative hyperthermic intraperitoneal chemotherapy following debulking surgery for colorectal cancer: A case report. Int J Surg Case Rep 2024; 123:110192. [PMID: 39241478 PMCID: PMC11405813 DOI: 10.1016/j.ijscr.2024.110192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 08/13/2024] [Accepted: 08/15/2024] [Indexed: 09/09/2024] Open
Abstract
INTRODUCTION Colorectal cancer leads to peritoneal metastasis in 8-15 % of cases and necessitates treatments, such as hyperthermic intraperitoneal chemotherapy (HIPEC). However, HIPEC may result in perioperative complications, some often overlooked, such as abdominal compartment syndrome. CASE PRESENTATION A 52-year-old female with colorectal cancer and peritoneal metastasis underwent debulking surgery followed by HIPEC. During HIPEC, a sudden increase in airway pressure and severe hypotension were noted. Pneumothorax with abdominal compartment syndrome (ACS) was suspected and HIPEC was terminated. Despite intravenous fluids and vasopressors, she experienced circulatory and respiratory collapse. Laparotomy sutures were promptly removed, which effectively alleviated the intra-abdominal hypertension and immediately restored the vital signs. An inadequately repaired diaphragm defect was identified and repaired. A chest tube was inserted for pleural effusion. DISCUSSION ACS is characterized by an increase in abdominal cavity pressure above 20 mmHg, leading to end-organ damage. It can mimic physiological effects of HIPEC and result in adverse outcomes. Early detection of ACS is essential, especially when complicated by pneumothorax from diaphragmatic tumor dissection. The closed technique for HIPEC, while efficient, can increase the risk of ACS and requires careful management. CONCLUSIONS This case underscores the complexity of HIPEC and the importance of promptly identifying and managing ACS during the procedure. Monitoring intra-abdominal pressure during HIPEC is essential. Thoroughly check for iatrogenic injuries, including the diaphragm, is crucial before starting before HIPEC.
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Affiliation(s)
- Chen-Hsi Chiu
- Department of Anesthesiology, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan
| | - Cheng-Wei Lu
- Department of Anesthesiology, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan; Department of Mechanical Engineering, Yuan Ze University, Taoyuan 320, Taiwan
| | - Tzu-Yu Lin
- Department of Anesthesiology, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan; Department of Mechanical Engineering, Yuan Ze University, Taoyuan 320, Taiwan
| | - Pei-Fu Chen
- Department of Anesthesiology, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan; Department of Electrical Engineering, Yuan Ze University, Taoyuan 320, Taiwan.
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Kouw IWK, Melchers M, Mändul M, Arabi YM, Casaer MP, Cotoia A, Gunst J, Malbrain MLNG, Schaller SJ, Starkopf J, Sundström Rehal M, Reintam Blaser A, van Zanten ARH. Prospective multicenter study to validate the gastrointestinal dysfunction score (GIDS) in intensive care patients: Study protocol for Part A of the international GUTPHOS study. Clin Nutr ESPEN 2024; 63:702-708. [PMID: 39069258 DOI: 10.1016/j.clnesp.2024.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 07/17/2024] [Accepted: 07/22/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND While gastrointestinal (GI) dysfunction is commonly encountered among critically ill patients, a uniform prospectively validated scoring system is lacking. The present study aims to validate the recently developed Gastrointestinal Dysfunction Score (GIDS) in a multicenter, prospective cohort of consecutive adult patients admitted to intensive care units (ICU). METHODS GUTPHOS is a prospective, multicenter, non-interventional cohort study in which at least 1400 consecutive adult patients (age ≥18 years) admitted to the ICU will be monitored daily for abdominal signs and symptoms of GI dysfunction. The previously developed GIDS constructed from these signs and symptoms will be tested in relation to mortality and duration of ICU dependency and parenteral nutrition (PN) dependency. Between January and June 2024, each participating clinical site will include 50-120 consecutive patients over an eight-week period. Study data will be collected in three phases: baseline data upon ICU admission, daily observations throughout a maximum of 7 days in ICU or until discharge, and a follow-up period of 90 days. The primary outcomes are 28- and 90-day all-cause mortality. Secondary outcomes include ICU and hospital mortality, ICU and hospital length of stay, days alive and free of ICU by day 28 and day 90, days alive and free of hospital by day 28 and day 90, and days alive and free of organ support and PN dependency by day 28. DISCUSSION The GUTPHOS study will be the first worldwide, multicenter, prospective, observational cohort study to validate the GIDS in adult patients admitted to ICUs against 28- and 90-day mortality. The availability of a validated tool will allow its use in interventional studies that are currently hindered by the lack of a validated measurement tool for GI dysfunction. CLINICAL TRIAL REGISTRY NCT05909722.
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Affiliation(s)
- Imre W K Kouw
- Department of Intensive Care Medicine, Gelderse Vallei Hospital, Ede, the Netherlands; Wageningen University & Research, Division of Human Nutrition and Health, Wageningen, the Netherlands.
| | - Max Melchers
- Department of Intensive Care Medicine, Gelderse Vallei Hospital, Ede, the Netherlands; Wageningen University & Research, Division of Human Nutrition and Health, Wageningen, the Netherlands.
| | - Merli Mändul
- Institute of Mathematics and Statistics, University of Tartu, Tartu, Estonia; Estonian Genome Center, Institute of Genomics, University of Tartu, Tartu, Estonia.
| | - Yaseen M Arabi
- Department of Intensive Care, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia.
| | - Michael P Casaer
- Clinical Department and Laboratory of Intensive Care Medicine, KU Leuven, Leuven, Belgium.
| | - Antonella Cotoia
- Department of Anesthesia and Intensive Care, University Hospital Policlinico of Foggia, Foggia, Italy.
| | - Jan Gunst
- Clinical Department and Laboratory of Intensive Care Medicine, KU Leuven, Leuven, Belgium.
| | - Manu L N G Malbrain
- First Department of Anesthesiology and Intensive Therapy, Medical University of Lublin, Lublin, Poland; Medical Data Management (Medaman), Geel, Belgium.
| | - Stefan J Schaller
- Department of Anesthesiology and Intensive Care Medicine (CCM/CKV), Charité - Universitätsmedizin Berlin, Berlin, Germany; Department of Anesthesiology and Intensive Care, School of Medicine and Health, Technical University of Munich, Munich, Germany.
| | - Joel Starkopf
- Department of Anesthesiology and Intensive Care, University of Tartu, Estonia.
| | - Martin Sundström Rehal
- Perioperative Medicine and Intensive Care (PMI), Karolinska University Hospital, Stockholm, Sweden; Division of Anesthesia and Intensive Care, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden.
| | - Annika Reintam Blaser
- Department of Anesthesiology and Intensive Care, University of Tartu, Estonia; Department of Intensive Care Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland.
| | - Arthur R H van Zanten
- Department of Intensive Care Medicine, Gelderse Vallei Hospital, Ede, the Netherlands; Wageningen University & Research, Division of Human Nutrition and Health, Wageningen, the Netherlands.
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Cai X, Wang F, Zhu Y, Shen Y, Peng P, Cui Y, Di Z, Chen J. Application of bridging mesh repair in giant ventral incisional hernia. Updates Surg 2024; 76:2411-2420. [PMID: 38555536 DOI: 10.1007/s13304-024-01825-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 03/06/2024] [Indexed: 04/02/2024]
Abstract
Achieving ideal abdominal wall reconstruction in giant ventral incisional hernia has been a challenging for surgeons. This study aimed to verify the safety and efficacy of bridging repair by comparing it with primary fascial closure (PFC) repair in the treatment of giant ventral incisional hernia. We retrospectively analyzed the clinical data of 92 patients with giant ventral incisional hernia who underwent mesh repair at our medical institution from January 1, 2014 to December 31, 2020. Patients were divided into 2 groups: the bridging repair group with 40 patients in whom repair was completed using the bridging technique and the PFC group with 52 patients in whom primary fascial closure was achieved and all patients underwent mesh reinforcement during the operation. The main outcome measures were recurrence rate and morbidity, especially intra-abdominal hypertension (IAH). Follow-up time of both groups lasted at least 24 months after surgery. After a median of 46 months and 65 months of follow-up, respectively, in the two groups, bridging repair did not increase the long-term recurrence rate (2.56%) in the larger defect area group compared to the PFC group (1.96%). There were no significant differences in perioperative morbidity, IAH, incidence of postoperative chronic pain, and sensory impairment of the abdominal wall between both groups. The application of bridging surgery in the treatment of complex giant ventral incisional hernias is safe and effective and does not significantly increase the postoperative recurrence rate.
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Affiliation(s)
- Xuan Cai
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongtinan Road, Chaoyang District, Beijing, 100020, China
| | - Fan Wang
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongtinan Road, Chaoyang District, Beijing, 100020, China
| | - Yilin Zhu
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongtinan Road, Chaoyang District, Beijing, 100020, China
| | - Yingmo Shen
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongtinan Road, Chaoyang District, Beijing, 100020, China
| | - Peng Peng
- Department of Hernia and Abdominal Wall Surgery, Peking University People's Hospital, No.11 Xizhimennan Str., Xicheng District, Beijing, 100044, China
| | - Yan Cui
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongtinan Road, Chaoyang District, Beijing, 100020, China
| | - Zhishan Di
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongtinan Road, Chaoyang District, Beijing, 100020, China
| | - Jie Chen
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongtinan Road, Chaoyang District, Beijing, 100020, China.
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Halalmeh DR, Aftab N, Hussein M, Ansari Y, White H, Jenkins P, Mercer L, Beer P, Sachwani-Daswani G. The role of a specialized urethral catheter in early detection of intra-abdominal hypertension: a case report. J Surg Case Rep 2024; 2024:rjae653. [PMID: 39421340 PMCID: PMC11483752 DOI: 10.1093/jscr/rjae653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2024] [Accepted: 10/07/2024] [Indexed: 10/19/2024] Open
Abstract
Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) impact morbidity and mortality in burn patients, exacerbated by extensive fluid resuscitation required for more than 20% of total body surface area burns. We report a case of a 28-year-old male with severe burns and a TBSA of 49% who presented after a fire incident. The trauma team managed the patient's fluid resuscitation, followed by early burn debridement. A TraumaGuard catheter was used for continuous intra-abdominal pressure (IAP) monitoring. On the second day of admission, a critical IAP of 20 mm Hg was detected, indicative of impending ACS. Immediate intervention with cistracurium and increased sedation reduced the IAP to 9 mm Hg, preventing the progression to ACS. This case demonstrates the importance of routine IAP monitoring in severely burned patients to prevent ACS. Early identification and management of elevated IAP can avert the progression to ACS and reduce the need for more invasive interventions.
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Affiliation(s)
- Dia R Halalmeh
- Department of Trauma and Acute Care Surgery, Hurley Medical Center, 1 Hurley Plaza, Flint, MI, 48503, United States
- Michigan State University College of Human Medicine, 220 Trowbridge Rd, East Lansing, MI, 48824, United States
| | - Neha Aftab
- Department of Trauma and Acute Care Surgery, Hurley Medical Center, 1 Hurley Plaza, Flint, MI, 48503, United States
- Michigan State University College of Human Medicine, 220 Trowbridge Rd, East Lansing, MI, 48824, United States
| | - Mohamed Hussein
- Department of Emergency Medicine, Homer Stryker MD School of Medicine, Western Michigan University, 300 Portage St, Kalamazoo, MI, 49007, United States
| | - Yusuf Ansari
- College of Science and Technology, Temple University, 13th St, Philadelphia, PA, 19122, United States
| | - Hutton White
- Ascension Genesys Hospital, 1 Genesys Pkwy, Grand Blanc Twp, MI, 48439, United States
| | - Phillip Jenkins
- Detroit Medical Center (DMC)/Wayne State University (WSU), 4201 St Antoine, Detroit, MI, 48201, United States
| | - Leo Mercer
- Texas Tech University Health Science Center, 2500 Broadway W, Lubbock TX, 79409, United States
| | - Patrick Beer
- Department of Trauma and Acute Care Surgery, Hurley Medical Center, 1 Hurley Plaza, Flint, MI, 48503, United States
- Michigan State University College of Human Medicine, 220 Trowbridge Rd, East Lansing, MI, 48824, United States
| | - Gul Sachwani-Daswani
- Department of Trauma and Acute Care Surgery, Hurley Medical Center, 1 Hurley Plaza, Flint, MI, 48503, United States
- Michigan State University College of Human Medicine, 220 Trowbridge Rd, East Lansing, MI, 48824, United States
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Zhang HY, Guo Y, Zhao DC, Huang XY, Li Y, Zhang LY. Combined effect of intermittent hemostasis and a modified external hemorrhage control device in a lethal swine model. Heliyon 2024; 10:e37017. [PMID: 39296135 PMCID: PMC11408843 DOI: 10.1016/j.heliyon.2024.e37017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Revised: 08/26/2024] [Accepted: 08/26/2024] [Indexed: 09/21/2024] Open
Abstract
Background Non-compressible torso hemorrhage (NCTH) presents the ultimate challenge in pre-hospital care. While external hemorrhage control devices (EHCDs) such as the Abdominal Aortic and Junctional Tourniquet (AAJT) and SAM Junctional Tourniquet (SJT) have been invented, the current design and application strategy requires further improvement. Therefore, researchers devised a novel apparatus named Modified EHCD (M-EHCD) and implemented intermittent hemostasis (IH) as a preventive measure against ischemia-reperfusion injury. The objective of this study was to ascertain the combined effect of M-EHCD and IH on the hemostatic effect of NCTH. Methods Eighteen swine were randomized to M-EHCD, AAJT or SJT. The NCTH model was established by inducing Class Ⅲ hemorrhagic shock and performing a hemi-transection of common femoral artery (CFA). EHCDs were rapidly fastened since the onset of free bleeding (T0min). The IH strategy was implemented by fully releasing M-EHCD at T40min, T70min and T100min, respectively, whereas AAJT and SJT maintained continuous hemostasis (CH) until T120min. All groups underwent CFA bridging at T110min, and EHCDs were removed at T120min. Reperfusion lasted for 60 min, after which euthanasia was performed. Hemodynamics, intra-vesical pressure (IVP), and blood samples were collected periodically. Histological examinations were also conducted. Results M-EHCD demonstrated the fastest application time (M-EHCD: 26.38 ± 6.32s vs. SJT: 30.84 ± 5.62s vs. AAJT: 54.28 ± 5.45s, P < 0.001) and reduced free blood loss (M-EHCD: 17.77 ± 9.85g vs. SJT: 51.80 ± 33.70g vs. AAJT: 115.20 ± 61.36g, P = 0.011) compared to SJT and AAJT. M-EHCD exhibited inhibitory effects on heart rate (M-EHCD: 91.83 ± 31.61bpm vs. AAJT: 129.00 ± 32.32bpm vs. SJT: 135.17 ± 21.24bpm, P = 0.041) and shock index. The device's external pressure was lowest in M-EHCD and highest in SJT (P = 0.001). The resultant increase in IVP were still the lowest in M-EHCD (M-EHCD: -0.07 ± 0.45 mmHg vs. AAJT: 27.04 ± 5.03 mmHg vs. SJT: 5.58 ± 2.55 mmHg, P < 0.001). Furthermore, M-EHCD caused the least colonic injury (M-EHCD: 1.17 ± 0.41 vs. AAJT: 2.17 ± 0.41 vs. SJT: 2.17 ± 0.41, P = 0.001). The removal of M-EHCD showed the slightest impact on pH (P < 0.001), while AAJT group was more susceptible to the lethal triad based on the arterial lactate and thrombelastogram results. Conclusions M-EHCD + IH protected the organs and reduced the risk of the lethal triad by decreasing disruptions to IVP, hemodynamics, acid-base equilibrium and coagulation. M-EHCD + IH was superior to the hemostatic safety and efficacy of AAJT/SJT + CH.
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Affiliation(s)
- Hua-Yu Zhang
- Department of Trauma Surgery, Medical Center of Trauma and War Injury, State Key Laboratory of Trauma, Burns and Combined Injuries, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Yong Guo
- Department of Trauma Surgery, Medical Center of Trauma and War Injury, State Key Laboratory of Trauma, Burns and Combined Injuries, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, China
- Emergency and Critical Care Center, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dong-Chu Zhao
- Department of Trauma Surgery, Medical Center of Trauma and War Injury, State Key Laboratory of Trauma, Burns and Combined Injuries, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Xiao-Ying Huang
- Department of Trauma Surgery, Medical Center of Trauma and War Injury, State Key Laboratory of Trauma, Burns and Combined Injuries, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Yang Li
- Department of Trauma Surgery, Medical Center of Trauma and War Injury, State Key Laboratory of Trauma, Burns and Combined Injuries, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Lian-Yang Zhang
- Department of Trauma Surgery, Medical Center of Trauma and War Injury, State Key Laboratory of Trauma, Burns and Combined Injuries, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, China
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Bowen AT, Meckmongkol T. Paediatric abdominal compartment syndrome in a 4.6 kg infant. BMJ Case Rep 2024; 17:e260272. [PMID: 39256180 PMCID: PMC11409344 DOI: 10.1136/bcr-2024-260272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2024] Open
Abstract
An infant with a history of intestinal atresia type IV repaired at birth presented to the emergency department with recurrent abdominal distension. She was admitted 1 month before for abdominal distension secondary to formula intolerance. Hypothermia and mild respiratory distress prompted an evaluation with imaging, laboratory investigations, and blood and urine cultures. She was admitted to the intensive care unit and management included immediate surgical consultation, nothing by mouth, nasogastric tube placement for decompression and initiation of intravenous fluids and antibiotics. Her clinical status deteriorated within hours, requiring intubation and initiation of pressors. She responded to resuscitation but developed signs of abdominal compartment syndrome (ACS), prompting surgical decompression. The patient had a prolonged hospital stay and was discharged with total parenteral nutrition and G-tube feeds. This case highlights the importance of prompt recognition of risk factors, symptoms and management of paediatric ACS facilitating a reduction in morbidity and mortality.
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Kotani Y, D'Andria Ursoleo J, Murru CP, Landoni G. Blood Pressure Management for Hypotensive Patients in Intensive Care and Perioperative Cardiovascular Settings. J Cardiothorac Vasc Anesth 2024; 38:2089-2099. [PMID: 38918089 DOI: 10.1053/j.jvca.2024.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 03/23/2024] [Accepted: 04/08/2024] [Indexed: 06/27/2024]
Abstract
Blood pressure is a critical physiological parameter, particularly in the context of cardiac intensive care and perioperative settings. As a primary indicator of organ perfusion, the maintenance of adequate blood pressure is imperative for the assurance of sufficient tissue oxygen delivery. Among critically ill and major surgery patients, the continuous monitoring of blood pressure is performed as a standard practice for patients. Nonetheless, uncertainties remain regarding blood pressure goals, and there is no consensus regarding blood pressure targets. This review describes the determinants of blood pressure, examine the influence of blood pressure on organ perfusion, and synthesize the current clinical evidence from various intensive care and perioperative settings to provide a concise guidance for daily clinical practice.
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Affiliation(s)
- Yuki Kotani
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Department of Intensive Care Medicine, Kameda Medical Center, Kamogawa, Japan
| | - Jacopo D'Andria Ursoleo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Carlotta Pia Murru
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
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Liu Y, Li S, Huang J, Li X, Li Z, Chen C, Qu G, Chen K, Teng Y, Ma R, Wu X, Ren J. Photo-crosslinking modified gelatin-silk fibroin hydrogel for accelerating wound repair of open abdomen. CHEMICAL ENGINEERING JOURNAL 2024; 496:154161. [DOI: 10.1016/j.cej.2024.154161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2025]
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Toma M, Jose R, Syed F, Devine T. A Safety-Centric Study on the Use of Inflatable Abdominal Binders for Managing Orthostatic Hypotension. Clin Pract 2024; 14:1737-1743. [PMID: 39311288 PMCID: PMC11417920 DOI: 10.3390/clinpract14050138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2024] [Revised: 07/19/2024] [Accepted: 08/27/2024] [Indexed: 09/26/2024] Open
Abstract
The study focuses on the design and evaluation of inflatable abdominal binders for managing Orthostatic Hypotension. Orthostatic hypotension is a condition characterized by a significant drop in blood pressure when a person stands up, leading to symptoms such as dizziness, lightheadedness, and even fainting. The management of orthostatic hypotension typically involves a combination of pharmacological and non-pharmacological strategies. In the context of this research, an inflatable abdominal binder was designed, leveraging components that are not only economically viable but also easily obtainable. The evaluation of this device was conducted using a medical education manikin, specifically the CAE iStan manikin. The results demonstrated a correlation between the inflation values of the belt and the resulting pressure values exerted on the body. The general recommendation for an abdominal binder is to exert a pressure of 20-40 mmHg. Contrary to this, the study found that to maintain safe external pressure on the abdomen, the binder should not be inflated over 25 mmHg. This safety threshold was used as a reference point in the study, suggesting a potential need to revisit the standard recommendations for abdominal binder pressure. Further research is needed to assess the device's effectiveness in human subjects and to potentially redefine the safe and effective pressure range for abdominal binders.
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Affiliation(s)
- Milan Toma
- Department of Osteopathic Manipulative Medicine, College of Osteopathic Medicine, New York Institute of Technology, Old Westbury, NY 11568, USA;
| | - Rejath Jose
- Department of Osteopathic Manipulative Medicine, College of Osteopathic Medicine, New York Institute of Technology, Old Westbury, NY 11568, USA;
| | - Faiz Syed
- Mather Hospital, Northwell Health, 75 N Country Rd., Port Jefferson, NY 11777, USA;
| | - Timothy Devine
- The Ferrara Center for Patient Safety and Clinical Simulation, College of Osteopathic Medicine, New York Institute of Technology, Old Westbury, NY 11568, USA;
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Ribitsch W, Lehner TA, Sauseng N, Rosenkranz AR, Schneditz D. Susceptibility of hepato-splanchnic perfusion to intra-abdominal pressure in peritoneal dialysis patients. Perit Dial Int 2024:8968608241275922. [PMID: 39196595 DOI: 10.1177/08968608241275922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND The impact of peritoneal filling on hepato-splanchnic perfusion during peritoneal dialysis has not been fully elucidated yet. METHODS Measurements were done in 20 prevalent peritoneal dialysis patients during a peritoneal equilibration test (PET) with 2L of standard dialysate. Data were obtained in the drained state at baseline (T0), after instillation (T1), and after 2 h of dwell time (T2). Intra-abdominal pressure (IAP) was measured by Durand's approach. The hepatic clearance index (KI) of indocyanine-green (ICG) was determined as an indirect measure of hepato-splanchnic blood flow. Cardiac index (CI), heart rate (HR), and total peripheral resistance index (TPRI) were derived from continuous arterial pulse analysis. Fluid volume overload (VO) was evaluated by multifrequency bioimpedance analysis. Ejection fraction (EF) was obtained from echocardiographic examination. RESULTS IAP was 5.8 ± 3.5 mmHg at baseline (T0), rose to 9.4 ± 2.8 mmHg after instillation of dialysate (T1), and further to 9.7 ± 2.8 mmHg after 2 h of dwell time (p < 0.001). KI slightly declined from 0.60 ± 0.22 L/min/m2 at T0 to 0.53 ± 0.15 L/min/m2 at T1 (p = 0.075), and returned to 0.59 ± 0.22 L/min/m2 at T2 (p = 0.052). CI, HR, and TPRI did not change significantly. In five patients with an EF < 40% KI was significantly lower at T1 (0.42 ± 0.12 L/min/m2; p = 0.039), and further decreased at T2 (0.40 ± 0.04 L/min/m2; p = 0.016) compared to patients with normal EF (T1: 0.58 ± 0.15 L/min/m2 and T2: 0.67 ± 0.22 L/min/m2). CONCLUSIONS Overall, hepatic clearance of ICG as a marker of hepato-splanchnic blood flow is not affected by the filling of the peritoneal cavity.
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Affiliation(s)
- Werner Ribitsch
- Clinical Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Austria
| | - Thomas A Lehner
- Division of Physiology and Pathophysiology, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Medical University of Graz, Austria
| | - Notburga Sauseng
- Division of Physiology and Pathophysiology, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Medical University of Graz, Austria
| | - Alexander R Rosenkranz
- Clinical Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Austria
| | - Daniel Schneditz
- Division of Physiology and Pathophysiology, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Medical University of Graz, Austria
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Hancı P, Demir ET, Şekerci B, İnal V. Optimizing Positive End-Expiratory Pressure Based on Intra-Abdominal Pressure in Patients with Acute Respiratory Failure. Niger J Clin Pract 2024; 27:1033-1037. [PMID: 39212442 DOI: 10.4103/njcp.njcp_103_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 07/24/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Positive end-expiratory pressure (PEEP) is a crucial component of mechanical ventilation to improve oxygenation in critically ill patients with respiratory failure. The interaction between abdominal and thoracic compartment pressures is known well. Especially in intra-abdominal hypertension, lower PEEP may cause atelectotrauma by repetitive opening and closing of alveoli. AIM In this study, it was aimed to investigate the effect of PEEP adjustment according to the intra-abdominal pressure (IAP) on oxygenation and clarify possible harms. METHOD Patients older than 18 were mechanically ventilated due to hypoxemic respiratory failure and had normal IAP (<15 mmHg) included in the study. Patients with severe cardiovascular dysfunction were excluded. The following PEEP levels were applied: PEEPzero of 0 cmH2O, PEEPIAP/2 = 50% of IAP, and PEEPIAP = 100% of IAP. After a 30-minute equilibration period, arterial blood gases and mean arterial pressures were measured. RESULTS One hundred thirty-eight patients (mean age 66.5 ± 15.9, 56.5% male) enrolled on the study. The mean IAP was 9.8 ± 3.4. Seventy-nine percent of the patients' PaO2/FiO2 ratio was under 300 mmHg. Figure 1 shows the change in PaO2/FiO2 ratio, PaCO2, PPlato, and MAP of the patients according to the PEEP levels. Overall increases were detected in the PaO2/FiO2 ratio (P < 0.001) and Pplato (P < 0.001), while PaCO2 and MAP did not change after increasing PEEP gradually. Pairwise analyses revealed differences in PaO2/FiO2 between PEEPzero (186.4 [85.7-265.8]) and PEEPIAP/2 (207.7 [101.7-292.9]) (t = -0.77, P < 0.001), between baseline and PEEPIAP (236.1 [121.4-351.0]) (t = -1.7, P < 0.001), and between PEEPIAP/2 and PEEPIAP (t = -1.0, P < 0.001). Plato pressures were in the safe range (<30 cmH2O) at all three PEEP levels (PEEPzero = 12 [10-15], PEEPIAP/2 = 15 [13-18], PEEPIAP = 17 [14-22]). CONCLUSION In patients with acute hypoxemic respiratory failure and mechanically ventilated, PEEP adjustment according to the IAB improves oxygenation, especially in the settings of the limited source where other PEEP titration methods are absent.
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Affiliation(s)
- P Hancı
- Department of Pulmonology Medicine, Division of Intensive Care, Trakya University Faculty of Medicine, Edirne, Türkiye
| | - E T Demir
- Department of Anaesthesiology, Division of Intensive Care, Atatürk State Hospital, Turkish Ministry of Health, Aydın, Türkiye
| | - B Şekerci
- Department of General Surgery, Keşan State Hospital, Turkish Ministry of Health, Edirne, Türkiye
| | - V İnal
- Department of Internal Medicine, Division of Intensive Care, Trakya University Faculty of Medicine, Edirne, Türkiye
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Tran Z, Assali MA, Shin B, Benharash P, Mukherjee K. Trends and clinical outcomes of abdominal compartment syndrome among intensive care hospitalizations. Surgery 2024; 176:485-491. [PMID: 38806334 DOI: 10.1016/j.surg.2024.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 03/14/2024] [Accepted: 04/08/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND Abdominal compartment syndrome has been shown to be a highly morbid condition among patients admitted to the intensive care unit. The present study sought to characterize trends as well as clinical and financial outcomes of patients with abdominal compartment syndrome. METHODS The 2010 to 2020 National Inpatient Sample was used to identify adults (≥18 years) admitted to the intensive care unit. Standard mean differences were obtained to demonstrate effect size with >0.1 denoting significance. Hospitals were divided into tertiles based on annual institutional intensive care unit admissions. Multivariable regression models were used to evaluate the association of abdominal compartment syndrome on outcomes. The primary endpoint was in-hospital mortality, while complications, costs, and length of stay were secondarily considered. RESULTS Of 11,804,585 patients, 19,644 (0.17%) developed abdominal compartment syndrome. Over the study period, the incidence of abdominal compartment syndrome (2010-0.19%, 2020-0.20%, P < .001) remained similar. Those with abdominal compartment syndrome were more commonly admitted for gastrointestinal (22.8% vs 8.4%) and cardiovascular (22.6% vs 14.9%) etiologies and were more frequently managed at urban teaching hospitals (77.7% vs 65.1%) as well as high-volume intensive care units (85.2% vs 79.1%) (all standard mean differences >0.1). After adjustment, abdominal compartment syndrome was associated with higher odds of mortality (adjusted odds ratio: 3.84, 95% confidence interval: 3.57-4.13, reference: non-abdominal compartment syndrome). Incremental length of stay (β: +5.0 days, 95% confidence interval: 4.2-5.8) and costs (β: $49.3K, 95% confidence interval: 45.3-53.4) were significantly higher in abdominal compartment syndrome compared to non-abdominal compartment syndrome. CONCLUSION Abdominal compartment syndrome, while an uncommon occurrence among intensive care unit patients, remains highly morbid with significant resource burden. Further work exploring factors to mitigate its clinical and financial burden is needed.
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Affiliation(s)
- Zachary Tran
- Department of Surgery, Loma Linda University Health, Loma Linda, CA; Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, Department of Surgery, University of California, Los Angeles, CA
| | - Marc Abou Assali
- Department of Surgery, Loma Linda University Health, Loma Linda, CA
| | - Brandon Shin
- Department of Surgery, Loma Linda University Health, Loma Linda, CA
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, Department of Surgery, University of California, Los Angeles, CA
| | - Kaushik Mukherjee
- Department of Surgery, Loma Linda University Health, Loma Linda, CA.
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Oliveira E Silva PDD, Melo RMD, Gontijo CEDS, Oliveira ÊCD. INTRA-ABDOMINAL PRESSURE MONITORING DURING LÁZARO DA SILVA'S PROCEDURE FOR VENTRAL HERNIA REPAIR: A CROSS-SECTIONAL STUDY. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2024; 37:e1813. [PMID: 39046030 PMCID: PMC11259399 DOI: 10.1590/0102-6720202400020e1813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 05/16/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND Maintaining normal intra-abdominal pressure (IAP) levels must be one major outcome of any ventral hernia repair, avoiding hypertension or abdominal compartment syndrome. AIMS To evaluate IAP during ventral hernia repair using Lázaro da Silva's procedure. METHODS IAP measurements using intravesical pressure were performed during four crucial intraoperative moments. Twenty-eight patients submitted to incisional herniorrhaphy were analyzed. RESULTS The IAP increased by 0.5 mmHg during the procedure, regardless of the type of prior laparotomy, sex, age, obesity, or hernia width. CONCLUSIONS Despite the IAP increase observed, Lázaro da Silva's procedure did not result in intra-abdominal hypertension or abdominal compartment syndrome.
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Affiliation(s)
- Pedro Ducatti de Oliveira E Silva
- Universidade Federal de Goiás, Faculty of Medicine, Postgraduate Program in Health Sciences - Goiânia (GO), Brazil
- Hospital Geral de Goiânia Dr. Alberto Rassi - Goiânia (GO), Brazil
| | - Renato Miranda de Melo
- Hospital Geral de Goiânia Dr. Alberto Rassi - Goiânia (GO), Brazil
- Universidade Federal de Goiás, Faculty of Medicine, Department of Surgery - Goiânia (GO), Brazil
| | | | - Ênio Chaves de Oliveira
- Universidade Federal de Goiás, Faculty of Medicine, Postgraduate Program in Health Sciences - Goiânia (GO), Brazil
- Universidade Federal de Goiás, Faculty of Medicine, Department of Surgery - Goiânia (GO), Brazil
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Kember AJ, Anderson JL, Gorazd NE, House SC, Kerr KE, Torres Loza PA, Reuter DG, Hobson SR, Goergen CJ. Maternal posture-physiology interactions in human pregnancy: a narrative review. Front Physiol 2024; 15:1370079. [PMID: 39100275 PMCID: PMC11294255 DOI: 10.3389/fphys.2024.1370079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 07/02/2024] [Indexed: 08/06/2024] Open
Abstract
There are several well-known medical conditions in which posture and gravity interact with natural history, including pregnancy. In this review, we provide a comprehensive overview of interactions between maternal posture and maternal physiology and pathophysiology at rest during pregnancy. We conducted a systematic literature search of the MEDLINE database and identified 644 studies from 1991 through 2021, inclusive, that met our inclusion criteria. We present a narrative review of the resulting literature and highlight discrepancies, research gaps, and potential clinical implications. We organize the results by organ system and, commencing with the neurological system, proceed in our synthesis generally in the craniocaudal direction, concluding with the skin. The circulatory system warranted our greatest and closest consideration-literature concerning the dynamic interplay between physiology (heart rate, stroke volume, cardiac output, blood pressure, and systemic vascular resistance), pathophysiology (e.g., hypertension in pregnancy), and postural changes provide an intricate and fascinating example of the importance of the subject of this review. Other organ systems discussed include respiratory, renal, genitourinary, gastrointestinal, abdominal, and endocrine. In addition to summarizing the existing literature on maternal posture-physiology interactions, we also point out gaps and opportunities for further research and clinical developments in this area. Overall, our review provides both insight into and relevance of maternal posture-physiology interactions vis à vis healthcare's mission to improve health and wellness during pregnancy and beyond.
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Affiliation(s)
- Allan J. Kember
- Temerty Faculty of Medicine, Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON, Canada
- Shiphrah Biomedical Inc., Toronto, ON, Canada
| | - Jennifer L. Anderson
- Larner College of Medicine, University of Vermont, Burlington, VT, United States
| | - Natalyn E. Gorazd
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States
| | - Sarah C. House
- Temerty Faculty of Medicine, Medical Education, University of Toronto, Toronto, ON, Canada
| | - Katherine E. Kerr
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States
| | - Paula A. Torres Loza
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States
| | - David G. Reuter
- Cardiac Innovations, Seattle Children’s, Seattle, WA, United States
| | - Sebastian R. Hobson
- Temerty Faculty of Medicine, Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON, Canada
- Temerty Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Maternal-Fetal Medicine Division, Mount Sinai Hospital, Toronto, ON, Canada
| | - Craig J. Goergen
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States
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Moll V, Khanna AK, Kurz A, Huang J, Smit M, Swaminathan M, Minear S, Parr KG, Prabhakar A, Zhao M, Malbrain MLNG. Optimization of kidney function in cardiac surgery patients with intra-abdominal hypertension: expert opinion. Perioper Med (Lond) 2024; 13:72. [PMID: 38997752 PMCID: PMC11245849 DOI: 10.1186/s13741-024-00416-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 06/09/2024] [Indexed: 07/14/2024] Open
Abstract
Cardiac surgery-associated acute kidney injury (CSA-AKI) affects up to 42% of cardiac surgery patients. CSA-AKI is multifactorial, with low abdominal perfusion pressure often overlooked. Abdominal perfusion pressure is calculated as mean arterial pressure minus intra-abdominal pressure (IAP). IAH decreases cardiac output and compresses the renal vasculature and renal parenchyma. Recent studies have highlighted the frequent occurrence of IAH in cardiac surgery patients and have linked the role of low perfusion pressure to the occurrence of AKI. This review and expert opinion illustrate current evidence on the pathophysiology, diagnosis, and therapy of IAH and ACS in the context of AKI.
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Affiliation(s)
- Vanessa Moll
- Department of Anesthesiology, Division of Critical Care Medicine, University of Minnesota, Minneapolis, MN, USA
- Department of Anesthesiology, Division of Critical Care Medicine, Emory School of Medicine, Atlanta, GA, USA
| | - Ashish K Khanna
- Wake Forest University School of Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
- Perioperative Outcomes and Informatics Collaborative (POIC), Winston-Salem, NC, USA
- Outcomes Research Consortium, Cleveland, OH, USA
| | - Andrea Kurz
- Departments of General Anesthesiology and Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Anesthesiology, Emergency Medicine and Intensive Care Medicine, Medical University Graz, Graz, Austria
| | - Jiapeng Huang
- Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY, USA
| | - Marije Smit
- Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Madhav Swaminathan
- Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA
| | - Steven Minear
- Department of Anesthesiology, Cleveland Clinic Florida, Weston Hospital, Weston, FL, USA
| | - K Gage Parr
- Department of Anesthesiology and Critical Care Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Amit Prabhakar
- Department of Anesthesiology, Division of Critical Care Medicine, Emory School of Medicine, Atlanta, GA, USA
| | - Manxu Zhao
- Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Manu L N G Malbrain
- First Department of Anaesthesiology and Intensive Therapy, Medical University Lublin, Lublin, Poland.
- Medical Data Management, Medaman, Geel, Belgium.
- International Fluid Academy, Lovenjoel, Belgium.
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Kelm M, Pistorius R, Germer CT, Reibetanz J. [Abdominal compartment syndrome in visceral surgery and intensive care medicine : Causes, prevention, detection, treatment]. CHIRURGIE (HEIDELBERG, GERMANY) 2024; 95:520-525. [PMID: 38639826 DOI: 10.1007/s00104-024-02079-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/18/2024] [Indexed: 04/20/2024]
Abstract
An increased intra-abdominal pressure can result in a manifest abdominal compartment syndrome (ACS) with significant organ damage, which is a life-threatening situation associated with a high mortality. Although the etiology is manifold and critically ill patients on the intensive care unit are particularly endangered, the disease is often not diagnosed even though the measurement of bladder pressure is available as a simple and standardized method; however, particularly the early detection of an increased intra-abdominal pressure is decisive in order to prevent the occurrence of a manifest ACS with (multi)organ failure by means of conservative measures. In cases of a conservative refractory situation, decompressive laparotomy is indicated.
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Affiliation(s)
- M Kelm
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Transplantations‑, Gefäß- und Kinderchirurgie, Zentrum Operative Medizin (ZOM), Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland
| | - R Pistorius
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Transplantations‑, Gefäß- und Kinderchirurgie, Zentrum Operative Medizin (ZOM), Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland
| | - C-T Germer
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Transplantations‑, Gefäß- und Kinderchirurgie, Zentrum Operative Medizin (ZOM), Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland
| | - J Reibetanz
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Transplantations‑, Gefäß- und Kinderchirurgie, Zentrum Operative Medizin (ZOM), Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland.
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50
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Li Z, Lu F, Dai Y, Sheng M, Su L, Yao P, Wang H. Knowledge, attitudes, and practices (KAP) regarding intra-abdominal pressure monitoring among pediatric intensive care nurses: A cross-sectional study. Int J Nurs Sci 2024; 11:381-386. [PMID: 39156680 PMCID: PMC11329026 DOI: 10.1016/j.ijnss.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 03/08/2024] [Accepted: 05/29/2024] [Indexed: 08/20/2024] Open
Abstract
Objectives This study aimed to assess the knowledge, attitudes, and practices (KAP) and the training requirements of pediatric intensive care nurses regarding intra-abdominal pressure (IAP) monitoring, in order to provide a reference for the development of relevant training programs and operational procedures in clinical practice. Methods This descriptive cross-sectional survey was conducted from April 2023 to June 2023. A convenience sample was created by recruiting 212 pediatric intensive care nurses in eight hospitals in Zhejiang Province. A self-developed IAP monitoring KAP assessment tool was used for evaluation, which included knowledge (14 items), attitude (6 items), and practice (8 items), three dimensions, 28 items. Results The overall KAP score was 60.73 ± 8.35; the knowledge score was 7.84 ± 2.35, with a scoring rate of 56.0%; the attitude score was 25.16 ± 3.23, with a scoring rate of 83.9%; and the practice score was 28.44 ± 6.46, with a scoring rate of 69.3%. Nurses wh-o have received IAP monitoring training have higher KAP score, knowledge score and practice score than those who have not received it (P < 0.05). Nurses aged ≤ 30 showed better knowledge of IAP monitoring than those aged > 30 (P < 0.05). Among the participants, 55.7% of the nurses believed the current knowledge was insufficient to perform IAP measurement effectively. Difficulty in identifying the high-risk population of intra-abdominal hypertension (IAH) (64.6%), unfamiliarity with the operation process of IAP measurement (55.6%), and unreasonable nurse-patient ratio allocation (52.8%) were the main obstacles for nurses to monitor IAP. Conclusions Pediatric intensive care nurses have a positive attitude towards IAP monitoring, but the knowledge level and practical behavior still need to be strengthened. In particular, the knowledge of published consensus definitions, measurement techniques, and frequency for IAP monitoring is inadequate. It is necessary to implement tailored IAP monitoring training based on their training needs and potential obstacles to promote the standardization and scientificity of IAP monitoring.
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Affiliation(s)
- Zhiru Li
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Fangyan Lu
- Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yanhong Dai
- Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Meijun Sheng
- Surgical Intensive Care Unit, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lidan Su
- Pediatric Intensive Care Unit, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Ping Yao
- Pediatric Intensive Care Unit, Huzhou Central Hospital, Huzhou, China
| | - Huafen Wang
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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