Current recognition and management of intra-abdominal hypertension and abdominal compartment syndrome among tertiary Chinese intensive care physicians |
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Authors: | Zhou Jian-cang Zhao Hong-chen Pan Kong-han Xu Qiu-ping |
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Institution: | (1) ICU, ZiekenhuisNetwerk Antwerpen Campus Stuivenberg, Lange Beeldekensstraat 267, 2060 Antwerp, Belgium;(2) Surgical ICU, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium;(3) Department of Abdominal Surgery, ZiekenhuisNetwerk Antwerpen Campus Stuivenberg, Lange Beeldekensstraat 267, 2060 Antwerp, Belgium; |
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Abstract: | This survey was designed to clarify the current understanding and clinical management of intra-abdominal hypertension (IAH)/abdominal
compartment syndrome (ACS) among intensive care physicians in tertiary Chinese hospitals. A postal twenty-question questionnaire
was sent to 141 physicians in different intensive care units (ICUs). A total of 108 (76.6%) questionnaires were returned.
Among these, three quarters worked in combined medical-surgical ICUs and nearly 80% had primary training in internal or emergency
medicine. Average ICU beds, annual admission, ICU length of stay, acute physiology and chronic health evaluation (APACHE)
II score, and mortality were 18.2 beds, 764.5 cases, 8.3 d, 19.4, and 21.1%, respectively. Of the respondents, 30.6% never
measured intra-abdominal pressure (IAP). Although the vast majority of the ICUs adopted the exclusively transvesicular method,
the overwhelming majority (88.0%) only measured IAP when there was a clinical suspicion of IAH/ACS and only 29.3% measured
either often or routinely. Moreover, 84.0% used the wrong priming saline volume while 88.0% zeroed at reference points which
were not in consistence with the standard method for IAP monitoring recommended by the World Society of Abdominal Compartment
Syndrome. ACS was suspected mainly when there was a distended abdomen (92%), worsening oliguria (80%), and increased ventilatory
support requirement (68%). Common causes for IAH/ACS were “third-spacing from massive volume resuscitation in different settings”
(88%), “intra-abdominal bleeding”, and “liver failure with ascites” (52% for both). Though 60% respondents would recommend
surgical decompression when the IAP exceeded 25 mmHg, accompanied by signs of organ dysfunction, nearly three quarters of
respondents preferred diuresis and dialysis. A total of 68% of respondents would recommend paracentesis in the treatment for
ACS. In conclusion, urgent systematic education is absolutely necessary for most intensive care physicians in China to help
to establish clear diagnostic criteria and appropriate management for these common, but life-threatening, diseases. |
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Keywords: | Questionnaire Intra-abdominal pressure Intra-abdominal hypertension Decompression laparotomy Abdominal compartment syndrome |
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