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Intra-abdominal Hypertension after Life-Threatening Penetrating Abdominal Trauma
- Source :
- The Journal of Trauma: Injury, Infection, and Critical Care. 44:1016-1023
- Publication Year :
- 1998
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 1998.
-
Abstract
- Objective: To define the incidence, prophylaxis, and treatment of intra-abdominal hypertension (IAH) and its relevance to gut mucosal pH (pHi), multiorgan dysfunction syndrome, and the abdominal compartment syndrome (ACS). Methods: Seventy patients in the SICU at a Level I trauma center (1992-1996) with life threatening penetrating abdominal trauma had intra-abdominal pressure estimated by bladder pressure. pHi was measured by gastric tonometry every 4 to 6 hours. IAH (intra-abdominal pressure> 25 cm of H 2 O) was treated by bedside or operating room laparotomy. Results: Injury severity was comparable between patients who had mesh closure as prophylaxis for IAH (n = 45) and those who had fascial suture (n = 25). IAH was seen in 10 (22.2%) in the mesh group versus 13 (52%) in the fascial suture group (p = 0.012) for an overall incidence of 32.9%. Forty-two patients had pHi monitoring, and 11 of them had IAH. Of the 11patients, eight patients (72.7%) had acidotic pHi (7.10± 0.2) with IAH without exhibiting the classic signs of ACS. The pHi improved after abdominal decompression in six and none developed ACS. Only two patients with IAH and low pHi went on to develop ACS, despite abdominal decompression. Multiorgan dysfunction syndrome points and death were less in patients without IAH than those with IAH and in patients who had mesh closure. Conclusions: IAH is frequent after major abdominal trauma. It may cause gut mucosal acidosis at lower bladder pressures, long before the onset of clinical ACS. Uncorrected, it may lead to splanchnic hypoperfusion, ACS, distant organ failure, and death. Prophylactic mesh closure of the abdomen may facilitate the prevention and bedside treatment of IAH and reduce these complications.
- Subjects :
- Adult
Male
medicine.medical_specialty
Abdominal compartment syndrome
medicine.medical_treatment
Wounds, Penetrating
Abdominal Injuries
Compartment Syndromes
Abdominal decompression
Laparotomy
Abdomen
Humans
Medicine
Gastric tonometry
business.industry
Incidence
Hydrogen-Ion Concentration
medicine.disease
Survival Analysis
Surgery
Treatment Outcome
medicine.anatomical_structure
Abdominal trauma
Gastric Mucosa
Hypertension
Female
Intra-Abdominal Hypertension
business
Complication
Subjects
Details
- ISSN :
- 10796061
- Volume :
- 44
- Database :
- OpenAIRE
- Journal :
- The Journal of Trauma: Injury, Infection, and Critical Care
- Accession number :
- edsair.doi.dedup.....1356d0ec2de3bfbd36b5a125269b3e06