Advertisement

Open Abdomen pp 153-163 | Cite as

Intensive Care Unit Management of the Adult Open Abdomen

  • Michael L. Cheatham
  • Karen Safcsak
Chapter
Part of the Hot Topics in Acute Care Surgery and Trauma book series (HTACST)

Abstract

Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS), the pathophysiologic manifestations of elevated intra-abdominal pressure (IAP), are commonly encountered but under-appreciated causes of organ dysfunction, organ failure, and patient mortality in the ICU. Due to its detrimental physiologic effects, every attempt should be made to minimize the development of elevated IAP in the critically ill. Serial IAP measurements, optimization of systemic perfusion and end-organ function, institution of multimodality medical management strategies to minimize IAP, and prompt surgical decompression for refractory IAH/ACS are essential to reducing patient morbidity and mortality in the ICU setting.

References

  1. 1.
    Malbrain ML, Chiumello D, Pelosi P, et al. Incidence and prognosis of intraabdominal hypertension in a mixed population of critically ill patients: a multiple-center epidemiological study. Crit Care Med. 2005;33:315–22.CrossRefPubMedGoogle Scholar
  2. 2.
    Zhang HY, Liu D, Tang H, Sun SJ, Ai SM, Yang WQ, Jiang DP, Zhang LY. Study of intra-abdominal hypertension prevalence and awareness level among experienced ICU medical staff. Mil Med Res. 2016;3(1):27.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Hunt L, Frost SA, Newton PJ, Salamonson Y, Davidson PM. A survey of critical care nurses’ knowledge of intra-abdominal hypertension and abdominal compartment syndrome. Aust Crit Care. 2016;S1036–7314.Google Scholar
  4. 4.
    Smith C, Cheatham ML. Intra-abdominal hypertension and abdominal compartment syndrome in the medical patient. Am Surg. 2011;77(Suppl 1):S67–71.PubMedGoogle Scholar
  5. 5.
    Cheatham ML, Safcsak K. Is the evolving management of IAH/ACS improving survival? Crit Care Med. 2010;38(2):402–7.CrossRefPubMedGoogle Scholar
  6. 6.
    Cheatham ML, White MW, Sagraves SG, et al. Abdominal perfusion pressure: a superior parameter in the assessment of intra-abdominal hypertension. J Trauma. 2000;49:621–7.CrossRefPubMedGoogle Scholar
  7. 7.
    Kyoung K, Hong S. The duration of intra-abdominal hypertension strongly predicts outcomes for the critically ill surgical patient: a prospective observational study. World J Emerg Surg. 2015;10:22.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Cheatham ML, Safcsak K, Llerena LE, Morrow CE, Block EFJ. Long-term physical, mental, and functional consequences of abdominal decompression. J Trauma. 2004;56:237–42.CrossRefPubMedGoogle Scholar
  9. 9.
    Cheatham ML, Safcsak K, Sugrue M. Long-term implications of intra-abdominal hypertension and abdominal compartment syndrome: physical, mental, and financial. Am Surg. 2011;77(Suppl 1):S78–82.PubMedGoogle Scholar
  10. 10.
    Kirkpatrick AW, Roberts DJ, De Waele J, Jaeschke R, Malbrain ML, et al. Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome. Intensive Care Med. 2013;39:1190–206.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    De Keulenaer BL, Cheatham ML, De Waele JJ, Kimball EJ, Powell B, Davis WA, Jenkins IR. Intra-abdominal pressure measurements in lateral decubitus versus supine position. Acta Clin Belg. 2009;64:210–5.CrossRefPubMedGoogle Scholar
  12. 12.
    Cheatham ML, Safcsak K, Brzezinski SJ, Lube MW. Nitrogen balance, protein loss, and the open abdomen. Crit Care Med. 2007;35(1):127–31.CrossRefPubMedGoogle Scholar
  13. 13.
    Cheatham ML, Safcsak K. Percutaneous catheter decompression in the treatment of elevated intra-abdominal pressure. Chest. 2011;140:1428–35.CrossRefPubMedGoogle Scholar
  14. 14.
    Coccolini F, Biffl W, Catena F, Ceresoli M, Chiara O, et al. The open abdomen, indications, management, and definitive closure. World J Emerg Surg. 2015;10:32.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Cheatham ML, Demetriades D, Fabian TC, et al. Prospective study examining clinical outcomes associated with a negative pressure wound therapy system and Barker’s vacuum packing technique. World J Surg. 2013;37:2018–30.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Orlando Regional Medical CenterOrlandoUSA

Personalised recommendations