Abdominal Compartment Syndrome and Fluid Replacement: A Dog That Bites Its Own Tail?

Abstract

It’s 5:50 in the evening and the phone rings in the ICU. “Hi, Massimo, I was wondering if you had any beds free. Someone has been brought back to the operating room after undergoing surgery at the beginning of the week, because he had wound dehiscence on one of the sutures with a build-up of necrotic material and pus around the pancreas. I wanted to bring him to you as I’m having trouble maintaining correct pressure and have given anaesthesia. I’ve been told that since this morning he has had difficulty breathing and saturation is low. I have had to provide PEEP and 60% oxygen. He can urinate but before being transferred he took Lasix on the recommendation of his cardiologist because pulmonary oedema was suspected. But I don’t think that’s right. CVP is 6 and there are no X-rays. I still haven’t understood what they want to do, but so far they have only washed him; I’m sending you the cultures taken in the ward that were sent for microscopic analysis…”. The reality is that we have no free beds in intensive care, and so begins the customary “dance” that leads to unplanned discharge of the patient: selection of a lower-risk patient (what indicators? SOFA score, destination and good sense), bed availability in intended ward (always difficult), preparation of patient and documents, communication with patients and parents. Meanwhile the trainee doctor says: “Do you not think that this year we have had a few too many repeated surgical procedures? Why?” (perhaps it’s true, I’ll think about it). Immediately afterwards the nurse says, “Doctor, do we have to prepare anything in particular?”.