• Abdominal compartment syndrome
• Acute kidney injury
• Acute-on-chronic liver failure
• Liver cirrhosis

• abdominal perfusion pressure
• incomplete data
• intra-abdominal hypertension
• mortality prediction

• Humans
• Female
• Male
• Retrospective Studies
• Middle Aged
• Intra-Abdominal Hypertension/mortality
• Intra-Abdominal Hypertension/physiopathology
• Aged
• Prognosis
• Survival Analysis
• Machine Learning

• Abdominal compartment syndrome
• Abdominal hypertension
• Abdominal pressure
• Definitions
• Management
• Pathophysiology
• Survey

• Humans
• Intra-Abdominal Hypertension/physiopathology
• Intra-Abdominal Hypertension/diagnosis
• Cross-Sectional Studies
• Surveys and Questionnaires
• Internationality
• Male
• Female

• aerobic exercise
• anxiety
• autism
• intra-abdominal pressure
• prediction
• torso stiffness
• venous return

• abdominal constrictor
• force loads
• orthostatic hypotension
• statistical analysis

• acute gastrointestinal injury
• agi grade
• critically ill patients
• feeding intolerance
• intensive care unit
• intra-abdominal pressure

• Abdominal pressure
• Bladder pressure
• Compartment syndrome
• Critical illness
• Intensive care unit
• Intra-abdominal hypertension
• Measurement
• Ultrasonography

• Adult
• Humans
• Critical Illness
• Feasibility Studies
• Pressure
• Abdominal Cavity
• Intensive Care Units
• Abdomen/diagnostic imaging

• Graseby capsule
• acute abdomen
• animal model
• intra-abdominal pressure
• neonatal intensive care

• incentive spirometry
• intra-abdominal fluid collection
• percutaneous drainage

• T32 EB021955 NIBIB NIH HHS

• abdominal compartment syndrome
• acute pancreatitis
• intra-abdominal hypertension
• intra-abdominal pressure
• sepsis

• Abdominal hypertension
• Intra-abdominal pressure
• Intra-vesical measurement
• Monitoring
• Rectal measurement
• Validation

• Abdominal compartment syndrome (ACS)
• Abdominal paracentesis drainage (APD)
• Acute pancreatitis
• Intra-abdominal hypertension (IAH)
• Intra-abdominal pressure (IAP)

• Humans
• Pancreatitis/complications
• Pancreatitis/therapy
• Paracentesis/adverse effects
• Intra-Abdominal Hypertension/therapy
• Intra-Abdominal Hypertension/complications
• Retrospective Studies
• Acute Disease
• Drainage/adverse effects

• Aortic surgery
• Critical care
• Postoperative complications
• TEVAR
• Vascular surgery

• Humans
• Critical Care
• Intensive Care Units
• Vascular Surgical Procedures/adverse effects
• Postoperative Care
• Postoperative Complications/therapy
• Postoperative Complications/etiology

• Cardiogenic shock
• Heart failure
• Hemodynamics
• Mechanical circulatory support
• Physiology

Background  Acute pancreatitis is a significant challenge to health services. Remarkable progress has been made in the last decade in optimizing its management.

Methods  This review is a comprehensive assessment of 7 guidelines employed in current clinical practice with an appraisal of the underlying evidence, including 15 meta-analyses/systematic reviews, 16 randomized controlled trials, and 31 cohort studies.

Results  Key tenets of early management of acute pancreatitis include severity stratification based on the degree of organ failure and early goal-directed fluid resuscitation. Rigorous determination of etiology reduces the risk of recurrence. Early enteral nutrition and consideration of epidural analgesia have been pioneered in recent years with promising results. Indications for invasive intervention are becoming increasingly refined. The definitive indications for endoscopic retrograde cholangiopancreatography in acute pancreatitis are associated with cholangitis and common bile duct obstruction. The role of open surgical necrosectomy has diminished with the development of a minimally invasive step-up necrosectomy protocol. Increasing use of endoscopic ultrasound–guided intervention in the management of pancreatic necrosis has helped reduce pancreatic fistula rates and hospital stay.

Conclusion  The optimal approach to surgical management of complicated pancreatitis depends on patient physiology and disease anatomy, in addition to the available resources and expertise. This is best achieved with a multidisciplinary approach. This review provides a distillation of the recommendations of clinical guidelines and critical discussion of the evidence that informs them and presents an algorithmic approach to key areas of patient management.

• acute pancreatitis
• necrotizing pancreatitis
• pseudocyst
• biliary pancreatitis

• Cancer
• Complications
• Obesity
• Operating room
• Perioperative care

• Cardiogenic shock
• hemodynamics
• ventricular assist device

Constipation is frequent in critically ill adults receiving opioids. Naloxegol (N), a peripherally acting mu-receptor antagonist (PAMORA), may reduce constipation. The objective of this trial was to evaluate the efficacy and safety of N to prevent constipation in ICU adults receiving opioids. Methods and Patients. In this single-center, double-blind, randomized trial, adults admitted to a medical ICU receiving IV opioids (≥100 mcg fentanyl/day), and not having any of 17 exclusion criteria, were randomized to N (25 mg) or placebo (P) daily randomized to receive N (25mg) or placebo (P) and docusate 100 mg twice daily until ICU discharge, 10 days, or diarrhea (≥3 spontaneous bowel movement (SBM)/24 hours) or a serious adverse event related to study medication. A 4-step laxative protocol was initiated when there was no SBM ≥3 days.

Only 318 (20.6%) of the 1542 screened adults during the 1/17–10/19 enrolment period met all inclusion criteria. Of these, only 19/381 (4.9%) met all eligibility criteria. After 7 consent refusals, 12 patients were randomized. The study was stopped early due to enrolment futility. The N (n = 6) and P (n = 6) groups were similar. The time to first SBM (N 41.4 ± 31.7 vs. P 32.5 ± 25.4 hours, P = 0.56) was similar. The maximal daily abdominal pressure was significantly lower in the N group (N 10 ± 4 vs. P 13 ± 5, P = 0.002). The median (IQR) daily SOFA scores were higher in N (N 7 (4, 8) vs. P 4 (3, 5), P < 0.001). Laxative protocol use was similar (N 83.3% vs. P 66.6%; P = 0.51). Diarrhea prevalence was high but similar (N 66.6% vs. P 66.6%; P = 1.0). No patient experienced opioid withdrawal.

Important recruitment challenges exist for ICU trials evaluating the use of PAMORAs for constipation prevention. Despite being underpowered, our results suggest time to first SBM with naloxegol, if different than P, may be small. The effect of naloxegol on abdominal pressure, SOFA, and the interaction between the two requires further research.

• SOFA score
• acute abdomen
• exploratory laparotomy
• intra-abdominal hypertension (IAH)
• intra-abdominal pressure (IAP)

• Abdomen
• Abdomen, Acute/surgery
• Abdominal Cavity/surgery
• Humans
• Laparotomy
• Prospective Studies

• Acute pancreatitis
• Adverse events
• Aggressive hydration
• Meta-analysis
• Mortality

• Congenital diaphragmatic hernia (CDH)
• Intra vesical Pressure
• Intra-abdominal hypertension (IAH)
• Intra-abdominal pressure (IAP)

• abdominal compartment syndrome
• abdominal hypertension
• paediatric intensive care
• abdominal pressure

• Child
• Humans
• Intra-Abdominal Hypertension/diagnosis
• Intra-Abdominal Hypertension/therapy
• Physicians
• Surveys and Questionnaires
• Abdomen
• Critical Care
• Compartment Syndromes/diagnosis
• Compartment Syndromes/therapy

• Abdominal hypertension
• Cardiac surgery
• Intra-abdominal pressure

Intraabdominal hypertension (IAH) is poorly diagnosed condition that cause splanchnic hypoperfusion and abdominal organs ischemia and can lead to multiple organ failure. There are no scientific data regarding effect of intraabdominal pressure (IAP) on splanchnic circulation in children.

Ninety-four children after surgery for appendicular peritonitis were enrolled in the study. After IAP measurement children were included in one of two groups according IAP levels: “without IAH” (n = 51) and “with IAH” (n = 43). Superior mesenteric artery (SMA) and portal vein (PV) blood flows (BF_SMA, BF_PV, mL/min) were measured, and SMA and PV blood flow indexes (BFI_SMA, BFI_PV, ml/min*m2) and abdominal perfusion pressure (APP) were calculated in both groups.

Median BFI_SMA and BFI_PV in group “with IAH” were lower by 54.38% (P < 0.01) and 63.11% (P < 0.01) respectively compared to group “without IAH”. There were strong significant negative correlation between IAP and BFI_SMA (r_s = –0.66; P < 0.0001), weak significant negative correlation between IAP and BFI_PV (r_s = –0.36; P = 0.0001) in group “with IAH” and weak significant negative correlation between IAP and BFI_SMA (r_s = –0.30; P = 0.0047) in group “without IAH”. There were no statistically significant correlations between IAP and BFI_PV in group “without IAH”, between BFI_SMA and APP in both groups and between BFI_PV and APP in both groups.

Elevated IAP significantly reduces splanchnic blood flow in children with appendicular peritonitis. BFI_SMA and BFI_PV negatively correlate with IAP in these patients. There is no correlation between BFI_SMA/BFI_PV and APP in children with IAH due to appendicular peritonitis.

• Intraabdominal pressure
• portal vein
• splanchnic blood flow
• superior mesenteric artery

Intraoperative fluids are still poorly studied in veterinary medicine. In humans the dosage is associated with significant differences in postoperative outcomes.

The aim of this study is to verify the influence of three different fluid therapy rates in dogs undergoing video-assisted ovariohysterectomy.

Twenty-four female dogs were distributed into three groups: G5, G10, and G20. Each group was given 5, 10, and 20 mL·kg⁻¹·h⁻¹ of Lactate Ringer, respectively. This study evaluated the following parameters: central venous pressure, arterial blood pressure, heart rate, respiratory rate, temperature, acid-base balance, and serum lactate levels. Additionally, this study evaluated the following urinary variables: urea, creatinine, protein to creatinine ratio, urine output, and urine specific gravity. The dogs were evaluated up to 26 h after the procedure.

All animals presented respiratory acidosis during the intraoperative period. The G5 group evidenced intraoperative oliguria (0.80 ± 0.38 mL·kg⁻¹·h⁻¹), differing from the G20 group (2.17 ± 0.52 mL·kg⁻¹·h⁻¹) (p = 0.001). Serum lactate was different between groups during extubation (p = 0.036), with higher values being recorded in the G5 group (2.19 ± 1.65 mmol/L). Animals from the G20 group presented more severe hypothermia at the end of the procedure (35.93 ± 0.61°C) (p = 0.032). Only the members of the G20 group presented mean potassium values below the reference for the species. Anion gap values were lower in the G20 group when compared to the G5 and G10 groups (p = 0.017).

The use of lactated Ringer's solution at the rate of 10 mL·kg⁻¹·h⁻¹ seems to be beneficial in the elective laparoscopic procedures over the 5 or 20 mL·kg⁻¹·h⁻¹ rates of infusion.

• Dogs
• abdominal perfusion pressure
• crystalloids
• lactated Ringer's solution
• videosurgery

Intra-abdominal pressure (IAP) affects cardio-respiratory and hemodynamic parameters and can be measured directly or indirectly by measuring gastric or urinary bladder pressure. The aim of this study was to investigate the correlation between IAP, gastric pressure and urinary bladder pressure in patients with morbid obesity, at normal and elevated levels of IAP in two positions. As well, to examine the effects of increasing IAP and patient's position on hemodynamic and respiratory parameters. Twelve patients undergoing laparoscopic bariatric surgery were included. IAP, gastric pressure, and urinary bladder pressure were measured while patients were in the supine position and after 45° anti-Trendelenburg tilt. Mean inspiratory pressure, peak inspiratory pressure, and tidal volume were recorded and assessed. In supine position; directly measured IAP was 9.1 ± 1.8 mmHg, compared to 10 ± 3.6 and 8.9 ± 2.9 mmHg in the stomach and bladder, respectively. Increasing IAP to 15 mmHg resulted in an increased gastric pressure of 17 ± 3.8 mmHg, and urinary bladder pressure of 14.8 ± 3.9 mmHg. Gastric and urinary bladder pressures strongly correlated with IAP (R = 0.875 and 0.847, respectively). With 45° anti-Trendelenburg tilt; directly measured IAP was 9.4 ± 2.2 mmHg, and pressures of 10.8 ± 3.8 mmHg and 9.2 ± 3.8 mmHg were measured in the stomach and the bladder, respectively. Increasing IAP to 15 mmHg resulted in elevating gastric and bladder pressures to 16.6 ± 5.3 and 13.3 ± 4 mmHg, respectively. Gastric and urinary bladder pressures had good correlation with IAP (R = 0.843 and 0.819, respectively). Changing patient position from supine to 45° anti-Trendelenburg position resulted in decreased mean and peak inspiratory pressures, and increased tidal volume. Basal IAP is high in patients with morbid obesity. IAP shows positive correlation to gastric and urinary bladder pressures at both normal and elevated levels of IAP. Anti-Trendelenburg tilt of mechanically ventilated morbidly obese patients resulted in favorable effects on respiratory parameters.

Trial Registration: The study was retrospectively registered in the NIH registry. Registration number is pending.

• Gastric pressure
• Intra-abdominal pressure
• Laparoscopy
• Urinary bladder pressure

Liver cirrhosis and ascites are risk factors for intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS); however, data is scarce. We aimed to determine the prevalence of IAH/ACS in a population of critically ill cirrhotic patients with acute medical illness in intensive care and to assess for risk factors and clinical outcomes.

This was a multicentric retrospective cohort study including two general ICUs and pooled data from a multicentric study between January 2009 and October 2019.

A total of 9,345 patients were screened, and 95 were included in the analysis. Mean age was 56.7±1.3 years, and 79% were male. Liver cirrhosis etiology included alcohol in 45.3% and alcohol plus hepatitis C virus in 9.5%. Precipitating events included infection in 26% and bleeding in 21% of cases. Mean severity score MELD and SAPS II were 26.2±9.9 and 48.5±15.3, respectively, at ICU admission. The prevalence of IAH and ACS was respectively 82.1% and 23.2% with a mean value of maximum IAP of 16.0±5.7 mmHg and IAH grades: absent 17.9%, I 26.3%, II 33.7%, III 17.9%, and IV 4.2%. Independent risk factors for IAH were alcoholic cirrhosis (p = 0.01), West-Haven score (p = 0.01), and PaO2/FiO2 ratio (p = 0.02); as well as infection (p = 0.048) for ACS. Overall, 28-day mortality was 52.6% associated with higher IAP and ACS, and independent risk factors were MELD (p = 0.001), white blood cell count (p = 0.03), PaO2/FiO2 ratio (p = 0.03), and lactate concentration (p = 0.04) at ICU admission.

This study demonstrates a very high prevalence of IAH/ACS in the critically ill cirrhotic patient in intensive care. Increased IAP and ACS were associated with severity of disease and adverse outcomes and independent risk factors for IAH were alcoholic cirrhosis, hepatic encephalopathy and PO2/FiO2 ratio, as well as infection for ACS. Early diagnosis, prevention, and treatment of IAH/ACS might improve outcome in critically ill cirrhotic patients.

• Aged
• Critical Care
• Critical Illness/epidemiology
• Female
• Humans
• Intensive Care Units
• Intra-Abdominal Hypertension/complications
• Intra-Abdominal Hypertension/epidemiology
• Intra-Abdominal Hypertension/therapy
• Liver Cirrhosis/complications
• Liver Cirrhosis/epidemiology
• Liver Cirrhosis/therapy
• Male
• Middle Aged
• Prevalence
• Retrospective Studies
• Severity of Illness Index
• Treatment Outcome

Since the introduction of negative pressure therapy of the abdomen, care has been taken to protect the intestine from the effects of negative pressure in order to avoid impairments of abdominal organs. As an alternative to the widespread AB-Thera^R system (KCI, San Antonio, Texas, USA), the different concept of Suprasorb CNP^R (Lohmann & Rauscher, Austria-Germany) was introduced by the producer with the premise of achieving a better therapeutic effect. Due to numerous pores of the film, the effects of the negative pressure are brought to the surface of the intestinal organs and these effects were tested on seven experimental animals. Particular attention was paid to the small intestine, colon, liver, and pancreas. Over 8 h continuously, three animals were tested with −80 mmHg, 4 with −60 mmHg. The results showed no macroscopic pathological changes. The histological results showed borderline changes in the small intestine and colon with −80 mmHg application, minimal or none with −60 mmHg. The liver and pancreas were found free of pathological changes. For use on human organs, the intra-abdominal application of −60 mmHg for the Suprasorb CNP system is proposed as the standard.

• Suprasorb CNPR
• fistula
• negative pressure
• open abdominal therapy
• porcine model

• Abbreviated laparotomy
• Emergency
• Intra-abdominal hypertension
• Intravesical pressure
• Laparostomy
• Open abdomen

• Anesthesia
• Intensive care
• Vascular surgery

• Point-of-care testing
• To add intra-abdominal hypertension
• Ultrasound imaging

• intra‐abdominal hypertension
• intra‐abdominal pressure
• prognostic marker
• severe acute pancreatitis

• Bioimpedance
• Intra-abdominal pressure
• Non-invasive

• Abdominal Wall
• Female
• Humans
• Pressure
• Swine
• Animals

• 5777-8 Jerusalem College of Technology - Lev Academic Center

• acute abdomen
• equine
• intra-abdominal pressure