1 / 25

ABDOMINAL COMPARTMENT SYNDROME

ABDOMINAL COMPARTMENT SYNDROME. ACS. Reduced cardiac output Oliguria High peak inspiratory pressures Impaired oxygenation Impaired ventilation Reversed by decompression. ABDOMINAL COMPARTMENT SYNDROME Pathophysiology: Viscera. %. IAP (mm Hg). Diebel et al, 1992.

xander
Download Presentation

ABDOMINAL COMPARTMENT SYNDROME

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. ABDOMINAL COMPARTMENT SYNDROME

  2. ACS Reduced cardiac output Oliguria High peak inspiratory pressures Impaired oxygenation Impaired ventilation Reversed by decompression

  3. ABDOMINAL COMPARTMENT SYNDROME Pathophysiology: Viscera

  4. % IAP (mm Hg) Diebel et al, 1992

  5. IAP 25 for 60 minutes Bowel TPO2 IAP 15 for 60 minutes Baseline Axillary TPO2 50 100 0 Bongard et al, 1995

  6. IAP and Hepatic flow Decreased HABF 10 mm Hg Decreased HMVBF HABF 45% HMVBF 71% 20 mm Hg PVBF 65% (of control)

  7. IAP and pHi Compared with normal pHi, patients with pHi < 7.32 were 11 times more likely to have a high IAP Sugrue et al, 1996

  8. IAP and pHi Gastric mucosal pH (n=42) With IAH = 11 8 (64%) had acidotic pH 6 of the 8 improved with abdominal decompression 2 with low pHi and IAH died of ACS, MODS Ivatury et al, 1998

  9. IAP and pHi ACS by intraabdominal inflatable balloon in puppies. Baseline: 2 to 5 cm H2O in the stomach and bladder 1 to 3 mm Hg in the intraabdominal catheter = pHi of 7.4. BP and GP of 20 cm, IAP of 10 mm : pHi 7.0 BP 30 cm and GP 20 mm : pHi 6.8 BP 40 cm and GP 30 mm : pHi 6.5 ? Changes in pHi in association with increased IAP may be an early indicator of impending ACS Engum et al, 2002:

  10. IAP and bowel mucosa Quantitatively assessed: mucosal perfusion index, functional capillary density RBC velocity by intravital microscopy At an IAP of 10 and 15 mm Hg: Stewise decrease in all parameters indicating A progressive impairement of Mucosal circulation Samel et al, 2002:

  11. IAP and bowel mucosa Jejunal loop Exposed mucosa Abdominal chamber I V microscope Optical window Samel et al, 2002:

  12. IAP and bowel mucosa Samel et al, 2002:

  13. INTRAABDOMINAL HYPERTENSION IAH 10 (22.2%) 13 (52%) 0.012 Deaths 2 (10.6%)9 (36%) 0.003 MODS 1.3 ± 2.4 3.1 ± 3.9 0.023 Group II: closure Group I: mesh p (n=45) (n=25) Ivatury et al, 1998

  14. INTRAABDOMINAL HYPERTENSION No IAH IAH p (n=47) (n=23) Mortality 4 (8.5%) 10 (43.5%) 0.006 MODS 0.8 ± 1.9 4.3 ± 3.7 0.0001 Ivatury et al, 1998

  15. ACS, MOF and Mortality NO ACS ACS p (n=28) (n=49) Mortality 12% 43% 0.01 0.01 MOF 8% 32% Raeburn et al, 2001

  16. ACS & MOF ACS an independent risk factor for MOF ( OR 9.2, CI 3.8-22.8, p<0001) Mortality (OR 8.4, CI 3.5-20.6, p<0.001) Balogh et al, 2003

  17. ? Bacterial translocation E.coli, Enetrobacter in lymph nodes and liver after shock and IAH: Eleftheriadis et al, 1996 Diebel et al, 1997 Gargiulo et al, 1998 No bacterial translocation Jacobi et al, 1997 Doty et al, 2002

  18. ACS & Systemic Cytokines TNF IL-6 PMNs Il-1 ß Rezende-Neto et al, 2002

  19. ACS & Lung pathology Rezende-Neto et al, 2002

  20. Sequential shock & ACS SMAF and CO are reduced to a greater degree by IAH after prior hemorrhage and resuscitation

  21. Sequential shock & ACS

  22. Sequential shock & ACS Group I animals had Significantly higher BAL PMNs, BAL protein and Lung MPO levels.

  23. ACS as a second-hit in a two-hit model of MODS Hemorrhagic shock-reperfusion in rodents Neutrophil CD-11b expression maximal at 8 hours Lung PMN sequestration (elastase concn) Lung injury (EB dye in BAL) Liver injury (ALT concn) Were maximal with ACS at 8 hours Rezende-Neto et al, 2002

  24. SUMMARY IAH has profound effects on the splanchnic bed. The effects of ischemia-reperfusion and IAH are additive IAH causes systemic inflammatory changes and can serve as the second-hit for the development of MODS IAH and ACS are morbid complications that increase mortality.

More Related