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Titolo:
INTRAABDOMINAL HYPERTENSION AFTER LIFE-THREATENING PENETRATING ABDOMINAL-TRAUMA - PROPHYLAXIS, INCIDENCE, AND CLINICAL RELEVANCE TO GASTRIC-MUCOSAL PH AND ABDOMINAL COMPARTMENT SYNDROME
Autore:
IVATURY RR; PORTER JM; SIMON RJ; ISLAM S; JOHN R; STAHL WM;
Indirizzi:
VIRGINIA COMMONWEALTH UNIV,MED COLL VIRGINIA,DEPT SURG,POB 980454 RICHMOND VA 23298 LINCOLN MED & MENTAL HLTH CTR,NEW JERSEY MED COLL,DEPT SURG BRONX NY 10451
Titolo Testata:
The journal of trauma, injury, infection, and critical care
fascicolo: 6, volume: 44, anno: 1998,
pagine: 1016 - 1021
Fonte:
ISI
Lingua:
ENG
Soggetto:
INCREASED INTRAABDOMINAL PRESSURE; BLOOD-FLOW; OXYGEN; RESUSCITATION; ARTERIAL; ISCHEMIA; INDEXES;
Keywords:
ABDOMINAL HYPERTENSION; ABDOMINAL COMPARTMENT SYNDROME; INTRAABDOMINAL PRESSURE; DAMAGE-CONTROL; ABBREVIATED LAPAROTOMY;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Citazioni:
32
Recensione:
Indirizzi per estratti:
Citazione:
R.R. Ivatury et al., "INTRAABDOMINAL HYPERTENSION AFTER LIFE-THREATENING PENETRATING ABDOMINAL-TRAUMA - PROPHYLAXIS, INCIDENCE, AND CLINICAL RELEVANCE TO GASTRIC-MUCOSAL PH AND ABDOMINAL COMPARTMENT SYNDROME", The journal of trauma, injury, infection, and critical care, 44(6), 1998, pp. 1016-1021

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. pi-Ii was measured by gastric tonometry every 4 to 6 hours. IAH (intra-abdominal pressure> 25 cm of H2O) was treated by bedside or operating room laparotomy, Results: Injury severity was comparable between patients whohad 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 pi-Ii monitoring, and 11 of them had IAH, Of the 11 patients, eight patients (72.7%) had acidotic pHi (7.10 +/- 0.2) with WH 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 pi-Ii went on to develop ACS, despite abdominal decompression, Multiorgan dysfunction syndrome points and death were less in patients without IAH than those with IAHand in patients who had mesh closure, Conclusions: IAH is frequent after major abdominal trauma. It may cause gut mucosal acidosis at lowerbladder 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.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 21/09/20 alle ore 18:57:37