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Open Access 01-07-2013 | Conference Reports and Expert Panel

Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome

Authors: Andrew W. Kirkpatrick, Derek J. Roberts, Jan De Waele, Roman Jaeschke, Manu L. N. G. Malbrain, Bart De Keulenaer, Juan Duchesne, Martin Bjorck, Ari Leppaniemi, Janeth C. Ejike, Michael Sugrue, Michael Cheatham, Rao Ivatury, Chad G. Ball, Annika Reintam Blaser, Adrian Regli, Zsolt J. Balogh, Scott D’Amours, Dieter Debergh, Mark Kaplan, Edward Kimball, Claudia Olvera, The Pediatric Guidelines Sub-Committee for the World Society of the Abdominal Compartment Syndrome

Published in: Intensive Care Medicine | Issue 7/2013

Abstract

Purpose

To update the World Society of the Abdominal Compartment Syndrome (WSACS) consensus definitions and management statements relating to intra-abdominal hypertension (IAH) and the abdominal compartment syndrome (ACS).

Methods

We conducted systematic or structured reviews to identify relevant studies relating to IAH or ACS. Updated consensus definitions and management statements were then derived using a modified Delphi method and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) guidelines, respectively. Quality of evidence was graded from high (A) to very low (D) and management statements from strong RECOMMENDATIONS (desirable effects clearly outweigh potential undesirable ones) to weaker SUGGESTIONS (potential risks and benefits of the intervention are less clear).

Results

In addition to reviewing the consensus definitions proposed in 2006, the WSACS defined the open abdomen, lateralization of the abdominal musculature, polycompartment syndrome, and abdominal compliance, and proposed an open abdomen classification system. RECOMMENDATIONS included intra-abdominal pressure (IAP) measurement, avoidance of sustained IAH, protocolized IAP monitoring and management, decompressive laparotomy for overt ACS, and negative pressure wound therapy and efforts to achieve same-hospital-stay fascial closure among patients with an open abdomen. SUGGESTIONS included use of medical therapies and percutaneous catheter drainage for treatment of IAH/ACS, considering the association between body position and IAP, attempts to avoid a positive fluid balance after initial patient resuscitation, use of enhanced ratios of plasma to red blood cells and prophylactic open abdominal strategies, and avoidance of routine early biologic mesh use among patients with open abdominal wounds. NO RECOMMENDATIONS were possible regarding monitoring of abdominal perfusion pressure or the use of diuretics, renal replacement therapies, albumin, or acute component-parts separation.

Conclusion

Although IAH and ACS are common and frequently associated with poor outcomes, the overall quality of evidence available to guide development of RECOMMENDATIONS was generally low. Appropriately designed intervention trials are urgently needed for patients with IAH and ACS.

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Title: Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome
Authors: Andrew W. Kirkpatrick
Derek J. Roberts
Jan De Waele
Roman Jaeschke
Manu L. N. G. Malbrain
Bart De Keulenaer
Juan Duchesne
Martin Bjorck
Ari Leppaniemi
Janeth C. Ejike
Michael Sugrue
Michael Cheatham
Rao Ivatury
Chad G. Ball
Annika Reintam Blaser
Adrian Regli
Zsolt J. Balogh
Scott D’Amours
Dieter Debergh
Mark Kaplan
Edward Kimball
Claudia Olvera
The Pediatric Guidelines Sub-Committee for the World Society of the Abdominal Compartment Syndrome
Publication date: 01-07-2013
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 7/2013
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-013-2906-z

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Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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