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01-09-2008 | Editorial

AIDS is coming to your ICU: be prepared for acute bowel injury and acute intestinal distress syndrome…

Authors: Manu L. N. G. Malbrain, Inneke De laet

Published in: Intensive Care Medicine | Issue 9/2008

Excerpt

In this issue of Intensive Care Medicine, Reintam et al. report the results of a study entitled “Primary and secondary intra-abdominal hypertension—different impact on ICU outcome” [1]. The authors collected prospective data on 257 mechanically ventilated critically ill patients with more than two risk factors for IAH (about one-third of the entire ICU population). The authors found that IAH (defined as a sustained increase in intraabdominal pressure (IAP) equal to or above 12 mmHg) was present on admission in 23.4% of cases, while a total of 37% developed IAH within 5 days of whom 4.7% developed ACS. Primary IAH (with an underlying cause within the abdomino-pelvic region) was seen in 63.2% of patients with IAH. Patients with secondary IAH demonstrated a different time course with a significant increase of mean IAP during the first 3 days (mean ΔIAP was 2.2 ± 4.7 mmHg), whilst in the patients with primary IAH, IAP decreased (mean ΔIAP −1.1 ± 3.7 mmHg). Patients with IAH were sicker, had more organ failure and a higher ICU (37.9 vs. 19.1%; P = 0.001), 28-day (48.4 vs. 27.8%; P = 0.001), and 90-day mortality (53.7 vs. 35.8%; P = 0.004) compared to patients with a normal IAP. Patients with secondary IAH had a significantly higher ICU mortality than patients with primary IAH (P = 0.032). The development of IAH during ICU stay was an independent risk factor for death (OR 2.52; 95% CI 1.23–5.14). Therefore, ICU physicians no longer have an excuse not to obtain a baseline IAP value in patients with two or more risk factors for IAH [2, 3]. …

Reintam A, Parm P, Kitus R, Kern H, Starkopf J (2008) Primary and secondary intra-abdominal hypertension—different impact on ICU outcome. Intensive Care Med. doi:10.1007/s00134-008-1134-4

Cheatham ML, Malbrain ML, Kirkpatrick A, Sugrue M, Parr M, De Waele J, Balogh Z, Leppaniemi A, Olvera C, Ivatury R, D’Amours S, Wendon J, Hillman K, Johansson K, Kolkman K, Wilmer A (2007) Results from the international conference of experts on intra-abdominal hypertension and abdominal compartment syndrome. II. Recommendations. Intensive Care Med 33:951–962PubMedCrossRef

Malbrain ML (2008) You don’t have any excuse, just start measuring abdominal pressure and act upon it! Minerva Anestesiol 74:1–2PubMed

Malbrain ML, Chiumello D, Pelosi P, Wilmer A, Brienza N, Malcangi V, Bihari D, Innes R, Cohen J, Singer P, Japiassu A, Kurtop E, De Keulenaer BL, Daelemans R, Del Turco M, Cosimini P, Ranieri M, Jacquet L, Laterre PF, Gattinoni L (2004) Prevalence of intra-abdominal hypertension in critically ill patients: a multicentre epidemiological study. Intensive Care Med 30:822–829PubMedCrossRef

Malbrain ML, Chiumello D, Pelosi P, Bihari D, Innes R, Ranieri VM, Del Turco M, Wilmer A, Brienza N, Malcangi V, Cohen J, Japiassu A, De Keulenaer BL, Daelemans R, Jacquet L, Laterre PF, Frank G, de Souza P, Cesana B, Gattinoni L (2005) Incidence and prognosis of intraabdominal hypertension in a mixed population of critically ill patients: a multiple-center epidemiological study. Crit Care Med 33:315–322PubMedCrossRef

Malbrain ML, Cheatham ML, Kirkpatrick A, Sugrue M, Parr M, De Waele J, Balogh Z, Leppaniemi A, Olvera C, Ivatury R, D’Amours S, Wendon J, Hillman K, Johansson K, Kolkman K, Wilmer A (2006) Results from the international conference of experts on intra-abdominal hypertension and abdominal compartment syndrome. I. Definitions. Intensive Care Med 32:1722–1732PubMedCrossRef

Malbrain ML, De laet I, Cheatham M (2007) Consensus conference definitions and recommendations on intra-abdominal hypertension (IAH) and the abdominal compartment syndrome (ACS)—the long road to the final publications, how did we get there? Acta Clin Belg Suppl 62:44–59

De Waele J, Pletinckx P, Blot S, Hoste E (2006) Saline volume in transvesical intra-abdominal pressure measurement: enough is enough. Intensive Care Med 32:455–459PubMedCrossRef

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10.

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Bellomo R, Kellum JA, Ronco C (2006) Defining and classifying acute renal failure: from advocacy to consensus and validation of the RIFLE criteria. Intensive Care Med 33(3):409–413PubMedCrossRef

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Kimball EJ (2006) Intra-abdominal hypertension and the abdominal compartment syndrome: ‘ARDS’ of the gut. Int J Intensive Care Spring:1–7

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Kirkpatrick AW, Balogh Z, Ball CG, Ahmed N, Chun R, McBeth P, Kirby A, Zygun DA (2006) The secondary abdominal compartment syndrome: iatrogenic or unavoidable? J Am Coll Surg 202:668–679PubMedCrossRef

14.

Kimball EJ, Kim W, Cheatham ML, Malbrain ML (2007) Clinical awareness of intra-abdominal hypertension and abdominal compartment syndrome in 2007. Acta Clin Belg Suppl 62:66–73

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Malbrain ML (2005) For the critically Ill and abdominal hypertension (CIAH) study group. Incidence of intraabdominal hypertension in the intensive care unit. Crit Care Med 33:2150–2153CrossRef

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Vidal M, Ruiz Weisser J, Gonzalez F, Toro M, Loudet C, Balasini C, Canales H, Reina R, Estenssoro E (2008) Incidence and clinical effects of intraabdominal hypertension in critically ill patients. Crit Care Med (in press)

Title: AIDS is coming to your ICU: be prepared for acute bowel injury and acute intestinal distress syndrome…
Authors: Manu L. N. G. Malbrain
Inneke De laet
Publication date: 01-09-2008
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 9/2008
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-008-1135-3

At a glance: The STEP trials

Springer Medicine

AIDS is coming to your ICU: be prepared for acute bowel injury and acute intestinal distress syndrome…

Excerpt

At a glance: The STEP trials

Springer Medicine

Excerpt

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