scholarly journals Open Abdomen during Extracorporeal Membrane Oxygenation is a Safe and Effective Treatment for Abdominal Compartment Syndrome

2020 ◽  
Vol 3 ◽  
Author(s):  
Joshua Brown ◽  
Brielle Warnock ◽  
Eamaan Turk ◽  
Gail Hocutt ◽  
Brian Gray
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Compartment Syndrome ◽  
Abdominal Compartment Syndrome ◽  
Open Abdomen ◽  
Surgical Patients ◽  
Bleeding Complications ◽  
Decompressive Laparotomy ◽  
Abdominal Compartment ◽  
Ecmo Treatment ◽  
Surgical Group

Background/Purpose                                                                    Historically, decompressive laparotomy and open abdomen for abdominal compartment syndrome has contraindicated Extracorporeal Membrane Oxygenation (ECMO) due to seemingly high risk of bleeding and infection. The literature shows few examples of this treatment, and the existing studies are inconclusive. The purpose of this study was to review the series at Riley Hospital for Children and evaluate the effectiveness of ECMO treatment for patients undergoing decompressive laparotomy with open abdomen to recommend future care guidelines.   Methods                          We reviewed all pediatric (30 days to 18 years) patients treated with ECMO concurrently with decompressive laparotomy and open abdomen at Riley Hospital for Children from 2000-2019. We compared these patients with non-surgical pediatric patients supported with ECMO for respiratory failure at Riley Hospital for Children during the same period. Demographics, ECMO data, and outcomes were assessed. We performed t-test, ROC, and chi-square analyses. We defined significance as p=0.05.   Results                      5 of 82 pediatric respiratory ECMO patients were treated with decompressive laparotomy and open abdomen. Survival among the surgical group was 60%, compared to 57% in the non-surgical group (p=0.9). Surgical patients had a similar incidence of bleeding complications (40%) compared to non-surgical patients (55.8%), p=0.486. Surgical patients had a significantly higher VIS (3126 vs 19.2, p=0.004), PaO2/FiO2 ratio (279.0 vs 72.9, p=0.031), and pump flow rate at 24hrs (112mL/kg/min vs 88.1mL/kg/min, p=0.045) than non-surgical patients, while receiving a similar volume of PRBCs (p=0.581) and requiring ECMO treatment for a similar amount of time (p=0.511).   Conclusion/Potential Impact                          ECMO support in patients with decompressive laparotomy and open abdomen was associated with similar survival and bleeding complications compared to non-surgical ECMO patients. ECMO should be offered to or continued in eligible patients with abdominal catastrophe, as it is effective in supporting organ function while not significantly increasing the risk for complications. 

scholarly journals Serial abdominal closure with Gore-tex mesh and Rives-Stoppa for an open abdomen secondary to intra-abdominal hypertension in burns

2018 ◽  
Vol 51 (03) ◽  
pp. 324-326 ◽  
Author(s):  
R Raja Shanmugakrishnan ◽  
Charles Yuen Yung Loh ◽  
Abhijeet Wakure ◽  
Naguib El-Muttardi
Keyword(s):  
Compartment Syndrome ◽  
Abdominal Wall ◽  
Abdominal Compartment Syndrome ◽  
Open Abdomen ◽  
Excess Pressure ◽  
Separation Technique ◽  
Abdominal Wall Closure ◽  
Decompressive Laparotomy ◽  
Abdominal Hypertension ◽  
Abdominal Compartment

ABSTRACTIntra-abdominal hypertension (IAH) leading to abdominal compartment syndrome (ACS) commonly occurs in major burns. To relieve the excess pressure, decompressive laparotomy is done which can lead to an open abdomen. Closure of the abdomen after a decompressive laparotomy is very difficult with bowel oedema. We describe our technique of closing the open abdomen in such situations with a combination of serial abdominal wall closure with a layered mesh and the Rives-Stoppa component separation technique.

scholarly journals Abdominal compartment syndrome in severe acute pancreatitis (review of literature)

2020 ◽  
Vol 179 (2) ◽  
pp. 73-78
Author(s):  
L. A. Otdelnov ◽  
A. S. Mukhin
Keyword(s):  
Acute Pancreatitis ◽  
Compartment Syndrome ◽  
Abdominal Compartment Syndrome ◽  
Severe Acute Pancreatitis ◽  
Medical Management ◽  
Abdominal Pressure ◽  
Decompressive Laparotomy ◽  
Russian Science Citation Index ◽  
Abdominal Hypertension ◽  
Abdominal Compartment

The study was performed for analysis of current understanding of intra-abdominal hypertension and abdominal compartment syndrome in patients with severe acute pancreatitis.The English and Russian articles about intra-abdominal hypertension and abdominal compartment syndrome in patients with severe acute pancreatitis were analyzed. The articles were found in «Russian Science Citation Index» and «PubMed».There is a pathogenetic relationship between increased intra-abdominal pressure and the development of severe acute pancreatitis.For today, it was shown that intra-abdominal hypertension in patients with severe acute pancreatitis is associated with significantly higher APACHE-II and MODS score, prevalence of pancreatic and peripancreatic tissue lesions, early infection of pancreatic necrosis and higher mortality.The article considers various variants of decompressive interventions such as decompressive laparotomy, fasciotomy and percutaneous catheter drainage. For today, there are no randomized studies devoted to researching effectiveness of different decompressive interventions.The study showed that it is necessary to regularly monitor intra-abdominal pressure in patients with severe acute pancreatitis. Patients with intra-abdominal hypertension require emergency medical management to reduce intra-abdominal pressure. Inefficiency of the medical management and development of abdominal compartment syndrome are indications for surgery. The effectiveness of different decompressive interventions requires further studies.

scholarly journals Decompressive Abdominal Laparotomy for Abdominal Compartment Syndrome in an Unengrafted Bone Marrow Recipient with Septic Shock

2010 ◽  
Vol 2010 ◽  
pp. 1-5 ◽  
Author(s):  
Derrick J. N. Dauplaise ◽  
Sean J. Barnett ◽  
Jason S. Frischer ◽  
Hector R. Wong
Keyword(s):  
Bone Marrow ◽  
Septic Shock ◽  
Compartment Syndrome ◽  
Abdominal Compartment Syndrome ◽  
Pediatric Intensive Care ◽  
Individual Case ◽  
Individual Case Report ◽  
Decompressive Laparotomy ◽  
Massive Fluid ◽  
Abdominal Compartment

Objective. To describe a profoundly immunocompromised (panleukopenia) child with septic shock who developed abdominal compartment syndrome (ACS) and was successfully treated with surgical decompression.Design. Individual case report.Setting. Pediatric intensive care unit of a tertiary children's hospital.Patient. A 32-month-old male with Fanconi anemia who underwent bone marrow transplantation (BMT) 5 days prior to developing septic shock secondary toStreptococcus viridansandEscherichia coliACS developed after massive fluid resuscitation, leading to cardiopulmonary instability.Interventions. Emergent surgical bedside laparotomy and silo placement.Measurements and Main Results. The patient's cardiopulmonary status stabilized after decompressive laparotomy. The abdomen was closed and the patient survived to hospital discharge without cardiac, respiratory, or renal dysfunction.Conclusions. The use of laparotomy and silo placement in an unengrafted BMT patient with ACS and septic shock did not result in additional complications. Surgical intervention for ACS is a reasonable option for high risk, profoundly immunocompromised patients.

Pathophysiology and Management of Abdominal Compartment Syndrome

2003 ◽  
Vol 12 (4) ◽  
pp. 367-371 ◽  
Author(s):  
Jeffrey Walker ◽  
Laura M. Criddle
Keyword(s):  
Compartment Syndrome ◽  
Abdominal Compartment Syndrome ◽  
Oxygen Free Radicals ◽  
Abdominal Pressure ◽  
Decompressive Laparotomy ◽  
Abdominal Hypertension ◽  
Translocation Of Bacteria ◽  
Serial Measurements ◽  
Abdominal Compartment ◽  
Multiorgan Dysfunction Syndrome

Abdominal compartment syndrome is a potentially lethal condition caused by any event that produces intra-abdominal hypertension; the most common cause is blunt abdominal trauma. Increasing intra-abdominal pressure causes progressive hypoperfusion and ischemia of the intestines and other peritoneal and retroperitoneal structures. Pathophysiological effects include release of cytokines, formation of oxygen free radicals, and decreased cellular production of adenosine triphosphate. These processes may lead to translocation of bacteria from the gut and intestinal edema, predisposing patients to multiorgan dysfunction syndrome. The consequences of abdominal compartment syndrome are profound and affect many vital body systems. Hemodynamic, respiratory, renal, and neurological abnormalities are hallmarks of abdominal compartment syndrome. Medical management consists of urgent decompressive laparotomy. Nursing care involves vigilant monitoring for early detection, including serial measurements of intra-abdominal pressure.

Abdominal Compartment Syndrome During Extracorporeal Membrane Oxygenation

2012 ◽  
Vol 26 (5) ◽  
pp. 890-892 ◽  
Author(s):  
Giulia Maj ◽  
Maria Grazia Calabrò ◽  
Marina Pieri ◽  
Giulio Melisurgo ◽  
Alberto Zangrillo ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Compartment Syndrome ◽  
Abdominal Compartment Syndrome ◽  
Membrane Oxygenation ◽  
Abdominal Compartment

scholarly journals Abdominal Compartment Syndrome as a Multidisciplinary Challenge. A Literature Review

2018 ◽  
Vol 4 (4) ◽  
pp. 114-119 ◽  
Author(s):  
Gabriel Alexandru Popescu ◽  
Tivadar Bara ◽  
Paul Rad
Keyword(s):  
Compartment Syndrome ◽  
Abdominal Compartment Syndrome ◽  
Treatment Guidelines ◽  
Surgical Care ◽  
Abdominal Pressure ◽  
Decompressive Laparotomy ◽  
Abdominal Hypertension ◽  
Treatment Measures ◽  
Points Of View ◽  
Abdominal Compartment

Abstract Abdominal Compartment Syndrome (ACS), despite recent advances in medical and surgical care, is a significant cause of mortality. The purpose of this review is to present the main diagnostic and therapeutic aspects from the anesthetical and surgical points of view. Intra-abdominal hypertension may be diagnosed by measuring intra-abdominal pressure and indirectly by imaging and radiological means. Early detection of ACS is a key element in the ACS therapy. Without treatment, more than 90% of cases lead to death and according with the last reports, despite all treatment measures, the mortality rate is reported as being between 25 and 75%. There are conflicting reports as to the importance of a conservative therapy approach, although such an approach is the central to treatment guidelines of the World Society of Abdominal Compartment Syndrome, Decompressive laparotomy, although a backup solution in ACS therapy, reduces mortality by 16-37%. The open abdomen management has several variants, but negative pressure wound therapy represents the gold standard of surgical treatment.

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