open access

Vol 49, No 5 (2017)
Original and clinical articles
Published online: 2017-11-28
Submitted: 2017-10-14
Accepted: 2017-11-28
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The role of point-of-care ultrasound in intra-abdominal hypertension management

Bruno M. Pereira, Renato G. Pereira, Robert Wise, Gavin Sugrue, Tanya L. Zakrison, Alcir E. Dorigatti, Rossano K. Fiorelli, Manu L.N.G. Malbrain
DOI: 10.5603/AIT.a2017.0074
·
Pubmed: 29182210
·
Anaesthesiol Intensive Ther 2017;49(5):373-381.

open access

Vol 49, No 5 (2017)
Original and clinical articles
Published online: 2017-11-28
Submitted: 2017-10-14
Accepted: 2017-11-28

Abstract

Background: Intra-abdominal hypertension is a common complication in critically ill patients. Recently the Abdominal Compartment Society (WSACS) developed a medical management algorithm with a stepwise approach according to the evolution of the intra-abdominal pressure and aiming to keep IAP ≤ 15 mm Hg. With the increased use of ultrasound as a bedside modality in both emergency and critical care patients, we hypothesized that ultrasound could be used as an adjuvant point-of-care tool during IAH management. This may be particularly relevant to the first and second basic stages of the algorithm. The objective of this paper is to test the use of POCUS as an adjuvant tool in the management of patients with IAH/ACS. Methods: Seventy-three consecutive adult critically ill patients admitted to the surgical intensive care unit (ICU) of a single urban institution with risk factor for IAH/ACS were enrolled. Those who met the inclusion criteria were allocated to undergo POCUS as an adjuvant tool in their IAH/ACS management. Results: A total of 50 patients met the inclusion criteria and were included in the study. The mean age of study participants was 55 ± 22.6 years, 58% were men, and the most frequent admission diagnosis was post-operative care following abdominal intervention. All admitted patients presented with a degree of IAH during their ICU stay. Following step 1 of the WSACS IAH medical management algorithm, ultrasound was used for NGT placement, confirmation of correct positioning, and evaluation of stomach contents. Ultrasound was comparable to abdominal X-ray, but shown to be superior in determining the gastric content (fluid vs. solid). Furthermore, POCUS allowed faster determination of correct NGT positioning in the stomach (antrum), avoiding bedside radiation exposure. Ultrasound also proved useful in: 1) evaluation of bowel activity; 2) identification of large bowel contents; 3) identification of patients that would benefit from bowel evacuation (enema) as an adjuvant to lower IAP; 4) and in the diagnosis of moderate to large amounts of free intra-abdominal fluid. Conclusion: POCUS is a powerful systematic ultrasound technique that can be used as an adjuvant in intra-abdominal hypertension management. It has the potential to be used in both diagnosis and treatment during the course of IAH.

Abstract

Background: Intra-abdominal hypertension is a common complication in critically ill patients. Recently the Abdominal Compartment Society (WSACS) developed a medical management algorithm with a stepwise approach according to the evolution of the intra-abdominal pressure and aiming to keep IAP ≤ 15 mm Hg. With the increased use of ultrasound as a bedside modality in both emergency and critical care patients, we hypothesized that ultrasound could be used as an adjuvant point-of-care tool during IAH management. This may be particularly relevant to the first and second basic stages of the algorithm. The objective of this paper is to test the use of POCUS as an adjuvant tool in the management of patients with IAH/ACS. Methods: Seventy-three consecutive adult critically ill patients admitted to the surgical intensive care unit (ICU) of a single urban institution with risk factor for IAH/ACS were enrolled. Those who met the inclusion criteria were allocated to undergo POCUS as an adjuvant tool in their IAH/ACS management. Results: A total of 50 patients met the inclusion criteria and were included in the study. The mean age of study participants was 55 ± 22.6 years, 58% were men, and the most frequent admission diagnosis was post-operative care following abdominal intervention. All admitted patients presented with a degree of IAH during their ICU stay. Following step 1 of the WSACS IAH medical management algorithm, ultrasound was used for NGT placement, confirmation of correct positioning, and evaluation of stomach contents. Ultrasound was comparable to abdominal X-ray, but shown to be superior in determining the gastric content (fluid vs. solid). Furthermore, POCUS allowed faster determination of correct NGT positioning in the stomach (antrum), avoiding bedside radiation exposure. Ultrasound also proved useful in: 1) evaluation of bowel activity; 2) identification of large bowel contents; 3) identification of patients that would benefit from bowel evacuation (enema) as an adjuvant to lower IAP; 4) and in the diagnosis of moderate to large amounts of free intra-abdominal fluid. Conclusion: POCUS is a powerful systematic ultrasound technique that can be used as an adjuvant in intra-abdominal hypertension management. It has the potential to be used in both diagnosis and treatment during the course of IAH.
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Keywords

intra-abdominal hypertension; intra-abdominal compartment syndrome; ultrasound; point-of-care ultrasound; POCUS

About this article
Title

The role of point-of-care ultrasound in intra-abdominal hypertension management

Journal

Anaesthesiology Intensive Therapy

Issue

Vol 49, No 5 (2017)

Pages

373-381

Published online

2017-11-28

DOI

10.5603/AIT.a2017.0074

Pubmed

29182210

Bibliographic record

Anaesthesiol Intensive Ther 2017;49(5):373-381.

Keywords

intra-abdominal hypertension
intra-abdominal compartment syndrome
ultrasound
point-of-care ultrasound
POCUS

Authors

Bruno M. Pereira
Renato G. Pereira
Robert Wise
Gavin Sugrue
Tanya L. Zakrison
Alcir E. Dorigatti
Rossano K. Fiorelli
Manu L.N.G. Malbrain

References (13)
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