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Recognition and management of abdominal compartment syndrome among German pediatric intensivists: results of a national survey.


ABSTRACT:

Introduction

Several decades ago, the beneficial effects of goal-directed therapy, which include decompressive laparotomy (DL) and open abdomen procedures in cases of intra-abdominal hypertension (IAH) in children, were proven in the context of closures of abdominal wall defects and large-for-size organ transplantations. Different neonatologic and pediatric disease patterns are also known to be capable of increasing intra-abdominal pressure (IAP). Nevertheless, a considerable knowledge transfer regarding such risk factors has hardly taken place. When left undetected and untreated, IAH threatens to evolve into abdominal compartment syndrome (ACS), which is accompanied by a mortality rate of up to 60% in children. Therefore, the present study looks at the recognition and knowledge of IAH/ACS among German pediatric intensivists.

Methods

In June 2010, a questionnaire was mailed to the heads of pediatric intensive care units of 205 German pediatric hospitals.

Results

The response rate was 62%. At least one case of IAH was reported by 36% of respondents; at least one case of ACS, by 25%. Compared with adolescents, younger critically ill children appeared to develop IAH/ACS more often. Routine measurements of IAP were said to be performed by 20% of respondents. Bladder pressure was used most frequently (96%) to assess IAP. Some respondents (17%) only measured IAP in cases of organ dysfunction and failure. In 2009, the year preceding this study, 21% of respondents claimed to have performed a DL. Surgical decompression was indicated if signs of organ dysfunction were present. This was also done in cases of at least grade III IAH (IAP > 15 mmHg) without organ impairment.

Conclusions

Although awareness among pediatricians appears to have been increasing over the last decade, definitions and guidelines regarding the diagnosis and management of IAH/ACS are not applied uniformly. This variability could express an ever present lack of awareness and solid prospective data.

SUBMITTER: Kaussen T 

PROVIDER: S-EPMC3390295 | biostudies-literature | 2012 Jul

REPOSITORIES: biostudies-literature

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Recognition and management of abdominal compartment syndrome among German pediatric intensivists: results of a national survey.

Kaussen Torsten T   Steinau Gerd G   Srinivasan Pramod Kadaba PK   Otto Jens J   Sasse Michael M   Staudt Franz F   Schachtrupp Alexander A  

Annals of intensive care 20120705


<h4>Introduction</h4>Several decades ago, the beneficial effects of goal-directed therapy, which include decompressive laparotomy (DL) and open abdomen procedures in cases of intra-abdominal hypertension (IAH) in children, were proven in the context of closures of abdominal wall defects and large-for-size organ transplantations. Different neonatologic and pediatric disease patterns are also known to be capable of increasing intra-abdominal pressure (IAP). Nevertheless, a considerable knowledge t  ...[more]

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