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| 1 | Effect of intra-abdominal pressure on respiratory function in patients undergoing ventral hernia repair显示文摘AIM: To determine the influence of intra-abdominal pressure(IAP) on respiratory function after surgical repair of ventral hernia and to compare two different methods of IAP measurement during the perioperative period. METHODS: Thirty adult patients after elective repair of ventral hernia were enrolled into this prospective study.IAP monitoring was performed via both a balloontipped nasogastric probe [intragastric pressure(IGP), Ci MON, Pulsion Medical Systems, Munich, Germany] and a urinary catheter [intrabladder pressure(IBP), Uno Meter Abdo-Pressure Kit, Uno Medical, Denmark] on five consecutive stages:(1) after tracheal intubation(AI);(2) after ventral hernia repair;(3) at the end of surgery;(4) during spontaneous breathing trial through the endotracheal tube; and(5) at 1 h after tracheal extubation. The patients were in the complete supine position during all study stages.RESULTS: The IAP(measured via both techniques) increased on average by 12% during surgery compared to AI(P < 0.02) and by 43% during spontaneous breathing through the endotracheal tube(P < 0.01). In parallel, the gradient between РаСО2 and Et CO2 [Р(а-et)CO2] rose significantly, reaching a maximum during the spontaneous breathing trial. The PаO2/Fi O2 decreased by 30% one hour after tracheal extubation(P = 0.02). The dynamic compliance of respiratory system reduced intraoperatively by 15%-20%(P < 0.025). At all stages, we observed a significant correlation between IGP and IBP(r = 0.65-0.81, P < 0.01) with a mean bias varying from-0.19 mm Hg(2SD 7.25 mm Hg) to-1.06 mm Hg(2SD 8.04 mm Hg) depending on the study stage. Taking all paired measurements together(n = 133), the median IGP was 8.0(5.5-11.0) mm Hg and the median IBP was 8.8(5.8-13.1) mm Hg. The overall r2 value( n = 30) was 0.76(P < 0.0001). Bland and Altman analysis showed an overall bias for the mean values per patient of 0.6 mm Hg(2SD 4.2 mm Hg) with percentage error of 45.6%. Looking at changes in IAP between the different study stages, we found an excellent concordance coefficient of 94.9% comparing IBP and IGP( n = 117).CONCLUSION: During ventral hernia repair, the IAP rise is accompanied by changes in Р(а-et)CO2 and PаO2/Fi O2-ratio. Estimation of IAP via IGP or IBP demonstrated excellent concordance. | Konstantin M Gaidukov Elena N Raibuzhis Ayyaz Hussain Alexey Y Teterin Alexey A Smetkin Vsevolod V Kuzkov Manu LNG Malbrain Mikhail Y Kirov | 2013 | World Journal of Critical Care Medicine2013，2，2： | 2 |
| 2 | Results from the international conference of experts on intra - abdominal hypertension and abdominal compartment syndrome 显示文摘 | Manu LNG Malbrain Michael LC | 2006 | Intensive Care Med2006，32，： | 1 |
| 3 | Prevalence of intra-abdominal hypertension in critically ill patients:a multicentre epidemiological study显示文摘 | Manu LNG Malbrain ML Davide Chiumello | | 0，，30： | 1 |
| 4 | Results from the international conference of experts on intra - abdominal hypertension and abdominal compartment syndrome显示文摘 | Manu LNG Malbrain MLC | 2006 | Definitions Intensive Care Med2006，32，： | 1 |
| 5 | Is itwise not to think about intraabdom inalhypertension in the ICU显示文摘 | Malbrain Manu LNG | 2004 | Current Opinion in Critical Care2004，10，2： | 1 |
| 6 | Surgical decompression for the management of abdominal compartment syndrome with severe acute pancreatitis: A narrative review显示文摘Intra-abdominal hypertension(IAH)and abdominal compartment syndrome(ACS)play a pivotal role in the pathophysiology of severe acute pancreatitis(SAP)and contribute to new-onset and persistent organ failure.The optimal management of ACS involves a multi-disciplinary approach,from its early recognition to measures aiming at an urgent reduction of intra-abdominal pressure(IAP).A targeted literature search from January 1,2000,to November 30,2022,revealed 20 studies and data was analyzed on the type and country of the study,patient demographics,IAP,type and timing of surgical procedure performed,post-operative wound management,and outcomes of patients with ACS.There was no randomized controlled trial published on the topic.Decom-pressive laparotomy is effective in rapidly reducing IAP(standardized mean difference=2.68,95%confidence interval:1.19-1.47,P<0.001;4 studies).The morbidity and complications of an open abdomen after decompressive laparotomy should be weighed against the inadequately treated but,potentially lethal ACS.Disease-specific patient selection and the role of less-invasive decompressive measures,like subcutaneous linea alba fasciotomy or component separation techniques,is lacking in the 2013 consensus management guidelines by the Abdominal Compartment Society on IAH and ACS.This narrative review focuses on the current evidence regarding surgical decompression techniques for managing ACS in patients with SAP.However,there is a lack of high-quality evidence on patient selection,timing,and modality of surgical decompression.Large prospective trials are needed to identify triggers and effective and safe surgical decompression methods in SAP patients with ACS. | Prashant Nasa Gunjan Chanchalani Deven Juneja Manu LNG Malbrain | 2023 | World Journal of Gastrointestinal Surgery2023，15，9： | 0 |
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