Intra-abdominal hypertension after life-threatening penetrating abdominal trauma : Prophylaxis, incidence, and clinical relevance to gastric mucosal pH and abdominal compartment syndrome. Discussion.
Annual Meeting of the American Association for the Surgery of Trauma and the Japanese Association for Acute Medicine. Waikoloa, HI, USA, 1997/09/24.
To define the incidence, prophylaxis, and treatment of intra-abdominal hypertension (IAH) and its relevance to gut mucosal pH (pHi), multiorgan dysfunction syndrome, and the abdominal compartment syndrome (ACS).
Seventy patients in the SICU at a Level I trauma center (1992-1996) with life threatening penetrating abdominal trauma had intra-abdominal pressure estimated by bladder pressure. pHi was measured by gastric tonometry every 4 to 6 hours.
IAH (intra-abdominal pressure>25 cm of H2O) was treated by bedside or operating room laparotomy.
Injury severity was comparable between patients who had mesh closure as prophylaxis for IAH (n=45) and those who had fascial suture (n=25).
IAH was seen in 10 (22.2%) in the mesh group versus 13 (52%) in the fascial suture group (p=0.012) for an overall incidence of 32.9%. Forty-two patients had pHi monitoring, and 11 of them had IAH.
Of the 11patients, eight patients (72.7%) had acidotic pHi (7.10± 0.2) with IAH without exhibiting the classic signs of ACS.
The pHi improved after abdominal decompression in six and none developed ACS.
Only two patients with IAH and low pHi went on to develop ACS, despite abdominal decompression.
Multiorgan dysfunction syndrome points and death were less in patients without IAH than those with IAH and in patients who had mesh closure.
IAH is frequent after major abdominal trauma. (...)
Mots-clés Pascal : Plaie pénétrante, Abdomen, Complication, Insuffisance organique multiple, Diagnostic, Homme, Epidémiologie, Prévalence, Prévention, Traitement, Traumatisme, Abdomen pathologie, Hypertension intraabdominale
Mots-clés Pascal anglais : Penetrating injury, Abdomen, Complication, Multiple organ failure, Diagnosis, Human, Epidemiology, Prevalence, Prevention, Treatment, Trauma, Abdominal disease
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Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 98-0322067
Code Inist : 002B16G. Création : 27/11/1998.