| Defining intra-abdominal hypertension and abdominal compartment syndrome in acute thermal injury: a multicenter survey. | |
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MedLine Citation:
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PMID: 18535480 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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The definitions of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are not uniform despite the increasing awareness of IAH/ACS in burn patients. A short survey including definitions, resuscitation protocols, and monitoring practices was sent to every physician listed in the American Burn Association Directory. Thirty-two of 123 (26%) surveys were returned; 22 (69%) were from verified burn centers. Survey respondents said that bladder pressure indicating IAH is 19.6 mm Hg (range 12-30) and ACS is 25.9 mm Hg (range 15-40). Fifteen percentage of those responding do not include clinical sequellae in their definition of ACS. Bladder pressure is not routinely measured by 22 (69%) burn physicians, and staff at 17 centers (53%) wait until the abdomen is tense to measure abdominal pressure. Tense abdomen, along with elevated peak inspiratory pressures (PIP), is used in most centers (94%) to determine IAH/ACS, followed by oliguria (88%), and difficulty ventilating (78%). Resuscitation formulae used are primarily the Parkland/modified Parkland in 24 (75%) burn centers. Criteria for abdominal decompression is based on bladder pressures alone in 25 centers (78%); 16/32 (50%) use PIP, and 10/32 (31%) staff use other criteria including organ dysfunction or increased lactate. Eleven physicians (34%) advocate percutaneous decompression before decompressive laparotomy. Although most United States burn physicians define ACS as >or=25 mm Hg along with physiologic compromise, bladder pressure is routinely measured by only 31% of burn physicians. Most burn staff do not differentiate between IAH and ACS. Consensus definitions of IAH/ACS are necessary for burn care practitioners to compare research studies and discuss outcomes. Concise definitions will promote understanding of the pathophysiological processes involved and allow us to develop data-driven patient care protocols. |
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Authors:
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Bridget A Burke; Barbara A Latenser |
Publication Detail:
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Type: Journal Article; Multicenter Study |
Journal Detail:
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Title: Journal of burn care & research : official publication of the American Burn Association Volume: 29 ISSN: 1559-047X ISO Abbreviation: - Publication Date: 2008 Jul-Aug |
Date Detail:
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Created Date: 2008-08-18 Completed Date: 2008-11-18 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101262774 Medline TA: J Burn Care Res Country: United States |
Other Details:
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Languages: eng Pagination: 580-4 Citation Subset: IM |
Affiliation:
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Division of Burns, Trauma, and Critical Care, Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52240, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Abdomen
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blood supply,
physiopathology*,
surgery Blood Component Transfusion / utilization Burn Units Burns / physiopathology*, therapy* Compartment Syndromes / diagnosis*, physiopathology, therapy Decompression, Surgical Enteral Nutrition / utilization Fluid Therapy / methods Heart Failure / physiopathology Humans Lactic Acid / blood Obesity / complications Oliguria / physiopathology Physician's Practice Patterns / statistics & numerical data* Questionnaires Respiration, Artificial Respiratory Insufficiency / physiopathology United States Urinary Bladder / physiopathology Work of Breathing / physiology |
| Chemical | |
Reg. No./Substance:
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50-21-5/Lactic Acid |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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