Anaesthesiology intensive therapy
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Anaesthesiol Intensive Ther · Jan 2015
ReviewMethodological background and strategy for the 2012-2013 updated consensus definitions and clinical practice guidelines from the abdominal compartment society.
The Abdominal Compartment Society (www.wsacs.org) previously created highly cited Consensus Definitions/Management Guidelines related to intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS). Implicit in this previous work, was a commitment to regularly reassess and update in relation to evolving research. Two years preceding the Fifth World Congress on Abdominal Compartment Syndrome, an International Guidelines committee began preparation. ⋯ No recommendations were made for the use of diuretics, albumin, renal replacement therapies, and utilizing abdominal perfusion pressure as a resuscitation-endpoint. Collaborating Methodological Guideline Development and Clinical Experts produced Consensus Definitions/Clinical Management statements encompassing the most contemporary evidence. Data summaries now exist for clinically relevant IAH/ACS questions, which will facilitate future scientific reanalysis.
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Anaesthesiol Intensive Ther · Jan 2015
ReviewIntra-abdominal hypertension and abdominal compartment syndrome in pancreatitis, paediatrics, and trauma.
Intra-abdominal hypertension (IAH) is an important contributor to early organ dysfunction among patients with trauma and sepsis. However, the impact of increased intra-abdominal pressure (IAP) among pediatric, pregnant, non-septic medical patients, and those with severe acute pancreatitis (SAP), obesity, and burns has been studied less extensively. The aim of this review is to outline the pathophysiologic implications and treatment options for IAH and abdominal compartment syndrome (ACS) for the above patient populations. ⋯ Patients at risk for IAH should be identified early during their treatment (with a low threshold to initiate IAP monitoring). Appropriate actions should be taken when IAP increases above 20 mm Hg, especially in patients developing difficulty with ventilation. Although on-operative measures should be instituted first, one should not hesitate to resort to surgical decompression if they fail.
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Anaesthesiol Intensive Ther · Jan 2015
ReviewUltrasound guided axillary brachial plexus plexus block. Part 2 - technical issues.
Axillary brachial plexus block is one of the most frequently employed peripheral blocks. The popularity of axillary block stems from its success as a safe and relatively easy technique with numerous applications. The technique of axillary block has evolved. ⋯ Axillary block under US-guidance can be performed using a traditional perivascular method and by placing a selective blockade of individual nerves that supply the surgical area. Regardless of the selected method, it enables the incorporation of individual patient anatomical variation in an anaesthesia plan. This paper discusses the technical details and efficacy issues of US-guided axillary brachial plexus block techniques.
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Anaesthesiol Intensive Ther · Jan 2015
ReviewWhat's new in medical management strategies for raised intra-abdominal pressure: evacuating intra-abdominal contents, improving abdominal wall compliance, pharmacotherapy, and continuous negative extra-abdominal pressure.
In the future, medical management may play an increasingly important role in the prevention and management of intra-abdominal hypertension (IAH). A review of different databases was used (PubMed, MEDLINE and EMBASE) with the search terms 'Intra-abdominal Pressure' (IAP), 'IAH', ' Abdominal Compartment Syndrome' (ACS), 'medical management' and 'non-surgical management'. We also reviewed all papers with the search terms 'IAH', 'IAP' and 'ACS' over the last three years, only extracting those papers which showed a novel approach in the non-surgical management of IAH and ACS. ⋯ Many treatment options are available and are often part of routine daily management in the ICU (nasogastric, rectal tube, prokinetics, enema, sedation, body position). Some of the newer treatments are very promising options in specific patient populations with raised IAP. Future studies are warranted to confirm some of these findings.
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Anaesthesiol Intensive Ther · Jan 2015
ReviewMust hypervolaemia be avoided? A critique of the evidence.
Anaesthetists are cautioned to avoid hypervolaemia in their patients. The most cited reason is that hypervolaemia elicits the release of atrial natriuretic peptides that damage the endothelial glycocalyx layer. Although shedding of the glycocalyx causes extravasation of protein in inflammatory disorders, it is more uncertain whether hypervolaemia alone is enough to cause clinically important shedding. ⋯ A re-calculation based on theoretical ICG data, taking account of the transit time, shows the plasma volume expansion was closer to 100% than to 40% of the infused volume. This figure is supported by the dilution of the reported blood haemoglobin and plasma protein concentrations, as well as by other sources. In conclusion, only weak evidence supports a fluid-induced release of atrial peptides of sufficient size to alter the kinetics of colloid fluid by shedding of the endothelial glycocalyx layer.