The American surgeon
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The American surgeon · Jul 2011
Comparative StudyPredictors and outcomes of prolonged ventilation after coronary artery bypass graft surgery.
This study investigated and compared the risk factors and outcomes of patients undergoing coronary artery bypass graft surgery with and without the occurrence of prolonged mechanical ventilation. Data in a cardiac surgery database were examined retrospectively. Data selected included any isolated coronary artery bypass graft surgery performed by the surgical group from August 2005 to June 2009. ⋯ Patients undergoing coronary artery bypass graft that experienced a prolonged ventilation time (cases) were more likely female, had a New York Hospital Association functional class of III or IV, and had a longer perfusion time. There was no significant difference between cases and controls with diabetes, chronic obstructive pulmonary disease, left ventricular ejection fraction, or body mass index while controlling for all significant risk factors. Careful patient selection and preparation during preoperative evaluation may help identify patients at risk for prolonged mechanical ventilation and thus help prevent the added morbidity and mortality associated with it.
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The American surgeon · Jul 2011
ReviewResuscitation in intra-abdominal hypertension and abdominal compartment syndrome.
Resuscitation and the development of abdominal compartment syndrome (ACS) are closely associated and frequently overlapping critical care topics. Elevated intra-abdominal pressure (IAP) can cause major deterioration of cardiac function by affecting preload, contractility, and afterload. ⋯ Excessive or overzealous resuscitation in an attempt to restore perfusion and correct these organ dysfunctions and failures can worsen elevated IAP and increase the risk of ACS. The aim of this review is to discuss these multilevel interactions between resuscitation and ACS identifying appropriate resuscitative strategies for the patient with elevated IAP.
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The American surgeon · Jul 2011
ReviewIntra-abdominal hypertension and abdominal compartment syndrome in nontrauma surgical patients.
Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are commonly encountered in nontrauma surgical patients. Depending on the etiology of the patient's surgical illness (ruptured abdominal aortic aneurysm, acute pancreatitis, burns, etc.), both the incidence and mortality of IAH/ACS may be quite high. Recent advances in both the diagnosis and resuscitation of these surgical patients have resulted in significantly improved survival over that seen in years past. Intra-abdominal pressure measurements should be performed in any surgical patient who demonstrates risk factors for IAH/ACS.
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The American surgeon · Jul 2011
ReviewPatient populations at risk for intra-abdominal hypertension and abdominal compartment syndrome.
Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are critical care conditions with significant morbidity and mortality. The surgical measure to treat ACS (decompressive laparotomy) is hazardous and results in an open abdomen with potential major complications such as fistulas, abscesses, and large ventral hernias. ⋯ Knowledge of the patient populations at high risk for developing IAH/ACS is crucial. The aim of this review is to discuss the high-risk populations for acute IAH/ACS among surgical patients.
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The American surgeon · Jul 2011
ReviewIntra-abdominal measurement techniques: is there anything new?
Intra-abdominal pressure (IAP) measurements are essential to the diagnosis and management of intra-abdominal hypertension (IAH) and abdominal compartment syndrome. A variety of IAP measurement techniques have been described. The intravesicular or "bladder" technique remains the gold standard. ⋯ Putting patients in the semirecumbent position changes the IAP measurement significantly. The role of prone positioning in unstable patients with IAH remains unclear. PEEP has a small effect on IAP.