tailieunhanh - Báo cáo y học: "Prophylactic open abdomen in patients with postoperative intra-abdominal hypertensio"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học quốc tế cung cấp cho các bạn kiến thức về ngành y đề tài: Prophylactic open abdomen in patients with postoperative intra-abdominal hypertension. | Mentula and Leppăniemi Critical Care 2010 14 111 http content 14 1 111 CRITICAL CARE COMMENTARY L__ Prophylactic open abdomen in patients with postoperative intra-abdominal hypertension Panu Mentula and Ari Leppaniemi See related research by Batacchi etal. http content 13 6 R194 Abstract Postoperative intra-abdominal hypertension IAH is a frequent occurrence in critically ill patients operated on for severe abdominal trauma secondary peritonitis or ruptured abdominal aortic aneurysm. IAH may progress to abdominal compartment syndrome ACS with new-onset organ dysfunction. Early recognition of IAH and interventions that prevent the development of ACS may preserve vital organ functions and increase the probability of survival. The best method to prevent postoperative ACS is to leave the abdomen open during the operation. The decision to leave the abdomen open is usually based on the surgeon s judgment without intra-abdominal pressure IAP measurements during the operation. Because significant morbidity and mortality are associated with the open abdomen the measurement of IAP immediately after the fascial closure when feasible could offer an objective method for determining the optimal IAP threshold for leaving the abdomen open. The management of the open abdomen requires a temporary abdominal closure TAC system that would ideally prevent the development of ACS and facilitate later primary fascia closure. Among several TAC systems the most promising are those that provide negative pressure to the wound or continuous fascial traction or both. A considerable number of patients with surgical emergencies may develop visceral or retroperitoneal oedema due to severe inflammation shock and fluid resuscitation. This oedema may prevent primary closure of the abdomen or may lead to dangerously high intra-abdominal Correspondence Department of Gastroenterological Surgery Helsinki University Central Hospital PL 340 00029 HUS .