Recognition and management of abdominal compartment syndrome among German anesthetists and surgeons: a national survey

Kaussen Torsten, Otto Jens, Steinau Gerd, Höer Jörg, Srinivasan Pramod, Schachtrupp, Schachtrupp Alexander

Description

Abdominal compartment syndrome (ACS) is a life threatening condition that may affect any critically ill patient. Little is known about the recognition and management of ACS in Germany. Methods A questionnaire was mailed to departments of surgery and anesthesia from German hospitals with more than 450 beds. Results Replies (113) were received from 222 eligible hospitals (51%). Most respondents (95%) indicated that ACS plays a role in their clinical practice. Intra-abdominal pressure (IAP) is not measured at all by 26%, while it is routinely done by 30%. IAP is mostly (94%) assessed via the intra-vesical route. Of the respondents, 41% only measure IAP in patients expected to develop ACS; 64% states that a simpler, more standardized application of IAP measurement would lead to increased use in daily clinical practice. Conclusions German anesthesiologists and surgeons are familiar with ACS. However, approximately one fourth never measures IAP, and there is considerable uncertainty regarding which patients are at risk as well as how often IAP should be measured in them.

Sujets

• Abdominal compartment syndrome
• Intensive care unit
• Survey
• Questionnaire

Informations

• Publié par: biomed
• Publié le: 01 janvier 2012
• Nombre de lectures: 5
• Langue: English

Extrait

Kaussen et al . Annals of Intensive Care 2012, 2 (Suppl 1):S7 http://www.annalsofintensivecare.com/content/2/S1/S7

R E S E A R C H

Open Access

Recognition and management of abdominal compartment syndrome among German anesthetists and surgeons: a national survey Torsten Kaussen 1* † , Jens Otto 2 † , Gerd Steinau 2 , Jörg Höer 3 , Pramod Kadaba Srinivasan 4 , Alexander Schachtrupp 2

Abstract Background: Abdominal compartment syndrome (ACS) is a life threatening condition that may affect any critically ill patient. Little is known about the recognition and management of ACS in Germany. Methods: A questionnaire was mailed to departments of surgery and anesthesia from German hospitals with more than 450 beds. Results: Replies (113) were received from 222 eligible hospitals (51%). Most respondents (95%) indicated that ACS plays a role in their clinical practice. Intra-abdominal pressure (IAP) is not measured at all by 26%, while it is routinely done by 30%. IAP is mostly (94%) assessed via the intra-vesical route. Of the respondents, 41% only measure IAP in patients expected to develop ACS; 64% states that a simpler, more standardized application of IAP measurement would lead to increased use in daily clinical practice. Conclusions: German anesthesiologists and surgeons are familiar with ACS. However, approximately one fourth never measures IAP, and there is considerable uncertainty regarding which patients are at risk as well as how often IAP should be measured in them.

Introduction regarding the indication fo r IAP measurement and its Abdominal compartment syndrome (ACS) is defined as  timing [4]. Moreover, the threshold for decompression a persistent intra-abdomin al pressure (IAP) of more  is still a matter of debate, as prospective randomized than 20 mmHg accompanied by new organ dysfunction trials are missing [1,10]. or failure. Left untreated, this condition has a high mor-  Whether a similar level of uncertainty concerning the tality rate [1-6]. Intra-abdominal hypertension (IAH) is recognition and management of ACS exists in Germany, defined by a sustained or repeated pathological elevation and whether this may be related to the techniques avail- of IAP to more than 12 mmHg and is considered a pre-  able in clinical routine is unknown. We also speculate that cursor of ACS [1]. Both IAH and ACS may occur in any a simple, more standardized technique might help patient population requiring intensive care [7,8].  improve monitoring of IAP. As comparable studies have According to surveys in Canada, Great Britain,  yet to be published, we performed this one using a Australasia, Belgium, China and the USA, detection and questionnaire. management of IAH and ACS are inconsistent [2,4,9-16]. Familiarity with the devastating consequences Methods of increased IAP is abundant; however, the relevance of  In 2006, a questionnaire (see Additional file 1) was sent to ACS in routine care varies. There is no agreement the head physicians of departments of surgery and anesthe- sia in hospitals with more than 450 beds in Germany. This * Correspondence: [e-mail] 450-bed threshold was chosen because hospitals of this † Contributed equally size are frequently teaching hospitals and serve as referral 1 Department of Pediatric Cardiology and Intensive Care, University Children ’ s centers for smaller hospitals w ith elective or out-patient 3 H 0 o 6 s 2 p 5 ita H l, an H n a o n v n e o r v , e G r er M m ed a i n c y alSchool(MHH),OE6730,Carl-NeubergSt.1, surgery. Full list of author information is available at the end of the article © 2012 Kaussen et al.; licensee Springer This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.