Feasibility Metrics
| Population | n |
|---|---|
| Patients meeting inclusion criteria | 114 |
| Exclusion criteria -- death prior to assessment | 5 |
| Pregnancy | 0 |
| Expected ICU discharge less than 24 hrs. | 8 |
| Organ donors | 0 |
| Clinical team or SDM declined to enroll | 13 |
| Enrolled by deferred consent but subsequently declined | 2 |
| No SDM available within the time constraint | 18 |
| Total number enrolled | 70 |
Medical management algorithm for management of IAH/ACS, adapted from World Society for the Abdominal Compartment Syndrome
| Step Number / Action | Evacuate gastrointestinal intraluminal contents | Evacuate intra-abdominal space-occupying lesions/collections | Improve abdominal wall compliance | Optimize fluid administration | Optimize systemic/regional perfusion |
|---|---|---|---|---|---|
| Step 1 | Insert nasogastric and/or rectal tube | Abdominal ultrasound to identify lesions | Ensure adequate sedation and analgesia | Avoid excessive fluid resuscitation | Goal-directed fluid resuscitation |
| Initiate prokinetic agents | Remove constrictive dressings, abdominal eschars | Aim for zero to negative fluid balance by day 3 | |||
| Step 2 | Minimize enteral nutrition | Abdominal computed tomography to identify lesions Percutaneous catheter drainage | Consider reverse Trendelenberg position | Resuscitate using hypertonic fluids, colloids Fluid removal through judicious diuresis once stable | Hemodynamic monitoring to guide resuscitation |
| Administer enemas | |||||
| Step 3 | Consider colonoscopic decompression | Consider surgical evacuation | Consider neuromuscular blockade | Consider hemodialysis/ultrafiltration | |
| Discontinue enteral nutrition | |||||
| Step 4 | If intraabdominal pressure greater than 20 mm Hg and new organ dysfunction/failure is present, patient's IAH/ACS is refractory to medical management. Strongly consider surgical abdominal decompression. | ||||
Prevalence of IAH, ACS, and incomplete IAP measurements
| Descriptor | Total | Observation period | Intervention period |
|---|---|---|---|
| IAH: IAP ≥ 12 mm Hg on two consecutive measurements (N (%)) | 21 (16.2 ) | 11 (8.5 ) | 10 (7.8 ) |
| IAP ≥ 12 mm Hg on any two measurements (N (%)) | 32 (24.8) | 13 (22.0) | 19 (27.1) |
| IAP ≥ 20 mm Hg on any two measurements (N (%)) | 1 (0.8) | 0 (0.0) | 1 (1.4) |
| Patients who did not have IAP measured twice (N (%)) | 53 (41.1) | 19 (32.2) | 34 (48.6) |
Patient demographics and clinical characteristics
| Descriptor | Total | Observation period | Intervention period | p-value |
|---|---|---|---|---|
| N | 129 | 59 | 70 | |
| Male, N (%) | 76 (58.8) | 33 (55.9) | 43 (61.4) | 0.592 |
| Age, mean ± s.d., years | 61.6 ± 14.5 | 60.6 ± 15.4 | 62.7 ± 13.7 | 0.672 |
| Indication for admission, N (%) | 0.542 | |||
| Medical | 90 (69.8) | 44 (74.6) | 46 (65.7) | |
| Surgical | 15 (11.6) | 6 (10.2) | 9 (12.9) | |
| Trauma | 24 (18.6) | 9 (15.3) | 15 (21.4) | |
| MODS, mean ± s.d. | 4.8 ± 2.8 | 4.1 ± 2.3 | 5.5 ± 2.9 | 0.003 |