patients with an iap >25mmhg need abdominal decompression michael sugrue
TRANSCRIPT
![Page 1: Patients with an IAP >25mmHg need abdominal decompression Michael Sugrue](https://reader036.vdocuments.us/reader036/viewer/2022062312/55204d6149795902118b4d1e/html5/thumbnails/1.jpg)
Patients with an IAP >25mmHg need abdominal
decompression
Michael Sugrue
![Page 2: Patients with an IAP >25mmHg need abdominal decompression Michael Sugrue](https://reader036.vdocuments.us/reader036/viewer/2022062312/55204d6149795902118b4d1e/html5/thumbnails/2.jpg)
IAP > 25mmHgOccurs in 8% of ICU population
Sugrue Arch Surg 1999
![Page 3: Patients with an IAP >25mmHg need abdominal decompression Michael Sugrue](https://reader036.vdocuments.us/reader036/viewer/2022062312/55204d6149795902118b4d1e/html5/thumbnails/3.jpg)
Prevalence of IAP >25mmHg
0
10
20
30
40
50
60
70
IAP< 18 IAP18-25 IAP >25
Sugrue et al Arch Surg 1999
![Page 4: Patients with an IAP >25mmHg need abdominal decompression Michael Sugrue](https://reader036.vdocuments.us/reader036/viewer/2022062312/55204d6149795902118b4d1e/html5/thumbnails/4.jpg)
Is IAP the Key?
![Page 5: Patients with an IAP >25mmHg need abdominal decompression Michael Sugrue](https://reader036.vdocuments.us/reader036/viewer/2022062312/55204d6149795902118b4d1e/html5/thumbnails/5.jpg)
ROC curve analysis of predictors of survival from IAH
Sensitivity
1- Specificity
0 1.0
1.0
Cheatham et al J Trauma 00
![Page 6: Patients with an IAP >25mmHg need abdominal decompression Michael Sugrue](https://reader036.vdocuments.us/reader036/viewer/2022062312/55204d6149795902118b4d1e/html5/thumbnails/6.jpg)
Heinricius Bern 1890
Ueber den einfluss der bauchfulling auf circulation und respiration Z Biol
![Page 7: Patients with an IAP >25mmHg need abdominal decompression Michael Sugrue](https://reader036.vdocuments.us/reader036/viewer/2022062312/55204d6149795902118b4d1e/html5/thumbnails/7.jpg)
Abdominal Pressure Volume Curve
0
2
4
6
8
10
12
14
16
18
20
1 2 3 4 5 6
IAP
mmHg
Litres Sugrue et al Inten Care Med 94
![Page 8: Patients with an IAP >25mmHg need abdominal decompression Michael Sugrue](https://reader036.vdocuments.us/reader036/viewer/2022062312/55204d6149795902118b4d1e/html5/thumbnails/8.jpg)
Paediatric Surgeons
![Page 9: Patients with an IAP >25mmHg need abdominal decompression Michael Sugrue](https://reader036.vdocuments.us/reader036/viewer/2022062312/55204d6149795902118b4d1e/html5/thumbnails/9.jpg)
![Page 10: Patients with an IAP >25mmHg need abdominal decompression Michael Sugrue](https://reader036.vdocuments.us/reader036/viewer/2022062312/55204d6149795902118b4d1e/html5/thumbnails/10.jpg)
time
0h 6h 12h 18h 24h
100
200
300
400 15mmHg 30mmHg control
*
ANOVA p< 0.05 *: T-test p<0.05 *: T-test p<0.05
Alk Phos and IAPAlk Phos and IAP
![Page 11: Patients with an IAP >25mmHg need abdominal decompression Michael Sugrue](https://reader036.vdocuments.us/reader036/viewer/2022062312/55204d6149795902118b4d1e/html5/thumbnails/11.jpg)
Histological changes after 4 hrsHistological changes after 4 hrs
Liver
Control 30mmHg
![Page 12: Patients with an IAP >25mmHg need abdominal decompression Michael Sugrue](https://reader036.vdocuments.us/reader036/viewer/2022062312/55204d6149795902118b4d1e/html5/thumbnails/12.jpg)
Study of compartment pressure on cardiac output
Kitano JAP 1999
0
200
400
600
800
1000
1200
base 8 15 30 40 50
IAP
C.O
.
![Page 13: Patients with an IAP >25mmHg need abdominal decompression Michael Sugrue](https://reader036.vdocuments.us/reader036/viewer/2022062312/55204d6149795902118b4d1e/html5/thumbnails/13.jpg)
Evidence Authors n Improved Survived
organ function %
Burrows 4 100 75Ertel 17 100 59Fietsam 4 100 25Ivatury 23 71 65Kron 11 100 71Kopelman 6 83 17Morris 16 80 40Sugrue49 20 61
![Page 14: Patients with an IAP >25mmHg need abdominal decompression Michael Sugrue](https://reader036.vdocuments.us/reader036/viewer/2022062312/55204d6149795902118b4d1e/html5/thumbnails/14.jpg)
Evidence Authors n Improved Survived
organ function %
Burrows 4 100 75Ertel 17 100 59Fietsam 4 100 25Ivatury 23 71 65Kron 11 100 71Kopelman 6 83 17Morris 16 80 40Sugrue49 20 61
![Page 15: Patients with an IAP >25mmHg need abdominal decompression Michael Sugrue](https://reader036.vdocuments.us/reader036/viewer/2022062312/55204d6149795902118b4d1e/html5/thumbnails/15.jpg)
When IAP > 25mmHg
Too LATE
![Page 16: Patients with an IAP >25mmHg need abdominal decompression Michael Sugrue](https://reader036.vdocuments.us/reader036/viewer/2022062312/55204d6149795902118b4d1e/html5/thumbnails/16.jpg)
Get Real