FACE TO FACE AGAIN - REPORT FROM THE DOCTORAL SYMPOSIUM IN ENGINEERING EDUCATION RESEARCH AT SEFI 2022

The 6th Doctoral Symposium at SEFI 2022 attracted 20 doctoral students and 17 senior researchers. After two years as an online event during the pandemic, it was organised as a fully in-person event. In preparation, the doctoral students wrote extended abstracts to introduce themselves and their PhD projects, while the seniorsprovided reading recommendations and advice. The intense, full-day program was based on group discussions and interactive plenary sessions. The Doctoral Symposium was concluded by a session in which each participant presented their take-home message. This paper outlines how the Doctoral Symposium was organised and summarizes some of the documentation

Awareness and knowledge of intra-abdominal hypertension and abdominal compartment syndrome: results of an international survey

Background: Surveys have demonstrated a lack of physician awareness of intra-abdominal hypertension and abdominal compartment syndrome (IAH/ACS) and wide variations in the management of these conditions, with many intensive care units (ICUs) reporting that they do not measure intra-abdominal pressure (IAP). We sought to determine the association between publication of the 2006/2007 World Society of the Abdominal Compartment Syndrome (WSACS) Consensus Definitions and Guidelines and IAH/ACS clinical awareness and management. Methods: The WSACS Executive Committee created an interactive online survey with 53 questions, accessible from November 2006 until December 2008. The survey was endorsed by the WSACS, the European Society of Intensive Care Medicine (ESICM) and the Society of Critical Care Medicine (SCCM). A link to the survey was emailed to all members of the supporting societies. Participants of the 3rd World Congress on Abdominal Compartment Syndrome meeting (March 2007, Antwerp, Belgium) were also asked to complete the questionnaire. No reminders were sent. Based on 13 knowledge questions, an overall score was calculated (expressed as percentage). Results: A total of 2,244 of the approximately 10,000 clinicians who were sent the survey responded (response rate: 22.4%). Most of the 2,244 respondents (79.2%) completing the survey were physicians or physicians in training and the majority were residing in North America (53.0%). The majority of responders (85%) were familiar with IAP/IAH/ACS, but only 28% were aware of the WSACS consensus definitions for IAH/ACS. Three quarters of respondents considered the cut-off for IAH to be at least 15 mm Hg, and nearly two thirds believed the cut-off for ACS was higher than the currently suggested consensus definition (20 mm Hg). In 67.8% of respondents, organ dysfunction was only considered a problem with IAP of 20 mm Hg or higher. IAP was measured most frequently via the bladder (91.9%), but the majority reported that they instilled volumes well above the current guidelines. Surgical decompression was frequently used to treat IAH/ACS, whereas medical management was only attempted by about half of the respondents. Decisions to decompress the abdomen were predominantly based on the severity of IAP elevation and presence of organ dysfunction (74.4%). Overall knowledge scores were low (43 +/- 15%); respondents who were aware of the WSACS had a better score compared to those who were not (49.6% vs 38.6%, P < 0.001). Conclusions: This survey showed that although most responding clinicians claim to be familiar with IAH and ACS, knowledge of published consensus definitions, measurement techniques, and clinical management is inadequate

Intra-abdominal hypertension and abdominal compartment syndrome in pancreatitis, paediatrics, and trauma

Intra-abdominal hypertension (IAH) is an important contributor to early organ dysfunction in trauma and sepsis. However, relatively little is known about the impact of intra-abdominal pressure (IAP) in general internal medicine, pregnant patients, and those with obesity or burns. The aim of this paper is to review the pathophysiologic implications and treatment options for IAH in these specific situations. A MEDLINE and PubMed search was performed and the resulting body-of-evidence included in the current review on the basis of relevance and scientific merit. There is increasing awareness of the role of IAH in different clinical situations. Specifically, IAH will develop in most (if not all) severely burned patients, and may contribute to early mortality. One should avoid over-resuscitation of these patients with large volumes of fluids, especially crystalloids. Acute elevations in IAP have similar effects in obese patients compared to non-obese patients, but the threshold IAP associated with organ dysfunction may be higher. Chronic elevations in IAP may, in part, be responsible for the pathogenesis of obesity-related co-morbid conditions such as hypertension, pseudotumor cerebri, pulmonary dysfunction, gastroesophageal reflux disease, and abdominal wall hernias. At the bedside, measuring IAP and considering IAH in all critical maternal conditions is essential, especially in preeclampsia/eclampsia where some have hypothesized that IAH may have an additional role. IAH in pregnancy must take into account the precautions for aorto-caval compression and has been associated with ovarian hyperstimulation syndrome. Recently, IAP has been associated with the cardiorenal dilemma and hepatorenal syndrome, and this has led to the recognition of the polycompartment syndrome. In conclusion, IAH and ACS have been associated with several patient populations beyond the classical ICU, surgical, and trauma patients. In all at risk conditions the focus should be on the early recognition of IAH and prevention of ACS. Patients at risk for IAH should be identified early through measurements of IAP. Appropriate actions should be taken when IAP increases above 15 mm Hg, especially if pressures reach above 20 mm Hg with new onset organ failure. Although non-operative measures come first, surgical decompression must not be delayed if these fail. Percutaneous drainage of ascites is a simple and potentially effective tool to reduce IAP if organ dysfunction develops, especially in burn patients. Escharotomy may also dramatically reduce IAP in the case of abdominal burns

A clinician’s guide to management of intra-abdominal hypertension and abdominal compartment syndrome in critically ill patients

This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2020. Other selected articles can be found online at . Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901

Climate, people, fire and vegetation: new insights into vegetation dynamics in the Eastern Mediterranean since the 1st century AD

Anatolia forms a bridge between Europe, Africa and Asia and is influenced by all three continents in terms of climate, vegetation and human civilisation. Unfortunately, well-dated palynological records focussing on the period from the end of the classical Roman period until subrecent times are rare for Anatolia and completely absent for southwest Turkey, resulting in a lacuna in knowledge concerning the interactions of climatic change, human impact, and environmental change in this important region. Two well-dated palaeoecological records from the Western Taurus Mountains, Turkey, provide a first relatively detailed record of vegetation dynamics from late Roman times until the present in SW Turkey. Combining pollen, non-pollen palynomorphs, charcoal, sedimentological, archaeological data, and newly developed multivariate numerical analyses allows for the disentangling of climatic and anthropogenic influences on vegetation change. Results show changes in both the regional pollen signal as well as local soil sediment characteristics match shifts in regional climatic conditions. Both climatic as well as anthropogenic change had a strong influence on vegetation dynamics and land use. A moist environmental trend during the late-3rd century caused an increase in marshes and wetlands in the moister valley floors, limiting possibilities for intensive crop cultivation at such locations. A mid-7th century shift to pastoralism coincided with a climatic deterioration as well as the start of Arab incursions into the region, the former driving the way in which the vegetation developed afterwards. Resurgence in agriculture was observed in the study during the mid-10th century AD, coinciding with the Medieval Climate Anomaly. An abrupt mid-12th century decrease in agriculture is linked to socio-political change, rather than the onset of the Little Ice Age. Similarly, gradual deforestation occurring from the 16th century onwards has been linked to changes in land use during Ottoman times. The pollen data reveal that a fast rise in <i>Pinus</i> pollen after the end of the Beyşehir Occupation Phase need not always occur. The notion of high <i>Pinus</i> pollen percentages indicating an open landscape incapable of countering the influx of pine pollen is also deemed unrealistic. While multiple fires occurred in the region through time, extended fire periods, as had occurred during the Bronze Age and Beyşehir Occupation Phase, did not occur, and no signs of local fire activity were observed. Fires were never a major influence on vegetation dynamics. While no complete overview of post-BO Phase fire events can be presented, the available data indicates that fires in the vicinity of Gravgaz may have been linked to anthropogenic activity in the wider surroundings of the marsh. Fires in the vicinity of Bereket appeared to be linked to increased abundance of pine forests. There was no link with specifically wet or dry environmental conditions at either site. While this study reveals much new information concerning the impact of climate change and human occupation on the environment, more studies from SW Turkey are required in order to properly quantify the range of the observed phenomena and the magnitude of their impacts

Intra-abdominal hypertension and abdominal compartment syndrome in burns, obesity, pregnancy, and general medicine

Intra-abdominal hypertension (IAH) is an important contributor to early organ dysfunction in trauma and sepsis. However, relatively little is known about the impact of intra-abdominal pressure (IAP) in general internal medicine, pregnant patients, and those with obesity or burns. The aim of this paper is to review the pathophysiologic implications and treatment options for IAH in these specific situations. A MEDLINE and PubMed search was performed and the resulting body-of-evidence included in the current review on the basis of relevance and scientific merit. There is increasing awareness of the role of IAH in different clinical situations. Specifically, IAH will develop in most (if not all) severely burned patients, and may contribute to early mortality. One should avoid over-resuscitation of these patients with large volumes of fluids, especially crystalloids. Acute elevations in IAP have similar effects in obese patients compared to non-obese patients, but the threshold IAP associated with organ dysfunction may be higher. Chronic elevations in IAP may, in part, be responsible for the pathogenesis of obesity-related co-morbid conditions such as hypertension, pseudotumor cerebri, pulmonary dysfunction, gastroesophageal reflux disease, and abdominal wall hernias. At the bedside, measuring IAP and considering IAH in all critical maternal conditions is essential, especially in preeclampsia/eclampsia where some have hypothesized that IAH may have an additional role. IAH in pregnancy must take into account the precautions for aorto-caval compression and has been associated with ovarian hyperstimulation syndrome. Recently, IAP has been associated with the cardiorenal dilemma and hepatorenal syndrome, and this has led to the recognition of the polycompartment syndrome. In conclusion, IAH and ACS have been associated with several patient populations beyond the classical ICU, surgical, and trauma patients. In all at risk conditions the focus should be on the early recognition of IAH and prevention of ACS. Patients at risk for IAH should be identified early through measurements of IAP. Appropriate actions should be taken when IAP increases above 15 mm Hg, especially if pressures reach above 20 mm Hg with new onset organ failure. Although non-operative measures come first, surgical decompression must not be delayed if these fail. Percutaneous drainage of ascites is a simple and potentially effective tool to reduce IAP if organ dysfunction develops, especially in burn patients. Escharotomy may also dramatically reduce IAP in the case of abdominal burns

Validation of less-invasive hemodynamic monitoring with Pulsioflex in critically ill patients

status: publishe