Incidence, Risk Factors, and Outcomes of Intra-Abdominal Hypertension in Critically Ill Patients-A Prospective Multicenter Study (IROI Study)

To identify the prevalence, risk factors, and outcomes of intra-abdominal hypertension in a mixed multicenter ICU population. Prospective observational study. Fifteen ICUs worldwide. Consecutive adult ICU patients with a bladder catheter. None. Four hundred ninety-one patients were included. Intra-abdominal pressure was measured a minimum of every 8 hours. Subjects with a mean intra-abdominal pressure equal to or greater than 12 mm Hg were defined as having intra-abdominal hypertension. Intra-abdominal hypertension was present in 34.0% of the patients on the day of ICU admission (159/467) and in 48.9% of the patients (240/491) during the observation period. The severity of intra-abdominal hypertension was as follows: grade I, 47.5%; grade II, 36.6%; grade III, 11.7%; and grade IV, 4.2%. The severity of intra-abdominal hypertension during the first 2 weeks of the ICU stay was identified as an independent predictor of 28-and 90-day mortality, whereas the presence of intra-abdominal hypertension on the day of ICU admission did not predict mortality. Body mass index, Acute Physiology and Chronic Health Evaluation II score greater than or equal to 18, presence of abdominal distension, absence of bowel sounds, and positive end-expiratory pressure greater than or equal to 7 cm H2O were independently associated with the development of intra-abdominal hypertension at any time during the observation period. In subjects without intra-abdominal hypertension on day 1, body mass index combined with daily positive fluid balance and positive end-expiratory pressure greater than or equal to 7 cm H2O (as documented on the day before intra-abdominal hypertension occurred) were-associated with the development of intraabdominal hypertension during the first week in the ICU. In our mixed ICU patient cohort, intra-abdominal hypertension occurred in almost half of all subjects and was twice as prevalent in mechanically ventilated patients as in spontaneously breathing patients. Presence and severity of intra-abdominal hypertension during the observation period significantly and independently increased 28-and 90-day mortality. Five admission day variables were independently associated with the presence or development of intra-abdominal hypertension. Positive fluid balance was associated with the development of intra-abdominal hypertension after day 1474535542NIGMS NIH HHSUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USANIH National Institute of General Medical Sciences (NIGMS) [U54 GM104940

Determining the Optimal Time of Gastric Emptying in Cats Using Dry or Wet Food

Background: Pulmonary aspiration of gastric content can result in intraoperative and postoperative complications, such as regurgitation, gastro-esophageal reflux and esophagitis. There are variations among authors about the ideal period of solid and liquid fasting. Determination of the appropriate amount of food abstinence in surgical patients is important, because of the metabolic disorders that interfere in response to anesthetic protocol or surgical intervention. Thereby, this research aimed to evaluate the appropriate period of fasting for elective anesthesia and surgical procedures in cats, by analysis of gastric emptying time based on the daily energy requirement.Materials, Methods & Results: Seven cats of mixed breed, health and with an average weight of 2.857 ± 0.3780 were evaluated by gastroscopy for the presence of food and obtaining tissue samples. To evaluate the gastric emptying time, dry and moist food were offered at two different times, 8 h and 4 h before each evaluation, with an interval of seven days between each food treatment (dry and moist). There was no significant difference in all biochemical parameters evaluated (cholesterol, glucose, and lactate) in both fasting times and food types (P > 0.05). All animals underwent gastric biopsy for histological evaluation and urease test, to discard morphological changes. After 4 h it was observed dry food in all cat’s stomach, however just five cats presented food in their stomach after eight hours. In other hand all the animals, which ate moist food, did not present any gastric content after four hours and eight hours of feeding. Gastric mucosa were considered normal in all cats with moderate amount of Helicobacter sp.Discussion: The difficulty of a consensus on the fast time in cats, and the great variability of the emptying time according to the feeding type, makes this study useful as basis for future studies on fasting with wet food, as well as providing immediate clinical application in surgical routine. Only a moderate gastritis related to helicobacter sp. was detected, but even healthy animals can carry Helicobacter sp.  Four h of fasting time if feed the patient with 80% humidity ration improve anesthetic security of the patient with typical biochemical values. As shown, the appropriate preoperative fasting directly implies on decrease in the number of complications related to full stomach. Thus, always should take into account the possibility to perform fast in an appropriate period to prevent vomiting and aspiration, without the risk of hypoglycemia benefiting the patient and reassuring the anesthesiologist, especially in situations requiring urgent or emergency intervention. As observed through endoscopy, even eight hours of fasting with dry feed is inappropriate due to significant gastric volume of food in almost all cats. This suggests that prolonged preoperative fasting is no guarantee of low stomach volume. Wet feed can be an option for elderly and debilitated patients requiring surgical intervention within a short period of fasting. The time varies with type and volume of food that is variable according patients and different species and digestive conditions. The research were conducted with none complications. By means, this experiment it was concluded that the fasting time of 4 h with 80% humidity moist food allows complete gastric emptying without any complication