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

Intra-abdominal hypertension in patients with severe acute pancreatitis

INTRODUCTION: Abdominal compartment syndrome has been described in patients with severe acute pancreatitis, but its clinical impact remains unclear. We therefore studied patient factors associated with the development of intra-abdominal hypertension (IAH), the incidence of organ failure associated with IAH, and the effect on outcome in patients with severe acute pancreatitis (SAP). METHODS: We studied all patients admitted to the intensive care unit (ICU) because of SAP in a 4 year period. The incidence of IAH (defined as intra-abdominal pressure ≥ 15 mmHg) was recorded. The occurrence of organ dysfunction during ICU stay was recorded, as was the length of stay in the ICU and outcome. RESULTS: The analysis included 44 patients, and IAP measurements were obtained from 27 patients. IAH was found in 21 patients (78%). The maximum IAP in these patients averaged 27 mmHg. APACHE II and Ranson scores on admission were higher in patients who developed IAH. The incidence of organ dysfunction was high in patients with IAH: respiratory failure 95%, cardiovascular failure 91%, and renal failure 86%. Mortality in the patients with IAH was not significantly higher compared to patients without IAH (38% versus 16%, p = 0.63), but patients with IAH stayed significantly longer in the ICU and in the hospital. Four patients underwent abdominal decompression because of abdominal compartment syndrome, three of whom died in the early postoperative course. CONCLUSION: IAH is a frequent finding in patients admitted to the ICU because of SAP, and is associated with a high occurrence rate of organ dysfunction. Mortality is high in patients with IAH, and because the direct causal relationship between IAH and organ dysfunction is not proven in patients with SAP, surgical decompression should not routinely be performed

Screening of Banana Hybrids for Resistance to Pratylenchus coffeae

The reaction of twenty-four new synthetic banana hybrids to Pratylenchus coffeae was studied under artificially inoculated pot conditions. Two banana hybrids, H-04-05 and H-04-06 were found to be resistant and ten hybrids, H-04-01, H-04-03, H-04-04, H-04-07, H-04-09, H-04-11, H-04-16, H-04-19, H-04-21 and H-04-24 were found to be tolerant to the lesion nematode, Pratylenchus coffeae and the remaining were rated as susceptible

Corrigendum to ‘Vermiculations from karst caves: The case of Pertosa-Auletta system (Italy)’. (Catena (2019) 182 (104178) (S0341816219303200), (10.1016/j.catena.2019.104178))

The authors regret the presence of incomplete information in the author affiliations (reported correctly above) and in the acknowledgments of the original article (provided in the amended version below). The authors are obliged to Mr. Vincenzo Manisera, speleologist of the MIdA Foundation, for sharing his experiences and for his invaluable help in all the field activities, to Dr. Sacha A. Berardo (University of Salerno, Italy) for the language editing, and to the two anonymous reviewers, who provided helpful comments and suggestions. Funding was provided by the Spanish project MINECO CGL2016-75590-P with ERDF funds, by the MIdA Foundation, which generously supported the whole project, and by the University of Salerno, which provided facilities for carrying out the research. The authors would like to apologise for any inconvenience caused

The microbial diversity of the Su Bentu cave, Italy and the influence of human exploration.

Introduction: The microbial diversity in the Su Bentu Cave (Sardinia, Italy) was investigated by means of Illumina MiSeq analysis. The hypogean environment is of great interest for astrobiological research as cave conditions may resemble those in extra-terrestrial regions. Furthermore, they hold high potential to identify novel, extremely adapted organisms to severely oligo-trophic habitats. However, the influence of human is not neglectable and in-depth investigations are needed to determine the impact of exploration on an otherwise mostly pristine ecosystem. The cave investigated in this study develops for several kilometres into the mountain, two hundred metres below the topographic surface and is characterized by a strong air circulation. Its structure is composed of huge passages carved in limestone where an ephemeral underground stream creates some lakes, close to which seven samples of visible calcite rafts, manganese deposits and moonmilk (a hydrated calcium carbonate speleothem), were sampled during an expedition in 2014. Other samples were re-trieved from a frequently used campsite and from some dry cave passages leading deeper into the cave

Hydrogeology and geochemistry of the sulfur karst springs at Santa Cesarea Terme (Apulia, southern Italy)

This work describes the geochemical and hydrogeological characteristics of Santa Cesarea Terme, an active sulfuric acid speleogenetic system located along the Adriatic coastline (Apulia, southern Italy). It represents a very peculiar site, where rising thermal and acidic waters mix with seawater creating undersaturated solutions with respect to CaCO3, able to dissolve and corrode limestone and create caves. The Santa Cesarea Terme system is composed of four caves: Fetida, Sulfurea, Gattulla, and Solfatara. Hypogene morphologies and abundant deposits of native sulfur (especially in Gattulla Cave) and sulfate minerals are present in these caves. Fetida and Gattulla caves were investigated primarily because they are easily accessible throughout the whole year through artificial entrances, the other caves being reachable only from the sea. Geochemical analysis of water, monitoring of cave atmosphere, and measurement of the stable isotopes of S, O, and H helped to identify the main processes occurring in this complex cave system. In particular, changes in Ba2+ and Sr2+ concentration allowed for the identification of two main domains of influence, characterized by marine and rising acidic waters

Perioperative factors determine outcome after surgery for severe acute pancreatitis

INTRODUCTION: There is evidence that postponing surgery in critically ill patients with severe acute pancreatitis (SAP) leads to improved survival, but previous reports included patients with both sterile and infected pancreatic necrosis who were operated on for various indications and with different degrees of organ dysfunction at the moment of surgery, which might be an important bias. The objective of this study is to analyze the impact of timing of surgery and perioperative factors (severity of organ dysfunction and microbiological status of the necrosis) on mortality in intensive care unit (ICU) patients undergoing surgery for SAP. METHODS: We retrospectively (January 1994 to March 2003) analyzed patients admitted to the ICU with SAP. Of 124 patients, 56 were treated surgically; these are the subject of this analysis. We recorded demographic characteristics and predictors of mortality at admission, timing of and indications for surgery, and outcome. We also studied the microbiological status of the necrosis and organ dysfunction at the moment of surgery. RESULTS: Patients' characteristics were comparable in patients undergoing early and late surgery, and there was a trend toward a higher mortality in patients who underwent early surgery (55% versus 29%, P = 0.06). In univariate analysis, patients who died were older, had higher organ dysfunction scores at the day of surgery, and had sterile necrosis more often; there was a trend toward earlier surgery in these patients. Logistic regression analysis showed that only age, organ dysfunction at the moment of surgery, and the presence of sterile necrosis were independent predictors of mortality. CONCLUSIONS: In this cohort of critically ill patients operated on for SAP, there was a trend toward higher mortality in patients operated on early in the course of the disease, but in multivariate analysis, only greater age, severity of organ dysfunction at the moment of surgery, and the presence of sterile necrosis, but not the timing of the surgical intervention, were independently associated with an increased risk for mortality

Management of abdominal sepsis - A paradigm shift?

Peer reviewe

Decompressive laparotomy for abdominal compartment syndrome

Background: The effect of decompressive laparotomy on outcomes in patients with abdominal compartment syndrome has been poorly investigated. The aim of this prospective cohort study was to describe the effect of decompressive laparotomy for abdominal compartment syndrome on organ function and outcomes. Methods: This was a prospective cohort study in adult patients who underwent decompressive laparotomy for abdominal compartment syndrome. The primary endpoints were 28-day and 1-year all-cause mortality. Changes in intra-abdominal pressure (IAP) and organ function, and laparotomy-related morbidity were secondary endpoints. Results: Thirty-three patients were included in the study (20 men). Twenty-seven patients were surgical admissions treated for abdominal conditions. The median (i.q.r.) Acute Physiology And Chronic Health Evaluation (APACHE) II score was 26 (20-32). Median IAP was 23 (21-27) mmHg before decompressive laparotomy, decreasing to 12 (9-15), 13 (8-17), 12 (9-15) and 12 (9-14) mmHg after 2, 6, 24 and 72 h. Decompressive laparotomy significantly improved oxygenation and urinary output. Survivors showed improvement in organ function scores, but non-survivors did not. Fourteen complications related to the procedure developed in eight of the 33 patients. The abdomen could be closed primarily in 18 patients. The overall 28-day mortality rate was 36 per cent (12 of 33), which increased to 55 per cent (18 patients) at 1 year. Non-survivors were no different from survivors, except that they tended to be older and on mechanical ventilation. Conclusion: Decompressive laparotomy reduced IAP and had an immediate effect on organ function. It should be considered in patients with abdominal compartment syndrome