Management of abdominal sepsis - A paradigm shift?

Peer reviewe

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

Peer reviewe

Core competencies in critical care for general medical practitioners in South Africa : a Delphi study

BACKGROUND : Despite a high burden of disease that requires critical care services, there are a limited number of intensivists in South Africa (SA). Medical practitioners at district and regional public sector hospitals frequently manage critically ill patients in the absence of intensivists, despite these medical practitioners having had minimal exposure to critical care during their undergraduate training. OBJECTIVES : To identify core competencies in critical care for medical practitioners who provide critical care services at public sector hospitals in SA where intensivists are not available to direct patient management. METHODS : A preliminary list of core competencies in critical care was compiled. Thereafter, 13 national and international experts were requested to achieve consensus on a final list of core competencies that are required for critical care by medical practitioners, using a modified Delphi process. RESULTS : A final list of 153 core competencies in critical care was identified. CONCLUSION: The core competencies identified by this study could assist in developing training programmes for medical practitioners to improve the quality of critical care services provided at district and regional hospitals in SA.http://www.sajcc.org.za/index.php/SAJCCam2024Critical CareSDG-04:Quality Educatio

Methodological background and strategy for the 2012-2013 updated consensus definitions and clinical practice guidelines from the abdominal compartment society

Peer reviewe

Transpulmonary pressure monitoring during mechanical ventilation : a bench-to-bedside review

Different ventilation strategies have been suggested in the past in patients with acute respiratory distress syndrome (ARDS). Airway pressure monitoring alone is inadequate to assure optimal ventilatory support in ARDS patients. The assessment of transpulmonary pressure (PTP ) can help clinicians to tailor mechanical ventilation to the individual patient needs. Transpulmonary pressure monitoring, defined as airway pressure (Paw ) minus intrathoracic pressure (ITP), provides essential information about chest wall mechanics and its effects on the respiratory system and lung mechanics. The positioning of an esophageal catheter is required to measure the esophageal pressure (Peso ), which is clinically used as a surrogate for ITP or pleural pressure (Ppl ), and calculates the transpulmonary pressure. The benefits of such a ventilation approach are avoiding excessive lung stress and individualizing the positive end-expiratory pressure (PEEP) setting. The aim is to prevent over-distention of alveoli and the cyclic recruitment/derecruitment or shear stress of lung parenchyma, mechanisms associated with ventilator-induced lung injury (VILI). Knowledge of the real lung distending pressure, i.e. the transpulmonary pressure, has shown to be useful in both controlled and assisted mechanical ventilation. In the latter ventilator modes, Peso measurement allows one to assess a patient's respiratory effort, patient-ventilator asynchrony, intrinsic PEEP and the calculation of work of breathing. Conditions that have an impact on Peso, such as abdominal hypertension, will also be discussed briefly

Intraabdominal hypertension and abdominal compartment syndrome: We have paid attention, now it is time to understand!

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Rational intraabdominal pressure monitoring: How to do it?

Introduction: Intraabdominal hypertension (IAH) is increasingly appreciated by intensivists as an important cause of organ dysfunction, even at pressure levels which were previously thought to be harmless. Therefore, the goal of this review is to describe the different methods commonly used in clinical practice for intraabdominal pressure (IAP) measurement, the advised methodology for each measurement method, and finally to give a rational approach for IAP monitoring in daily clinical practice. Methods: A Medline search of the English literature was performed using the term "intra abdominal pressure" and "measurement". This resulted in 194 studies, which were then analysed based on the title and abstract. Only clinical studies in human subjects with IAP measurement or related issues as the subject of the study, were considered for inclusion in the study. Reviews, animal experiments and case reports were excluded, white one specific review on IAP measurement and 3 large animal studies (domestic swine > 40 kg) were included in the analysis. This left us with 19 studies, published between 1984 and 2006: 1 specific review, 2 studies in children, 13 in adults and 3 in domestic swine. The references from these studies were searched for relevant articles that may have been missed in the primary search. These articles served as the basis for the recommendations below. Results: Clinical data regarding the validation of new IAP measurement methods or the reliability of established measurement techniques are scarce. The transvesical route, which has been studied most extensively, can be used as reliable route for intermittent IAP measurement, as long as instillation volumes below 25mL are used. Continuous IAP and APP monitoring can be done via a balloon-tipped catheter placed in the stomach or directly intraperitoneal. Conclusions: Rational IAP monitoring should be based on a site specific protocol, based on known risk factors, the monitoring equipment available and nursing staff experience, and should be linked directly to a local treatment protocol