DIAGNOSTICS AND INTENSIVE THERAPY OF INTRA-ABDOMINAL HYPERTENSION

The problem of intra-abdominal hypertension (IAH) for critically ill patients has remained relevant for a long time. Despite numerous studies conducted over the past 10 years, many issues remain unresolved in the treatment of patients with severe forms of IAH. Doctors of emergency care face them especially often. Recommendations and protocols for the examination and treatment of patients with IAH are beeing constantly changed and corrected as new data become available. To systematize existing information on IAH diagnosis and intensive therapy, this literature review was created. The data of publications, meta-analyzes, clinical recommendations for the last 10 years are analyzed. The search was conducted in the following databases: Scopus, Web of Science, MedLine, The Cochrane Library, CyberLeninka, Russian Science Citation Index. The review covers the issues of intra-abdominal pressure definition and diagnosis, abdominal compartment syndrome (ACS). The algorithm and methods for IAH treatment are examined and analyzed: mechanical gastrointestinal intubation, evacuation of bulk fluid clusters, muscle relaxation, prolonged epidural anesthesia, features of infusion therapy and mechanical ventilation. The variants of surgical tactics are considered, since it is surgical decompression that remains to date the only effective way to resolve IAH and ACS treatment. The critical value of intra-abdominal pressure indicating the absolute need for surgical abdominal decompression, depends on the presence/absence of organ dysfunction. Intra-abdominal hypertension combined with dysfunction of at least one organ is considered to be an absolute indication for surgical abdominal decompression with the subsequent use of temporary closure of the abdominal cavity, if necessary. Management of patients with elevated intra-abdominal pressure according to the adopted protocol allows to avoid the development of ACS and fatal complications.

Bokarev M.I., Nesterova E.A., Mamykin A.I., Malyuga V.Yu. Prognostic factor for patients with acute pancreatitis. Collection of materials of The First Congress of Surgeons of Volga Federal District. 2016: 151-2 (in Russ.).

Bokarev M.I., Nesterova E.A. Prognostic criteria of severe acute pancreatitis. Proceedings of the conference “High technologies in surgery and gynecology”. 2016: 53-5 (in Russ.).

Nesterova E.A., Bokarev M.I. The role of intra-abdominal hypertension in the pathogenesis of severe acute pancreatitis. Proceedings of the young scientists' conference “Actual aspects of diagnostics and treatment in abdominal surgery”. 2014: 65-6 (in Russ.).

Popugaev K.A., Savin I.A., Goryachev A.S., Oshorov A.V., Lubnin A.Yu. Intra-abdominal hypertension in neurosurgical patients. Vestnik Intensivnoy Terapii (Intensive Care Herald). 2011; 3 (7): 10-4 (in Russ.).

Helfand B.R., Protsenko D.M., Podachyn P.V., Chubchenko S.V., Lapshyna I.Yu. Abdominal hypertension syndrome: the state of the problem. Meditsina Neotlozhnykh Sostoyaniy (Emergency Medicine). 2015; 7 (70): 41-50 (in Russ.).

Hecker A., Hecker B., Hecker M., Riedel J.G., Weigand M.A., Padberg W. Acute abdominal compartment syndrome: current diagnostic and therapeutic options. Langenbeck's Arch. Surg. 2016; 401 (1): 15-24. DOI: 10.1007/s00423-015-1353-4

Kirkpatrick A.W., Roberts D.J., Ball C.G., De Waele J., Jaeschke R., Malbrain M.L., De Keulenaer B. Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome World Society of the Abdominal Compartment Syndrome. Intensive Care Med. 2013; 39 (7): 1190-206. DOI: 10.1007/s00134-013-2906-z

Maluso P., Olson J., Sarani B. Abdominal compartment hypertension and abdominal compartment syndrome. Crit. Care Clin. 2016; 32 (2): 213-22. DOI: 10.1016/j.ccc.2015.12.001

Malbrain M.L.N.G., Cheatham M.L., Kirkpatrick A., Sugrue M., Parr M., De Waele J. et al. Results from the International Conference of Experts on Intra-abdominal Hypertension and Abdominal Compartment Syndrome. I. Definitions. Intensive Care Med. 2006; 32 (11): 1722-32. DOI: 10.1007/s00134-006-0349-5

Malbrain M.L., Chiumello D., Cesana B.M., Blaser A.R., Starkopf J., Sugrue M. et al. A systematic review and individual patient data meta-analysis on intra-abdominal hypertension in critically ill patients: the wake-up project. World initiative on Abdominal Hypertension Epidemiology, a Unifying Project (WAKE-Up!). MinervaAnestesiol. 2014; 80 (3): 293-306.

Carr J.A. Abdominal compartment syndrome: a decade of progress. J. Am. Coll. Surg. 2013; 216 (1): 135-46. DOI: 10.1016/ j.jamcollsurg.2012.09.004

Cheatham M.L., Malbrain M.L., Kirkpatrick A., Sugrue M., Parr M., De Waele J. et al. Results from the International Conference of Experts on Intra-abdominal Hypertension and Abdominal Compartment Syndrome. II. Recommendations. Intensive Care Med. 2007; 33 (6): 951-62. DOI: 10.1007/s00134-007-0592-4

Cheatham M.L. Abdominal compartment syndrome: pathophysiology and definitions. Scand. J. Trauma. Resusc. Emerg. Med. 2009; 17 (1): 10. DOI: 10.1186/1757-7241-17-10

Wittmann D.H., Iskander G.A. The compartment syndrome of the abdominal cavity: a state of the art review. J. Intensive Care Med. 2010; 17 (2): 201-20. DOI: 10.1177/088506660001500403

Malbrain M. Abdominal perfusion pressure as a prognostic marker in intra-abdominal hypertension. Intensive Care Med. In: Vincent J.L. (Ed.) Intensive care medicine. New York: Springer; 2002: 792-814.

Cheatham M.L., White M.W., Sagraves S.G., Johnson J.L., Block E.F. Abdominal perfusion pressure: a superior parameter in the assessment of intra-abdominal hypertension. J. Trauma. 2000; 49 (4): 626-7.

Popugaev K.A. Intensive care in complicated postoperative period in adult patients with tumors of chiasm-sellar localization. Thesises of dr. med. sc. diss. Moscow; 2013 (in Russ.).

Ovchinnikov V.A., Sokolov V.A. Abdominal compartment syndrome. Sovremennye Tehnologii v Medicine (Modern Technologies in Medicine). 2013; 5 (1): 122-9 (in Russ.).

Chopra S.S., Wolf S., Rohde V., Freimann F.B. Pressure measurement techniques for abdominal hypertension: conclusions from an experimental model. Crit. Care Res. Pract. 2015; 2015: 278139. DOI: 10.1155/2015/278139

Mikhaylichenko V.Yu., Karakursakov N.E. Correction of microcirculatory disorders in the intestinal wall at intra-abdominal hypertension syndrome (experimental study). Sovremennye Problemy Nauki i Obrazovaniya (Modern Problems of Science and Education). 2015; 4. Available at: http://science-education.ru/ru/article/view?id=20671 (accessed February 15, 2018) (in Russ.).

Yi M., Leng Y., Bai Y., Yao G., Zhu X. The evaluation of the effect of body positioning on intra-abdominal pressure measurement and the effect of intra-abdominal pressure at different body positioning on organ function and prognosis in critically ill patients. J. Crit. Care. 2012; 27 (2): 222.e1-6. DOI: 10.1016/j.jcrc.2011.08.010

De Keulenaer B., Regli A., De laet I., Roberts D., Malbrain M.L. What's new in medical management strategies for raised intraabdominal pressure: evacuating intra-abdominal contents, improving abdominal wall compliance, pharmacotherapy, and continuous negative extra-abdominal pressure. Anaesthesiol. Intensive Ther. 2015; 47 (1): 54-62. DOI: 10.5603/AIT.a2014.0065

Timerbulatov V.M., Fayazov R.R., Timerbulatov Sh.V., Gareev R.N., Sultanbaev A.U. Intra abdominal hypertensia in practice of the surgeon. Vestnik Ural'skoi Meditsinskoi Akademicheskoi Nauki (Journal of Ural Medical Academic Science). 2010; 2 (30): 56-8 (in Russ.).

Zemlyakov D.S. Correction of intra-abdominal hypertension in the emergency and planned relaparotomies. Cand. med. sc. diss. Volgograd; 2016 (in Russ.).

Glushkov N.I., Skorodumov A.V., Safin M.G., Pakhmutova Yu.A., Gurina A.V., Bel'skiy I.I. The role of intraperitoneal pressure in predicting the severity of the disease in patients with destructive pancreatitis. Kubanskij Nauchnyj Medicinskij Vestnik (Kuban Scientific MedicalBulletin). 2013; 1383 (3): 46-7 (in Russ.).

Zabelin M.V. Intra-abdominal hypertension syndrome in emergency abdominal surgery. Voenno-Meditsinskiy Zhurnal (Military Medical Journal). 2010; 331 (2): 71-2 (in Russ.).

Mamykin A.I. Surgical tactics in patients with widespread purulent peritonitis. Cand. med. sc. thesises. Moscow; 2014: 133 (in Russ.).

Malbrain M.L., Chiumello D., Pelosi P., Wilmer A., Brienza N., Malcangi V. et al. Prevalence of intra-abdominal hypertension in critically ill patients: a multicentre epidemiological study. Intensive Care Med. 2004; 30 (5): 822-9. DOI: 10.1007/s00134-004-2169-9

Stakanov A.V. Epidural analgesia in the presence of intraabdominal hypertension in acute colonic obstruction. Obshchaya Reanimatologiya (General Reanimatology). 2013; 9 (2): 39 (in Russ.). DOI:10.15360/1813-9779-2013-2-39

Coccolini F., Biffl W., Catena F., Ceresoli M., Chiara O., Cimbanassi S. et al. The open abdomen, indications, management and definitive closure. World J. Emerg. Surg. 2015; 10 (1): 32. DOI: 10.1186/s13017-015-0026-5

Sartelli M., Abu-Zidan F.M., Ansaloni L., Bala M., Beltr_n M.A., Biffl W.L. et al. The role of the open abdomen procedure in managing severe abdominal sepsis: WSES position paper. World J. Emerg. Surg. 2015; 10 (1): 35. DOI: 10.1186/s13017-015-0032-7

Kyoung K.H., Hong S.K. The duration of intra-abdominal hypertension strongly predicts outcomes for the critically ill surgical patients: a prospective observational study. World J. Emerg. Surg. 2015; 10 (1): 22. DOI: 10.1186/s13017-015-0016-7

Blaser A.R., Sarapuu S., Tamme K., Starkopf J. Expanded measurements of intra-abdominal pressure do not increase the detection rate of intra-abdominal hypertension: a single-center observational study. Crit. Care Med. 2014; 42 (2): 378-86. DOI: 10.1097/CCM.0b013e3182a6459b

Zubritskiy V.F., Zabelin M.V., Mayorov A.V. The results of monitoring intra-abdominal pressure in acute intestinal obstruction. Voenno-Meditsinskiy Zhurnal (Military Medical Journal). 2010; 331 (1): 58 (in Russ.).

Timerbulatov S.V., Fayazov R.R., Timerbulatov M.V., Sakhautdinov R.M., Sultanbaev A.U. Features of medical tactics in emergency abdominal pathology, complicated by intra-abdominal hypertension syndrome. Kreativnaya Khirurgiya i Onkologiya (Creative Surgery and Oncology). 2013; 1 (2): 29-33 (in Russ.). DOI:10.24060/2076-3093-2013-0-1-2-29-33

Herbert M.K., Holzer P. Standardized concept for the treatment of gastrointestinal dysmotility in critically ill patients - current status and future options. Clin. Nutr. 2008; 27 (1): 25-41. DOI: 10.1016/j.clnu.2007.08.001

Zabelin M.V., Zubritskiy V.F., Yudin A.B., Mayorov A.V., Sal'nikov AV., Baranov M.A. Pathomorphological changes of internal organs during increased intra-abdominal pressure in small laboratory animals. Voenno-Meditsinskiy Zhurnal (Military Medical Journal). 2010; 331 (2): 65 (in Russ.).

Van Der Spoel J.I., Schultz M.J., Van Der Voort P.H., De Jonge E. Influence of severity of illness, medication and selective decontamination on defecation. Intensive Care Med. 2006; 32 (6): 875-80. DOI: 10.1007/s00134-006-0175-9

Popugaev K.A., Savin I.A., Lubnin A.U., Goriachev A.S., Kadashev B.A., Kalinin P.L. et al. Intra-abdominal hypertension in patients with sellar region tumors. Ann. Intensive Care. 2012; 2 (Suppl. 1): S2. DOI: 10.1186/2110-5820-2-S1-S2

Van Der Spoel J.I., Oudemans-van Straaten H.M., Stouten-beek C.P., Bosman R.J., Zandstra D.F. Neostigmine resolves critical illness-related colonic ileus in intensive care patients with multiple organ failure - a prospective, double-blind, placebo-controlled trial. Intensive Care Med. 2001; 27 (5): 822-7.

Ekka N.M.P., Malua S., Bodra P, Jha R.K., Murari K. Intraabdominal hypertension and abdominal syndrome: a review of current concept and trends. Int. J. Med. Dent. Sci. 2015; 4 (2): 922-31. DOI: 10.19056/ijmdsjssmes/2015/v4i2/79867

Zubritskiy V.F., Zemlyanoy A.B., Matveev D.A., Ayrapetyan A.T., Golubev I.V., Rozenberg E.P., Korenev D.N. Intraabdominal hypertension and pancreatogenic peritonitis. Meditsinskiy Vestnik MVD (Medical Bulletin of the Ministry of Internal Affairs). 2015; 76 (4): 27-31 (in Russ.).

Zubritskiy V.F., Zabelin M.V., Koltovich A.P., Levchuk A.L., Airapetyan A.T., Golubev I.V. et al. Intraabdominal hypertension and pancreatogenic peritonitis. Annaly Khirurgicheskoy Gepatologii (Annals of Surgical Hepatology). 2016; 21 (4): 41-6 (in Russ.).

Bel'skiy I.I. The role of intraperitoneal pressure in the diagnosis and treatment of acute pancreatitis. Cand. med. sc. diss. Saint-Petersburg; 2016: 162 (in Russ.).

Vikrama K.S., Shyamkumar N.K., Vinu M., Joseph P., Vyas F., Venkatramani S. Percutaneous catheter drainage in the treatment of abdominal compartment syndrome. Can. J. Surg. 2009; 52 (1): 19-20.

Valenza F., Irace M., Guglielmi M., Gatti S., Bottino N., Tedesco C. et al. Effects of continuous negative extra-abdominal pressure on cardiorespiratory function during abdominal hypertension: an experimental study. Intensive Care Med. 2005; 31 (1): 105-11. DOI: 10.1007/s00134-004-2483-2

Valenza F., Bottino N., Canavesi K., Lissoni A., Alongi S., Losap-pio S. et al. Intra-abdominal pressure may be decreased non-inva-sively by continuous negative extra-abdominal pressure (NEXAP). Intensive Care Med. 2003; 29 (11): 2063-7. DOI: 10.1007/s00134-003-2013-7

Tasdogan M., Memis D., Sut N., Yuksel M. Results of a pilot study on the effects of propofol and dexmedetomidine on inflammatory responses and intraabdominal pressure in severe sepsis. J. Clin. Anesth. 2009; 21 (6): 394-400. DOI: 10.1016/j.jclinane.2008.10.010

Chiles K.T., Feeney C.M. Abdominal compartment syndrome successfully treated with neuromuscular blockade. Indian J. Anaesth. 2011; 55 (4): 384-7. DOI: 10.4103/0019-5049.84867

Coccolini F., Agresta F., Bassi A., Catena F., Crovella F., Ferrara R. et al. Italian Biological Prosthesis Work-Group (IBPWG): proposal for a decisional model in using biological prosthesis. World J. Emerg. Surg. 2012; 7 (1): 34. DOI: 10.1186/1749-7922-7-34

Chen Y., Ye J., Song W., Chen J., Yuan Y., Ren J. Comparison of outcomes between early fascial closure and delayed abdominal closure in patients with open abdomen: a systematic review and metaanalysis. Gastroenterol. Res. Pract. 2014; 2014: ID 784056. DOI: 10.1155/2014/784056

Verzilli D., Constantin J.M., Sebbane M., Chanques G., Jung B., Perrigault P.F. et al. Positive end-expiratory pressure affects the value of intra-abdominal pressure in acute lung injury/acute respiratory distress syndrome patients: a pilot study. Crit. Care. 2010; 14 (4): R137. DOI: 10.1186/cc9193

Yokoyama Y., Nimura Y., Nagino M. Advances in the treatment of pancreatic cancer: limitations of surgery and evaluation of new therapeutic strategies. Surg. Today. 2009; 39 (6): 466-75. DOI: 10.1007/s00595-008-3904-6

Jacques D., Bendjelid K., Duperret S., Colling J., Piriou V., Viale J.P. Pulse pressure variation and stroke volume variation during increased intra-abdominal pressure: an experimental study. Crit. Care. 2011; 15 (1): R33. DOI: 10.1186/cc9980

Shano V.P., Gladkaya S.V., Gur'yanov V.G., Gumenyuk I.V., Gordienko I.V. Predicting the risk for development of abdominal compartment syndrome in patients with surgical pathology of the abdominal cavity. Meditsina Neotlozhnykh Sostoyaniy (Emergency Medicine). 2014; 2 (57): 153-8 (in Russ.).

Cheatham M.L., Demetrios D., Fabian T.C., Kaplan M.J., Miles W.S., Schreiber M.A. et al. Prospective study examining clinical outcomes associated with a negative pressure wound therapy system and Barker's vacuum packing technique. World J. Surg. 2013; 37 (9): 2018-30. DOI: 10.1007/s00268-013-2080-z