A Study of Raised Intra-abdominal Pressure and the Abdominal Compartment Syndrome in Liver Intensive Care
Introduction Interest in intra-abdominal pressure (IAP) measurement has increased significantly, with evidence of its deleterious effects demonstrated on every organ. Despite the volume of publications – several assumptions relating to the measurement of IAP remain unproven and there is a paucity of data relating to patients in a specialised liver Intensive Therapy Unit (ITU). Methods This thesis encompasses a survey of the available literature and national attitudes / practice with several clinical experiments; Generic Questions 1. IAP measurement technique – validation of current gold-standard against alternatives 2. Identification of potential sources of error in measurement of IAP 3. Impact of body position and zero-reference point on IAP Specialty Specific Questions 1. Incidence of raised IAP in specialised liver ITU and its link to complications / length of stay 2. Identification of early predictors of raised IAP 3. Study of regional abdominal compartmental variation in IAP Results & Conclusions • IAP is widely accepted by UK anaesthetists and surgeons, especially amongst those more recently graduated. Knowledge and practice is variable however and requires better education • The Foley Catheter Manometer represents a reliable and valid tool for the measurement of IAP, with excellent agreement to measurements obtained by other devices and directly transduced intra-peritoneal pressure • Body-position and bladder priming volumes both introduce significant clinical error in the measurement of IAP • Patients in liver ITU are at higher risk of developing elevated IAP than those in a general ITU. Within this patient cohort, complications are associated with elevated IAP and IAP is a better predictor of length of stay than other severity scores. A normal Day 1 IAP reliably predicts that abdominal compartment syndrome will not occur during the admission • Significant variation in upper and lower IAP occurs following liver transplantation and this regional variation can be manipulated by body positioning
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