A Study of Raised Intra-abdominal Pressure and the Abdominal Compartment Syndrome in Liver Intensive Care

Introduction<br/>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).<br/>Methods<br/>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<br/>2. Identification of potential sources of error in measurement of IAP<br/>3. Impact of body position and zero-reference point on IAP<br/>Specialty Specific Questions<br/>1. Incidence of raised IAP in specialised liver ITU and its link to complications / length of stay<br/>2. Identification of early predictors of raised IAP<br/>3. Study of regional abdominal compartmental variation in IAP<br/>Results &amp; Conclusions<br/>• 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<br/>• 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<br/>• Body-position and bladder priming volumes both introduce significant clinical error in the measurement of IAP<br/>• 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 <br/>• Significant variation in upper and lower IAP occurs following liver transplantation and this regional variation can be manipulated by body positioning

Name dc:type.qualificationname

Doctor of Medicine by Research

Level dc:type.qualificationlevel

Doctoral Thesis

Grantor dc:publisher.institution

King's College London

Year dc:date.issued

2013

Author dc:creator

• Cresswell, Ben

Advisor dc:contributor.advisor

• Wendon, Julia Alexis

Language dc:language

eng

Identifier

oai:kclpure.kcl.ac.uk:studenttheses/bf047b54-da8b-4a92-a05c-c22a27072827

OAI identifier oai:identifier

oai:kclpure.kcl.ac.uk:studenttheses/bf047b54-da8b-4a92-a05c-c22a27072827