Crtical Care and Shock Journal

The use of point-of-care ultrasound to guide clinical management in intra-abdominal hypertension

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Overview

Abstract

Introduction: The World Society for the Abdominal Compartment Syndrome (WSACS) developed a medical management algorithm with a stepwise approach to keep intra-abdominal pressure (IAP) £15 mmHg. The role of point-of-care ultrasound (POCUS) as a bedside modality in critical care patients, is not well studied in the intra-abdominal hypertension (IAH) management algorithm.

Aim: To test POCUS in the medical management of patients with IAH.

Method: We conducted a prospective observational study. Those who met the inclusion criteria were assigned to undergo POCUS and small bowel ultrasound as adjuvant tools in their IAH management.

Result: A total of 22 patients met the inclusion criteria and were included in the study. The mean age of the study participants was 65±22.6 years, 61% were men, and the most frequent admission diagnoses were hepatic encephalopathy and massive ascites (5 cases). Ultrasound and abdominal X-rays were comparable in confirming nasogastric tube (NGT)’s correct position, but the ultrasound was superior in determining the gastric content (fluid vs solid) and diagnoses of gastric paresis in 2 cases. Small bowel obstruction was present in four patients and confirmed with computerized tomography (CT) abdomen, and 2 of the patients underwent surgical intervention for mesenteric vessel occlusion and transmesenteric internal hernia. Enema treatment was found to empty the bowel incompletely in 72%, 56%, and 42% of the times on days 1, 2, and 3. Four patients with cirrhosis admitted with upper gastrointestinal bleeding and hepatic encephalopathy (out of a total of 8) were found to have large amounts of ascites and ultrasound (US)-guided paracentesis performed.

Conclusion: POCUS can be used in the nonoperative management of IAH. It is an important tool in the diagnosis and treatment of patients with IAH.

Zouheir Ibrahim Bitar, Ossama Sajeh Maadarani, Tamer Mohamed Zaalouk, Mohammed Jaber Mohsen, Ragab Desouky Elshabasy, Mahmoud Mostafa Elzoueiry

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