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

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Abstract

Introduction

The Abdominal Compartment Society (WSACS) developed a medical management algorithm with a stepwise approach to keep intra-abdominal pressure (IAP) ≤ 15 mm Hg. The role of point-of-care ultrasound (POCUS) as a bedside modality in the critical care patients is not well studied in relation to the intra-abdominal hypertension (IAH) management algorithm.

Aim

To test the role of point-of-care ultrasound (POCUS) in the medical management of patients with intra-abdominal hypertension (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.

Results

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 (five cases). Ultrasound and abdominal X-rays were comparable in confirming correct NGT position, but the ultrasound was superior in determining the gastric content (fluid vs. solid) and diagnoses of gastric paresis in two cases. Small bowel obstruction was present in four patients and confirmed with abdominal CT; two of the patients underwent surgical intervention for mesenteric vessel occlusion and transmesenteric internal hernia. Enema treatment was found to empty the bowel incompletely 72%, 56%, and 42% of the time on days 1, 2, and 3, respectively. 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 US-guided paracentesis was 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.

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Data availability statement

Data are available upon reasonable request. The data that support the findings of this study are available from the corresponding author upon reasonable request.

References

  1. Cheatham ML, Malbrain ML, Kirkpatrick A et al (2011) Definitions and pathophysiological implications of intra-abdominal hypertension and abdominal compartment syndrome. Am Surg 77(Suppl 1):S6–S11

    PubMed  Google Scholar 

  2. Kirkpatrick AW, Roberts DJ, De Waele J et al (2013) Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome. Intensive Care Med 39:1190–1206

    Article  Google Scholar 

  3. Zatelli M, Vezzali N (2017) 4-Point ultrasonography to confirm the correct position of the nasogastric tube in 114 critically ill patients. J Ultrasound 20:53–58

    Article  Google Scholar 

  4. Kirkpatrick AW, Roberts DJ, De Waele J, et al. Pediatric Guidelines Sub-Committee for the World Society of the Abdominal Compartment Syndrome Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome. Intensive Care Med. 2013; 39(7): 1190–1206, doi:https://doi.org/10.1007/s00134-013-2906-z.

  5. Cheatham ML, Safcsak K (2010) Is the evolving management of intra-abdominal hypertension and abdominal compartment syndrome improving survival? Crit Care Med 38(2):402–407

    Article  Google Scholar 

  6. Cheatham ML, Malbrain MLNG, Kirkpatrick A et al (2007) Results from the International Conference of Experts on Intra-abdominal Hypertension and Abdominal Compartment Syndrome. Part II: recommendations Intensive Care Med 33(6):951–962

    Google Scholar 

  7. Lichtenstein DA (2007) Point-of-care ultrasound: infection control in the intensive care unit. Crit Care Med 35(5 suppl):S262–S267

    Article  Google Scholar 

  8. Carpenter CR, Pines JM. The End of Xrays for Suspected Small Bowel Obstruction? Using Evidence based Diagnostics to Inform Best Practices in Emergency Medicine. Acad Emerg Med. 2013;20:61820.

  9. Mark R. Taylor, Nadim Lalani. Adult Small Bowel Obstruction. ACADEMIC EMERGENCY MEDICINE • June 2013, Vol. 20, No. 6

  10. Unlüer E, Yavaşi O, Eroğlu O, Yilmaz C, Akarca F (2010) Ultrasonography by emergency medicine and radiology residents for the diagnosis of small bowel obstruction. Eur J Emerg Med 17(5):260–264

    Article  Google Scholar 

  11. Alice Chao, MD and Laleh Gharahbaghian.Tips and Tricks: Clinical Ultrasound for Small Bowel Obstruction – A Better Diagnostic Tool? ACEP, 03/12/2016

  12. Suri S, Gupta S, Sudhakar PJ, Venkataramu NK, Sood B, Wig JD (1999) Comparative evaluation of plain films, ultrasound and CT in the diagnosis of intestinal obstruction. ActaRadiol 40(4):422–428

    CAS  Google Scholar 

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Funding

The authors received no financial support for the research, authorship, and/or publication of this article. The research was performed as part of the employment of the authors in Kuwait Oil Company.

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Authors and Affiliations

  1. Critical Care Unit, Ahmadi Hospital, Kuwait Oil Company, PO Box 46468, 64015, Fahaheel, Al Ahmadi, Kuwait

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

  2. Critical Care Unit, Internal Medicine Dept, Ahmadi Hospital, Al Ahmadi, Kuwait

    Mahmoud Mostafa Elzoueiry

Authors
  1. Zouheir Ibrahim Bitar
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  2. Ossama Sajeh Maadarani
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  3. Tamer Mohamed Zaalouk
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  4. Mohammed Jaber Mohsen
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  5. Ragab Desouky Elshabasy
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  6. Mahmoud Mostafa Elzoueiry
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Contributions

ZIB wrote the article, OSM shared in the discussion and with MM, REE and TMZ shared in collecting the data and revision of the manuscript.

Corresponding author

Correspondence to Zouheir Ibrahim Bitar.

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The author(s) declared no potential conflicts of interest concerning the research, authorship, and/or publication of this article.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research. Patient consent for publication Not required.

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Bitar, Z.I., Maadarani, O.S., Zaalouk, T.M. et al. The use of point-of-care ultrasound to guide clinical management in intra-abdominal hypertension. J Ultrasound 24, 183–189 (2021). https://doi.org/10.1007/s40477-020-00546-8

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  • DOI: https://doi.org/10.1007/s40477-020-00546-8

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