Current recognition and management of intra-abdominal hypertension and abdominal compartment syndrome among tertiary Chinese intensive care physicians

作     者：Jian-cang ZHOU Hong-chen ZHAO Kong-han PAN Qiu-ping XU 

作者机构：Department of Critical Care Medicine Sir Run Run Shaw Hospital School of Medicine Zhejiang University Hangzhou 310016 China 

出 版 物：《Journal of Zhejiang University-Science B(Biomedicine & Biotechnology)》 (浙江大学学报（英文版）B辑（生物医学与生物技术）)

年 卷 期：2011年第12卷第2期

页      面：156-162页

核心收录：

学科分类：0710[理学-生物学] 1007[医学-药学(可授医学、理学学位)] 1004[医学-公共卫生与预防医学(可授医学、理学学位)] 1002[医学-临床医学] 1001[医学-基础医学(可授医学、理学学位)] 0905[农学-畜牧学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 0906[农学-兽医学] 1010[医学-医学技术（可授医学、理学学位）] 100215[医学-康复医学与理疗学] 10[医学] 

基　　金：supported by the Medical Scientific Research Foundation of Zhejiang Province, China (No. 2010KYA109) the Administration of Traditional Chinese Medicine of Zhejiang Province, China (No. 2010ZB080) 

主　　题：Questionnaire Intra-abdominal pressure Intra-abdominal hypertension Decompression laparotomy Abdominal compartment syndrome 

摘      要：This survey was designed to clarify the current understanding and clinical management of intra-abdominal hypertension （IAH）/abdominal compartment syndrome （ACS） among intensive care physicians in tertiary Chinese hospitals. A postal twenty-question questionnaire was sent to 141 physicians in different intensive care units （ICUs）. A total of 108 （76.6%） questionnaires were returned. Among these, three quarters worked in combined medical-surgical ICUs and nearly 80% had primary training in internal or emergency medicine. Average ICU beds, annual admission, ICU length of stay, acute physiology and chronic health evaluation （APACHE）II score, and mortality were 18.2 beds, 764.5 cases, 8.3 d, 19.4, and 21.1%, respectively. Of the respondents, 30.6% never measured intra-abdominal pressure （IAP）. Although the vast majority of the ICUs adopted the exclusively transvesicular method, the over- whelming majority （88.0%） only measured lAP when there was a clinical suspicion of IAH/ACS and only 29.3% measured either often or routinely. Moreover, 84.0% used the wrong priming saline volume while 88.0% zeroed at reference points which were not in consistence with the standard method for lAP monitoring recommended by the World Society of Abdominal Compartment Syndrome. ACS was suspected mainly when there was a distended ab- domen （92%）, worsening oliguria （80%）, and increased ventilatory support requirement （68%）. Common causes for IAH/ACS were ＂third-spacing from massive volume resuscitation in different settings＂ （88%）, ＂intra-abdominal bleeding＂, and ＂liver failure with ascites＂ （52% for both）. Though 60% respondents would recommend surgical decompression when the lAP exceeded 25 mmHg, accompanied by signs of organ dysfunction, nearly three quarters of re- spondents preferred diuresis and dialysis. A total of 68% of respondents would recommend paracentesis in the treatment for ACS. In conclusion, urgent systematic education is absolutely necessary for most intensive care physician