Chest
Volume 140, Issue 6, December 2011, Pages 1428-1435
Journal home page for Chest

Original Research
Critical Care
Percutaneous Catheter Decompression in the Treatment of Elevated Intraabdominal Pressure

https://doi.org/10.1378/chest.10-2789Get rights and content

Background

Intraabdominal hypertension (IAH) and abdominal compartment syndrome (ACS) traditionally have been treated surgically through emergent laparotomy. Intensivist-performed bedside drainage of free intraperitoneal fluid or blood (percutaneous catheter decompression [PCD]) has been advocated as a less-invasive alternative to open abdominal decompression (OAD).

Methods

A single-center disease and severity of illness-matched case-control comparison of 62 patients with IAH/ACS treated with PCD vs traditional OAD was performed. The relative efficacy of each treatment in reducing elevated intraabdominal pressure (IAP) and improving organ dysfunction was assessed. Physiologic and demographic predictors of successful PCD therapy were determined.

Results

PCD and OAD both were effective in significantly decreasing IAP and peak inspiratory pressure as well as in increasing abdominal perfusion pressure. PCD potentially avoided the need for subsequent OAD in 25 of 31 patients (81%) treated. Successful PCD therapy was associated with fluid drainage of > 1,000 mL or a decrease in IAP of > 9 mm Hg in the first 4 h postdecompression.

Conclusions

Intensivist-performed PCD is an effective and less-invasive technique for treating patients with IAH/ACS where free intraperitoneal fluid or blood is present as determined by bedside ultrasonography. Failure to drain at least 1,000 mL of fluid and decrease IAP by at least 9 mm Hg in the first 4 h postdecompression is associated with PCD failure and should prompt urgent OAD.

Section snippets

Materials and Methods

Since January 2002, we have performed an ongoing, prospective, observational study to confirm the survival efficacy of our evidence-based medicine approach to the management of patients with IAH/ACS. This study was approved by the Orlando Health Institutional Review Board (09.068.04) with a waiver of informed consent. All patients aged ≥ 15 years who are admitted to the surgical teaching service of our institution and require either PCD or OAD during their resuscitation and management are

Results

Between March 2007 and May 2010, 265 consecutive patients with IAH/ACS were managed using OAD in our institution. We retrospectively identified an additional 31 consecutive patients during the same time period who were managed with PCD. The patients receiving PCD were evenly distributed through the study period as follows: 2007, six patients; 2008, eight patients; 2009, 11 patients; and 2010, six patients. The demographics of the 31 patients receiving PCD and 31 disease and severity of

Discussion

The diagnosis and management of IAH/ACS has evolved significantly over the past 2 decades through improved recognition of the risk factors for elevated IAP as well as understanding of the therapeutic treatment options available. Earlier diagnosis allows the application of a variety of nonoperative therapies that have been demonstrated to significantly improve survival from IAH/ACS.1, 10,13, 14,18, 19 Patients who manifest elevations in IAP and organ dysfunction that are refractory to these

Acknowledgments

Author contributions: Dr Cheatham had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Dr Cheatham: contributed to the study design, data collection, data analysis, and manuscript preparation.

Ms Safcsak: contributed to the study design, data collection, data analysis, and manuscript preparation.

Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Dr

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    Funding/Support: The authors have reported to CHEST that no funding was received for this study.

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).

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