This document presents updated consensus definitions and clinical practice guidelines for intra-abdominal hypertension and abdominal compartment syndrome from the World Society of the Abdominal Compartment Syndrome. It retains definitions from 2006 and introduces new definitions accepted by the 2012 consensus panel. Recommendations and suggestions are provided based on the GRADE methodology and address monitoring, prevention, and management of intra-abdominal hypertension and abdominal compartment syndrome.
The document presents updated consensus definitions and clinical practice guidelines for intra-abdominal hypertension and abdominal compartment syndrome from the World Society of the Abdominal Compartment Syndrome. It retains definitions from 2006 and introduces new definitions accepted by the 2012 consensus panel. It provides recommendations and suggestions regarding measuring intra-abdominal pressure, adopting standard measurement techniques, utilizing monitoring and management protocols, and using decompressive laparotomy for overt abdominal compartment syndrome. The recommendations and suggestions are assigned grades based on quality of evidence.
The document discusses intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS). It provides definitions for IAH, ACS, and their grading levels according to the World Society of the Abdominal Compartment Syndrome. Measurement of intra-abdominal pressure via transbladder technique using a pressure transducer is recommended for monitoring critically ill patients at risk. Early detection and treatment of elevated pressures can help reduce organ dysfunction, mortality, and length of stay in the ICU.
The document provides recommendations from an international conference of experts on intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS). It recommends screening ICU patients for IAH/ACS risk factors and monitoring intra-abdominal pressure if risk factors are present. Serial measurements are necessary to guide management and prevent organ dysfunction. Medical and surgical interventions are outlined to treat IAH and ACS depending on severity, including maintaining adequate abdominal perfusion pressure. Further research is still needed to clarify unanswered questions.
This document presents definitions agreed upon by experts for intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS). IAH is defined as an intra-abdominal pressure of 12 mmHg or higher and is graded based on severity. ACS occurs when IAH is over 20 mmHg and is associated with new organ dysfunction. The definitions standardize measurement of intra-abdominal pressure via bladder at 25 ml saline and establish abdominal perfusion pressure as key. Primary ACS originates in the abdomen while secondary ACS occurs elsewhere and can recur after initial treatment.
BCC4: Michael Parr on ICU - Surviving Trauma GuidelinesSMACC Conference
Michael Parr, director of Liverpool ICU in Australia, speaks about "Surviving Trauma Guidelines". He does so through the use of an interesting case of a patient admitted to ICU following a MVA. This educational podcast was recorded at BCC4.
This document discusses intra-abdominal hypertension and the relationship between fluids and intra-abdominal pressure. It defines key terms like intra-abdominal pressure, intra-abdominal hypertension, and abdominal compartment syndrome. It then summarizes research showing that factors like obesity, sepsis, surgery, and large-volume crystalloid resuscitation can increase the risk of elevated intra-abdominal pressure. The document advocates limiting crystalloid use and explores strategies for removing excess fluids like using colloids, diuretics, ultrafiltration, and plasma resuscitation. It concludes that fluid management is critical for preventing secondary intra-abdominal hypertension and its associated poor outcomes.
1) Evidence suggests restrictive fluid infusion and avoidance of fluid overload during and after surgery can significantly reduce complications and length of postoperative hospital stay.
2) Goal-directed fluid therapy using cardiac output monitoring can help guide fluid titration and has been shown in some studies to reduce complications compared to standard fluid management without monitoring.
3) For lower risk surgery in fast-track programs, restrictive fluid protocols limiting intravenous fluids after surgery and encouraging early oral intake may be sufficient.
The document presents updated consensus definitions and clinical practice guidelines for intra-abdominal hypertension and abdominal compartment syndrome from the World Society of the Abdominal Compartment Syndrome. It retains definitions from 2006 and introduces new definitions accepted by the 2012 consensus panel. It provides recommendations and suggestions regarding measuring intra-abdominal pressure, adopting standard measurement techniques, utilizing monitoring and management protocols, and using decompressive laparotomy for overt abdominal compartment syndrome. The recommendations and suggestions are assigned grades based on quality of evidence.
The document discusses intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS). It provides definitions for IAH, ACS, and their grading levels according to the World Society of the Abdominal Compartment Syndrome. Measurement of intra-abdominal pressure via transbladder technique using a pressure transducer is recommended for monitoring critically ill patients at risk. Early detection and treatment of elevated pressures can help reduce organ dysfunction, mortality, and length of stay in the ICU.
The document provides recommendations from an international conference of experts on intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS). It recommends screening ICU patients for IAH/ACS risk factors and monitoring intra-abdominal pressure if risk factors are present. Serial measurements are necessary to guide management and prevent organ dysfunction. Medical and surgical interventions are outlined to treat IAH and ACS depending on severity, including maintaining adequate abdominal perfusion pressure. Further research is still needed to clarify unanswered questions.
This document presents definitions agreed upon by experts for intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS). IAH is defined as an intra-abdominal pressure of 12 mmHg or higher and is graded based on severity. ACS occurs when IAH is over 20 mmHg and is associated with new organ dysfunction. The definitions standardize measurement of intra-abdominal pressure via bladder at 25 ml saline and establish abdominal perfusion pressure as key. Primary ACS originates in the abdomen while secondary ACS occurs elsewhere and can recur after initial treatment.
BCC4: Michael Parr on ICU - Surviving Trauma GuidelinesSMACC Conference
Michael Parr, director of Liverpool ICU in Australia, speaks about "Surviving Trauma Guidelines". He does so through the use of an interesting case of a patient admitted to ICU following a MVA. This educational podcast was recorded at BCC4.
This document discusses intra-abdominal hypertension and the relationship between fluids and intra-abdominal pressure. It defines key terms like intra-abdominal pressure, intra-abdominal hypertension, and abdominal compartment syndrome. It then summarizes research showing that factors like obesity, sepsis, surgery, and large-volume crystalloid resuscitation can increase the risk of elevated intra-abdominal pressure. The document advocates limiting crystalloid use and explores strategies for removing excess fluids like using colloids, diuretics, ultrafiltration, and plasma resuscitation. It concludes that fluid management is critical for preventing secondary intra-abdominal hypertension and its associated poor outcomes.
1) Evidence suggests restrictive fluid infusion and avoidance of fluid overload during and after surgery can significantly reduce complications and length of postoperative hospital stay.
2) Goal-directed fluid therapy using cardiac output monitoring can help guide fluid titration and has been shown in some studies to reduce complications compared to standard fluid management without monitoring.
3) For lower risk surgery in fast-track programs, restrictive fluid protocols limiting intravenous fluids after surgery and encouraging early oral intake may be sufficient.
ADVANCE CARDIAC LIFE SUPPORT BY AKRAM KHANAkram Khan
The document discusses advanced cardiac life support (ACLS) and provides definitions, statistical data, and guidelines regarding cardiopulmonary resuscitation (CPR) techniques including chest compressions, airway management, ventilation, and use of advanced airway devices to support circulation and breathing during cardiac arrest. It emphasizes the importance of high-quality, continuous CPR with minimal interruptions and describes monitoring techniques and treatment algorithms to optimize outcomes for cardiac arrest patients.
Saif Presentation (2)_102514.pptx low pressure pneumoperitoneumLoloGhost
This thesis investigates the clinical outcomes of using low-pressure pneumoperitoneum compared to normal pressures during laparoscopic cholecystectomy. A randomized controlled trial was conducted with 100 patients, 50 in each group. The low-pressure group had pressures of 8-10 mmHg while the control group had the standard 12-15 mmHg. Results showed the low-pressure group had longer operating times but significantly less post-operative pain, nausea, and shoulder tip pain. While visualization and bleeding risks may be slightly impacted at lower pressures, overall patient recovery appeared improved with no significant safety issues observed.
Abdominal compartment syndrome (ACS) occurs when sustained elevated intra-abdominal pressure above 20 mmHg is associated with new organ dysfunction. Risk factors include aggressive fluid resuscitation, burns over 30% total body surface area, liver transplantation, and abdominal/retroperitoneal conditions. Physiologic consequences of increased intra-abdominal pressure include decreased cardiac preload and output, impaired pulmonary and renal function, and reduced splanchnic blood flow. Definitive diagnosis requires direct measurement of intra-abdominal pressure. Management involves supportive care, surgical decompression if medical therapies fail, and temporary abdominal closure during open abdomen treatment. Failure to recognize ACS can lead to multiple organ failure and death in 40
A 54-year old female underwent a major surgery for carcinoma ovary with significant blood loss requiring multiple transfusions. Post-operatively she developed signs of intra-abdominal hypertension including decreased urine output, elevated CVP and hypotension. Her intra-abdominal pressure was measured to be over 20 mmHg consistent with abdominal compartment syndrome, a condition where elevated intra-abdominal pressure compromises organ function. She required surgical decompression to relieve the pressure and allow organ recovery.
This document compares biofeedback training and manual training for correcting paradoxical breathing patterns in obese patients. It finds that biofeedback training using electromyography to monitor muscle activation is more effective than manual training alone. A study of 40 obese patients with paradoxical breathing found that those receiving 20 sessions of EMG biofeedback training had significantly increased abdominal breathing amplitude and decreased paradox compared to those receiving only manual training including diaphragmatic breathing exercises. The document concludes EMG biofeedback is an effective treatment for abnormal breathing patterns.
This document summarizes the key points about constipation disorder and its medical management. It defines constipation according to Rome IV criteria and notes that 11.8% of people in Bangladesh experience chronic constipation. It discusses the burden of constipation-predominant irritable bowel syndrome and differentiates between functional constipation and IBS-C. The document reviews diagnostic approaches and treatment options for constipation including various laxatives. It highlights the efficacy of linaclotide based on clinical trials for both constipation and IBS-C in improving symptoms of abdominal pain, constipation and bloating through its mechanism of action as a guanylate cyclase-C agonist.
This document provides guidelines for the management of severe sepsis and septic shock. It recommends beginning resuscitation immediately for patients with hypotension or elevated lactate and administering intravenous antibiotics within the first hour. Goals for resuscitation include a central venous pressure of 8-12 mmHg, mean arterial pressure of at least 65 mmHg, urine output of at least 0.5 mL/kg/hr, and central venous or mixed venous oxygen saturation of at least 70% or 65% respectively. A specific infection site should be established within 6 hours and source control measures implemented as soon as possible after initial resuscitation, with the exception of infected pancreatic necrosis.
Intra Abdominal hypertension&Abdominal Compartment SyndromeAbdulgafoor MT
This document discusses intra-abdominal hypertension and abdominal compartment syndrome. It provides a brief history of discoveries related to measuring intra-abdominal pressure and defining abdominal compartment syndrome. Key points covered include definitions of intra-abdominal pressure, abdominal perfusion pressure, and grades of increased intra-abdominal hypertension. Causes, prevalence, incidence and physiological effects on multiple organ systems are summarized. Methods of measuring intra-abdominal pressure and treatments including decompressive laparotomy and temporary closure techniques are also mentioned.
Eras thoracic komen dec 2020. e:a:c conferenceHelga Komen
This document discusses the implementation of an enhanced recovery after surgery (ERAS) protocol for lung surgery at Barnes-Jewish Hospital. It provides an overview of ERAS, the development of their lung surgery ERAS protocol, and the key elements of the preoperative, intraoperative, and postoperative protocol. The multidisciplinary team implemented the protocol in 2018 and continues monitoring outcomes through regular meetings and quality improvement audits to optimize recovery for patients undergoing lung surgery.
Abdominal compartment syndrome (ACS) occurs when sustained high intra-abdominal pressure (>20 mmHg) causes organ dysfunction. It is increasingly recognized in critically ill patients and can lead to multi-organ failure if not treated. Intra-abdominal pressure is normally 5-7 mmHg but becomes a concern above 12 mmHg and dangerous above 20 mmHg. Causes include abdominal bleeding, edema from fluid resuscitation, and abdominal wall closure under tension. Early detection by bladder pressure monitoring and treatment by optimizing abdominal perfusion pressure can prevent progression to ACS and improve outcomes. Decompressive laparotomy may be needed for refractory cases.
The document discusses guidelines for the management of achalasia cardia. It provides definitions and classifications for achalasia. It outlines the appropriate diagnostic evaluation and treatment approaches for achalasia based on the level of facility - whether it is a secondary/non-metro hospital or a tertiary/metro super specialty center. Investigations and treatment options are more limited at secondary centers, while tertiary centers can utilize advanced tests like high resolution manometry and perform endoscopic or surgical therapies.
This document discusses the implementation of clinical practice guidelines for sepsis, specifically the Surviving Sepsis Campaign guidelines. It finds that while guidelines can be helpful, they are often not followed by more than 50% of clinicians. The document presents strategies to improve adherence through performance improvement initiatives at one medical center. These include identifying gaps in timely screening, diagnosis, initial resuscitation, antibiotics, and addressing goals of care. The focus is on both early identification and treatment of sepsis as well as the critical role of nurses in performance improvement efforts to optimize outcomes for patients with sepsis.
Enhanced external counterpulsation (eecp) role inMonir zaman
Enhanced external counterpulsation (EECP) involves the use of inflatable cuffs wrapped around the lower extremities that are synchronized with the cardiac cycle to improve coronary perfusion. A study investigated EECP in patients with heart failure and found it improved exercise duration but not peak oxygen consumption compared to medical therapy alone. While EECP appears safe, more research is still needed to determine its efficacy in treating heart failure.
The ProCESS trial found no significant difference in mortality between patients receiving protocol-based early goal-directed therapy (EGDT), protocol-based standard therapy, or usual care for early septic shock. While the EGDT group received fluid resuscitation more consistently, there were no differences in outcomes like mortality, organ failure, or length of stay. This prompted review by the Surviving Sepsis Campaign. They concluded that early diagnosis and treatment remain important. ProCESS did not assess patients with severe sepsis without shock. It also showed improved usual care since 2001, with mortality dropping from 46.5% to 18%, so key bundles should still be followed.
Medical device-Gastric banding- presented at Humber-By Shally bhardwajshallybhardwaj
This document summarizes a clinical trial comparing gastric bypass surgery and gastric banding for treating morbid obesity. 197 patients were randomly assigned to either laparoscopic gastric bypass (n=111) or laparoscopic adjustable gastric banding (LAP-BAND, n=86). The trial measured weight loss, quality of life improvements, costs, and complication rates over 5 years. At 5 years, gastric bypass resulted in greater excess weight loss than gastric banding (68.4% vs 45.4%). However, gastric bypass had higher complication and mortality rates in the first 30 days compared to gastric banding. The trial provides long-term data on the safety, efficacy and outcomes of these two bariatric surgery procedures.
1. The patient is experiencing dynamic hyperinflation from an acute asthma exacerbation, evidenced by unchanged plateau pressures but rising peak airway pressures over time.
2. Additional therapies needed include bronchodilators to reduce airflow obstruction and respiratory muscle fatigue, as well as optimizing ventilator settings to decrease the work of breathing.
3. Dynamic hyperinflation can lead to hypotension and cardiovascular instability in acute asthma or COPD exacerbations if not addressed.
Surgery
This document discusses damage control surgery (DCS), which is an abbreviated laparotomy designed to prioritize physiological recovery over anatomical reconstruction for seriously injured patients. It has four phases: pre-hospital resuscitation (Phase 0), abbreviated laparotomy to control bleeding and contamination (Phase I), intensive care to restore physiology (Phase II), and definitive repair once stabilized (Phase III). The goals of DCS are to restore physiology first before completing anatomical reconstruction, in order to improve survival outcomes for major trauma patients.
Dexmedetomidine and dexamethasone were compared as adjuvants to intrathecal bupivacaine for lower limb surgery. Dexmedetomidine prolonged the duration of spinal anesthesia and postoperative analgesia more than dexamethasone or saline control. It provided longer time to first analgesic request and less total analgesic consumption than the other groups. Dexmedetomidine also had higher patient satisfaction with pain control.
ERAS Cardiac is an evidence-based, multidisciplinary initiative to standardize perioperative care and promote faster recovery for cardiac surgery patients. It includes 22 interventions divided into pre, intra, and postoperative phases. Implementation of ERAS Cardiac protocols resulted in decreased length of stay, ICU hours, and complications, as well as increased patient satisfaction compared to conventional care. Standardizing key processes like preoperative education, intraoperative glycemic control, and multimodal analgesia through a team-based approach can successfully enhance recovery after cardiac surgery.
This document discusses sepsis and septic shock. It defines sepsis as a life-threatening organ dysfunction caused by a dysregulated host response to infection. Septic shock involves circulatory and metabolic abnormalities that increase mortality risk. The document reviews signs, laboratory findings, scoring systems, management principles, and treatment approaches for sepsis and septic shock such as early antibiotics, fluid resuscitation, vasopressors, inotropes, and glycemic control. The goal of treatment is to recognize sepsis early and provide timely, targeted resuscitation to improve outcomes.
“Psychiatry and the Humanities”: An Innovative Course at the University of Mo...Université de Montréal
“Psychiatry and the Humanities”: An Innovative Course at the University of Montreal Expanding the medical model to embrace the humanities. Link: https://www.psychiatrictimes.com/view/-psychiatry-and-the-humanities-an-innovative-course-at-the-university-of-montreal
ADVANCE CARDIAC LIFE SUPPORT BY AKRAM KHANAkram Khan
The document discusses advanced cardiac life support (ACLS) and provides definitions, statistical data, and guidelines regarding cardiopulmonary resuscitation (CPR) techniques including chest compressions, airway management, ventilation, and use of advanced airway devices to support circulation and breathing during cardiac arrest. It emphasizes the importance of high-quality, continuous CPR with minimal interruptions and describes monitoring techniques and treatment algorithms to optimize outcomes for cardiac arrest patients.
Saif Presentation (2)_102514.pptx low pressure pneumoperitoneumLoloGhost
This thesis investigates the clinical outcomes of using low-pressure pneumoperitoneum compared to normal pressures during laparoscopic cholecystectomy. A randomized controlled trial was conducted with 100 patients, 50 in each group. The low-pressure group had pressures of 8-10 mmHg while the control group had the standard 12-15 mmHg. Results showed the low-pressure group had longer operating times but significantly less post-operative pain, nausea, and shoulder tip pain. While visualization and bleeding risks may be slightly impacted at lower pressures, overall patient recovery appeared improved with no significant safety issues observed.
Abdominal compartment syndrome (ACS) occurs when sustained elevated intra-abdominal pressure above 20 mmHg is associated with new organ dysfunction. Risk factors include aggressive fluid resuscitation, burns over 30% total body surface area, liver transplantation, and abdominal/retroperitoneal conditions. Physiologic consequences of increased intra-abdominal pressure include decreased cardiac preload and output, impaired pulmonary and renal function, and reduced splanchnic blood flow. Definitive diagnosis requires direct measurement of intra-abdominal pressure. Management involves supportive care, surgical decompression if medical therapies fail, and temporary abdominal closure during open abdomen treatment. Failure to recognize ACS can lead to multiple organ failure and death in 40
A 54-year old female underwent a major surgery for carcinoma ovary with significant blood loss requiring multiple transfusions. Post-operatively she developed signs of intra-abdominal hypertension including decreased urine output, elevated CVP and hypotension. Her intra-abdominal pressure was measured to be over 20 mmHg consistent with abdominal compartment syndrome, a condition where elevated intra-abdominal pressure compromises organ function. She required surgical decompression to relieve the pressure and allow organ recovery.
This document compares biofeedback training and manual training for correcting paradoxical breathing patterns in obese patients. It finds that biofeedback training using electromyography to monitor muscle activation is more effective than manual training alone. A study of 40 obese patients with paradoxical breathing found that those receiving 20 sessions of EMG biofeedback training had significantly increased abdominal breathing amplitude and decreased paradox compared to those receiving only manual training including diaphragmatic breathing exercises. The document concludes EMG biofeedback is an effective treatment for abnormal breathing patterns.
This document summarizes the key points about constipation disorder and its medical management. It defines constipation according to Rome IV criteria and notes that 11.8% of people in Bangladesh experience chronic constipation. It discusses the burden of constipation-predominant irritable bowel syndrome and differentiates between functional constipation and IBS-C. The document reviews diagnostic approaches and treatment options for constipation including various laxatives. It highlights the efficacy of linaclotide based on clinical trials for both constipation and IBS-C in improving symptoms of abdominal pain, constipation and bloating through its mechanism of action as a guanylate cyclase-C agonist.
This document provides guidelines for the management of severe sepsis and septic shock. It recommends beginning resuscitation immediately for patients with hypotension or elevated lactate and administering intravenous antibiotics within the first hour. Goals for resuscitation include a central venous pressure of 8-12 mmHg, mean arterial pressure of at least 65 mmHg, urine output of at least 0.5 mL/kg/hr, and central venous or mixed venous oxygen saturation of at least 70% or 65% respectively. A specific infection site should be established within 6 hours and source control measures implemented as soon as possible after initial resuscitation, with the exception of infected pancreatic necrosis.
Intra Abdominal hypertension&Abdominal Compartment SyndromeAbdulgafoor MT
This document discusses intra-abdominal hypertension and abdominal compartment syndrome. It provides a brief history of discoveries related to measuring intra-abdominal pressure and defining abdominal compartment syndrome. Key points covered include definitions of intra-abdominal pressure, abdominal perfusion pressure, and grades of increased intra-abdominal hypertension. Causes, prevalence, incidence and physiological effects on multiple organ systems are summarized. Methods of measuring intra-abdominal pressure and treatments including decompressive laparotomy and temporary closure techniques are also mentioned.
Eras thoracic komen dec 2020. e:a:c conferenceHelga Komen
This document discusses the implementation of an enhanced recovery after surgery (ERAS) protocol for lung surgery at Barnes-Jewish Hospital. It provides an overview of ERAS, the development of their lung surgery ERAS protocol, and the key elements of the preoperative, intraoperative, and postoperative protocol. The multidisciplinary team implemented the protocol in 2018 and continues monitoring outcomes through regular meetings and quality improvement audits to optimize recovery for patients undergoing lung surgery.
Abdominal compartment syndrome (ACS) occurs when sustained high intra-abdominal pressure (>20 mmHg) causes organ dysfunction. It is increasingly recognized in critically ill patients and can lead to multi-organ failure if not treated. Intra-abdominal pressure is normally 5-7 mmHg but becomes a concern above 12 mmHg and dangerous above 20 mmHg. Causes include abdominal bleeding, edema from fluid resuscitation, and abdominal wall closure under tension. Early detection by bladder pressure monitoring and treatment by optimizing abdominal perfusion pressure can prevent progression to ACS and improve outcomes. Decompressive laparotomy may be needed for refractory cases.
The document discusses guidelines for the management of achalasia cardia. It provides definitions and classifications for achalasia. It outlines the appropriate diagnostic evaluation and treatment approaches for achalasia based on the level of facility - whether it is a secondary/non-metro hospital or a tertiary/metro super specialty center. Investigations and treatment options are more limited at secondary centers, while tertiary centers can utilize advanced tests like high resolution manometry and perform endoscopic or surgical therapies.
This document discusses the implementation of clinical practice guidelines for sepsis, specifically the Surviving Sepsis Campaign guidelines. It finds that while guidelines can be helpful, they are often not followed by more than 50% of clinicians. The document presents strategies to improve adherence through performance improvement initiatives at one medical center. These include identifying gaps in timely screening, diagnosis, initial resuscitation, antibiotics, and addressing goals of care. The focus is on both early identification and treatment of sepsis as well as the critical role of nurses in performance improvement efforts to optimize outcomes for patients with sepsis.
Enhanced external counterpulsation (eecp) role inMonir zaman
Enhanced external counterpulsation (EECP) involves the use of inflatable cuffs wrapped around the lower extremities that are synchronized with the cardiac cycle to improve coronary perfusion. A study investigated EECP in patients with heart failure and found it improved exercise duration but not peak oxygen consumption compared to medical therapy alone. While EECP appears safe, more research is still needed to determine its efficacy in treating heart failure.
The ProCESS trial found no significant difference in mortality between patients receiving protocol-based early goal-directed therapy (EGDT), protocol-based standard therapy, or usual care for early septic shock. While the EGDT group received fluid resuscitation more consistently, there were no differences in outcomes like mortality, organ failure, or length of stay. This prompted review by the Surviving Sepsis Campaign. They concluded that early diagnosis and treatment remain important. ProCESS did not assess patients with severe sepsis without shock. It also showed improved usual care since 2001, with mortality dropping from 46.5% to 18%, so key bundles should still be followed.
Medical device-Gastric banding- presented at Humber-By Shally bhardwajshallybhardwaj
This document summarizes a clinical trial comparing gastric bypass surgery and gastric banding for treating morbid obesity. 197 patients were randomly assigned to either laparoscopic gastric bypass (n=111) or laparoscopic adjustable gastric banding (LAP-BAND, n=86). The trial measured weight loss, quality of life improvements, costs, and complication rates over 5 years. At 5 years, gastric bypass resulted in greater excess weight loss than gastric banding (68.4% vs 45.4%). However, gastric bypass had higher complication and mortality rates in the first 30 days compared to gastric banding. The trial provides long-term data on the safety, efficacy and outcomes of these two bariatric surgery procedures.
1. The patient is experiencing dynamic hyperinflation from an acute asthma exacerbation, evidenced by unchanged plateau pressures but rising peak airway pressures over time.
2. Additional therapies needed include bronchodilators to reduce airflow obstruction and respiratory muscle fatigue, as well as optimizing ventilator settings to decrease the work of breathing.
3. Dynamic hyperinflation can lead to hypotension and cardiovascular instability in acute asthma or COPD exacerbations if not addressed.
Surgery
This document discusses damage control surgery (DCS), which is an abbreviated laparotomy designed to prioritize physiological recovery over anatomical reconstruction for seriously injured patients. It has four phases: pre-hospital resuscitation (Phase 0), abbreviated laparotomy to control bleeding and contamination (Phase I), intensive care to restore physiology (Phase II), and definitive repair once stabilized (Phase III). The goals of DCS are to restore physiology first before completing anatomical reconstruction, in order to improve survival outcomes for major trauma patients.
Dexmedetomidine and dexamethasone were compared as adjuvants to intrathecal bupivacaine for lower limb surgery. Dexmedetomidine prolonged the duration of spinal anesthesia and postoperative analgesia more than dexamethasone or saline control. It provided longer time to first analgesic request and less total analgesic consumption than the other groups. Dexmedetomidine also had higher patient satisfaction with pain control.
ERAS Cardiac is an evidence-based, multidisciplinary initiative to standardize perioperative care and promote faster recovery for cardiac surgery patients. It includes 22 interventions divided into pre, intra, and postoperative phases. Implementation of ERAS Cardiac protocols resulted in decreased length of stay, ICU hours, and complications, as well as increased patient satisfaction compared to conventional care. Standardizing key processes like preoperative education, intraoperative glycemic control, and multimodal analgesia through a team-based approach can successfully enhance recovery after cardiac surgery.
This document discusses sepsis and septic shock. It defines sepsis as a life-threatening organ dysfunction caused by a dysregulated host response to infection. Septic shock involves circulatory and metabolic abnormalities that increase mortality risk. The document reviews signs, laboratory findings, scoring systems, management principles, and treatment approaches for sepsis and septic shock such as early antibiotics, fluid resuscitation, vasopressors, inotropes, and glycemic control. The goal of treatment is to recognize sepsis early and provide timely, targeted resuscitation to improve outcomes.
“Psychiatry and the Humanities”: An Innovative Course at the University of Mo...Université de Montréal
“Psychiatry and the Humanities”: An Innovative Course at the University of Montreal Expanding the medical model to embrace the humanities. Link: https://www.psychiatrictimes.com/view/-psychiatry-and-the-humanities-an-innovative-course-at-the-university-of-montreal
Spontaneous Bacterial Peritonitis - Pathogenesis , Clinical Features & Manage...Jim Jacob Roy
In this presentation , SBP ( spontaneous bacterial peritonitis ) , which is a common complication in patients with cirrhosis and ascites is described in detail.
The reference for this presentation is Sleisenger and Fordtran's Gastrointestinal and Liver Disease Textbook ( 11th edition ).
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7shruti jagirdar
Unit 4: MRA 103T Regulatory affairs
This guideline is directed principally toward new Molecular Entities that are
likely to have significant use in the elderly, either because the disease intended
to be treated is characteristically a disease of aging ( e.g., Alzheimer's disease) or
because the population to be treated is known to include substantial numbers of
geriatric patients (e.g., hypertension).
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
Nutritional deficiency Disorder are problems in india.
It is very important to learn about Indian child's nutritional parameters as well the Disease related to alteration in their Nutrition.
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)MuskanShingari
Statistics- Statistics is the science of collecting, organizing, presenting, analyzing and interpreting numerical data to assist in making more effective decisions.
A statistics is a measure which is used to estimate the population parameter
Parameters-It is used to describe the properties of an entire population.
Examples-Measures of central tendency Dispersion, Variance, Standard Deviation (SD), Absolute Error, Mean Absolute Error (MAE), Eigen Value
The biomechanics of running involves the study of the mechanical principles underlying running movements. It includes the analysis of the running gait cycle, which consists of the stance phase (foot contact to push-off) and the swing phase (foot lift-off to next contact). Key aspects include kinematics (joint angles and movements, stride length and frequency) and kinetics (forces involved in running, including ground reaction and muscle forces). Understanding these factors helps in improving running performance, optimizing technique, and preventing injuries.
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
The Children are very vulnerable to get affected with respiratory disease.
In our country, the respiratory Disease conditions are consider as major cause for mortality and Morbidity in Child.
Are you looking for a long-lasting solution to your missing tooth?
Dental implants are the most common type of method for replacing the missing tooth. Unlike dentures or bridges, implants are surgically placed in the jawbone. In layman’s terms, a dental implant is similar to the natural root of the tooth. It offers a stable foundation for the artificial tooth giving it the look, feel, and function similar to the natural tooth.
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
1. The World Society of the
Abdominal Compartment
Syndrome
(www.wsacs.org)
presents
2. Intra-abdominal Hypertension and
the Abdominal Compartment
Syndrome: Updated Consensus
Definitions and Clinical Practice
Guidelines from the World Society
of the Abdominal Compartment
Syndrome
5. Retained Definitions from the
Original 2006 Consensus
Statements1
• 1) Intra-abdominal pressure (IAP) is
the steady-state pressure concealed
within the abdominal cavity.
1Malbrain ML et al., Results from the International Conference of Experts on Intra-Abdominal hypertension and
Abdominal Compartment Syndrome. I. Definitions , Intensive Care Medicine 2006;32:1722 -1732
6. Retained Definitions from the
Original 2006 Consensus
Statements1
• 2) The reference standard for
intermittent IAP measurements is via
the bladder with a maximal instillation
volume of 25 mL of sterile saline.
1Malbrain ML et al., Results from the International Conference of Experts on Intra-Abdominal hypertension and
Abdominal Compartment Syndrome. I. Definitions , Intensive Care Medicine 2006;32:1722 -1732
7. Retained Definitions from the
Original 2006 Consensus
Statements1
• 3) IAP should be expressed in mmHg and
measured at end-expiration in the
complete supine position after ensuring
that abdominal muscle contractions are
absent and with the transducer zeroed at
the level of the midaxillary line.
1Malbrain ML et al., Results from the International Conference of Experts on Intra-Abdominal hypertension and
Abdominal Compartment Syndrome. I. Definitions , Intensive Care Medicine 2006;32:1722 -1732
8. Retained Definitions from the
Original 2006 Consensus
Statements1
• 4) The IAP is approximately 5-7
mmHg in critically ill adults
1Malbrain ML et al., Results from the International Conference of Experts on Intra-Abdominal hypertension and
Abdominal Compartment Syndrome. I. Definitions , Intensive Care Medicine 2006;32:1722 -1732
9. Retained Definitions from the
Original 2006 Consensus
Statements1
• 5) IAH is defined by a sustained or
repeated pathological elevation in
IAP > 12 mmHg
1Malbrain ML et al., Results from the International Conference of Experts on Intra-Abdominal hypertension and
Abdominal Compartment Syndrome. I. Definitions , Intensive Care Medicine 2006;32:1722 -1732
10. Retained Definitions from the
Original 2006 Consensus
Statements1
• 6) ACS is defined as a sustained
IAP>20mmHg (with or without an
APP < 60mmHg) that is associated
with new organ dysfunction/failure
1Malbrain ML et al., Results from the International Conference of Experts on Intra-Abdominal hypertension and
Abdominal Compartment Syndrome. I. Definitions , Intensive Care Medicine 2006;32:1722 -1732
11. Retained Definitions from the
Original 2006 Consensus
Statements1
• 7) IAH is graded as follows:
Grade I, IAP 12-15 mmHg
Grade II, IAP 16-20 mmHg
Grade III, IAP 21-25 mmHg
Grade IV, IAP > 25 mmHg
1Malbrain ML et al., Results from the International Conference of Experts on Intra-Abdominal hypertension and
Abdominal Compartment Syndrome. I. Definitions , Intensive Care Medicine 2006;32:1722 -1732
12. Retained Definitions from the
Original 2006 Consensus
Statements1
• 8) Primary IAH or ACS is a condition
associated with injury or disease in the
abdominopelvic region that frequently
requires early surgical or interventional
radiological intervention
1Malbrain ML et al., Results from the International Conference of Experts on Intra-Abdominal hypertension and
Abdominal Compartment Syndrome. I. Definitions , Intensive Care Medicine 2006;32:1722 -1732
13. Retained Definitions from the
Original 2006 Consensus
Statements1
• 9) Secondary IAH or ACS refers to
conditions that do not originate from
the abdominopelvic region.
1Malbrain ML et al., Results from the International Conference of Experts on Intra-Abdominal hypertension and
Abdominal Compartment Syndrome. I. Definitions , Intensive Care Medicine 2006;32:1722 -1732
14. Retained Definitions from the
Original 2006 Consensus
Statements1
• 10) Recurrent IAH or ACS refers to the
condition in which ACS redevelops
following previous surgical or medical
treatment of primary or secondary ACS
1Malbrain ML et al., Results from the International Conference of Experts on Intra-Abdominal hypertension and
Abdominal Compartment Syndrome. I. Definitions , Intensive Care Medicine 2006;32:1722 -1732
15. Retained Definitions from the
Original 2006 Consensus
Statements1
• 11) Abdominal perfusion pressure
(APP) =Mean arterial pressure (MAP)
– IAP
1Malbrain ML et al., Results from the International Conference of Experts on Intra-Abdominal hypertension and
Abdominal Compartment Syndrome. I. Definitions , Intensive Care Medicine 2006;32:1722 -1732
16. Retained Definitions from the
Original 2006 Consensus
Statements1
• 2) The reference standard for
intermittent IAP measurements is via
the bladder with a maximal instillation
volume of 25 mL of sterile saline.
1Malbrain ML et al., Results from the International Conference of Experts on Intra-Abdominal hypertension and
Abdominal Compartment Syndrome. I. Definitions , Intensive Care Medicine 2006;32:1722 -1732
18. Retained Definitions from the
Original 2006 Consensus
Statements1
• 12) A poly-compartment syndrome is
a condition where two or more
anatomical compartments have
elevated compartmental pressures.
1Malbrain ML et al., Results from the International Conference of Experts on Intra-Abdominal hypertension and
Abdominal Compartment Syndrome. I. Definitions , Intensive Care Medicine 2006;32:1722 -1732
19. Retained Definitions from the
Original 2006 Consensus
Statements1
• 13) Abdominal compliance quantifies the ease
of abdominal expansion, is determined by the
elasticity of the abdominal wall and diaphragm,
and is expressed as the change in intra-
abdominal volume per change in intra-
abdominal pressure.
1Malbrain ML et al., Results from the International Conference of Experts on Intra-Abdominal hypertension and
Abdominal Compartment Syndrome. I. Definitions , Intensive Care Medicine 2006;32:1722 -1732
20. Retained Definitions from the
Original 2006 Consensus
Statements1
• 14) An open abdomen is any abdomen
requiring a temporary abdominal closure due
to the skin and fascia not being closed after
laparotomy. The technique of temporary
abdominal closure should be explicitly
described.
1Malbrain ML et al., Results from the International Conference of Experts on Intra-Abdominal hypertension and
Abdominal Compartment Syndrome. I. Definitions , Intensive Care Medicine 2006;32:1722 -1732
21. Retained Definitions from the
Original 2006 Consensus
Statements1
• 15) Lateralization of the abdominal wall
refers to the phenomenon whereby the
musculature and fascia of the abdominal
wall, most well seen by the rectus
abdominus muscles and their enveloping
fascia, move lateraly away from the midine
with time.
1Malbrain ML et al., Results from the International Conference of Experts on Intra-Abdominal hypertension and
Abdominal Compartment Syndrome. I. Definitions , Intensive Care Medicine 2006;32:1722 -1732
22. Classification System for the
Complexity of an Open abdomen
1Bjorck M, Bruhin A, Cheatham M, et al. Classification--important step to improve management of patients with an
open abdomen. World J Surg 2009; 33(6):1154-7.
25. Recommendations
• Updated consensus definitions and management
statements were then derived using a modified
Delphi method and the Grading of
Recommendations, Assessment, Development,
and Evaluation (GRADE) methodology. Quality of
evidence was graded from high (A) to very low
(D) and management statements from strong
RECOMMENDATIONS (desirable effects clearly
outweigh potential undesirable ones) to weaker
SUGGESTIONS (potential risks and benefits of the
intervention are less clear).
26. Consensus Management
Statements - Recommendation
• 1) We RECOMMEND measuring intra-
abdominal pressure versus not when any
known risk factor for IAH/ACS is present in
critically ill or injured patients1 (Unchanged
Management Recommendation 1 [GRADE 1C]).
1Risk Factors are presented in the next slide
30. Consensus Management
Statements - Recommendation
• 2) We also RECOMMEND that studies of IAH
or ACS adopt the trans-bladder technique as
a standard IAP measurement technique1
(Unchanged Management Recommendation
2; [not GRADED]).
1Risk IAP should be expressed in mmHg and measured at end-expiration in
the complete supine position after ensuring that abdominal muscle
contractions are absent and with the transducer zeroed at the level of the
midaxillary line.
31. Consensus Management
Statements - Recommendation
• 3) we RECOMMEND use of protocolized
monitoring and management of IAP versus
not (New Management Recommendation 3
[GRADE 1C]).
32. Consensus Management
Statements - Recommendation
• 4) Efforts and/or protocols should be utilized
to avoid sustained IAH in critically ill patients
GRADE 1C
33. Consensus Management
Statements - Recommendation
• 5) We recommend decompressive
laparotomy to decrease IAP in cases of overt
ACS compared to strategies that do not use
decompressive laparotomy in critically ill
adults with ACS [GRADE 1D]
34. Consensus Management
Statements - Recommendation
• 6) We recommend that among ICU patients
with open abdominal wounds, conscious
and/or protocolized efforts be made to obtain
an early or at least same hospital stay closure
[GRADE 1D]
35. Consensus Management
Statements - Recommendation
• 7) We recommend that among critically
ill/injured patients with open abdominal
wounds, strategies utilizing negative pressure
wound therapy should be used versus not
[GRADE 1C]
36. Suggestions
• Updated consensus definitions and management
statements were then derived using a modified
Delphi method and the Grading of
Recommendations, Assessment, Development,
and Evaluation (GRADE) methodology. Quality of
evidence was graded from high (A) to very low
(D) and management statements from strong
RECOMMENDATIONS (desirable effects clearly
outweigh potential undesirable ones) to weaker
SUGGESTIONS (potential risks and benefits of the
intervention are less clear).
37. Consensus Management
Statements - Suggestions
• 1) We suggest that critically ill or injured
patients receive optimal pain and anxiety
relief [GRADE 2D]
38. Consensus Management
Statements - Suggestions
• 2) We suggest brief trials of neuromuscular
blockade as temporizing measure in the
treatment of IAH [GRADE 2D]
39. Consensus Management
Statements - Suggestions
• 3) We suggest that the potential contribution
of body position to elevated IAP be considered
among patients with, or at risk of, IAH or ACS
[GRADE 2D]
40. Consensus Management
Statements - Suggestions
• 4) We suggest using a protocol to try and
avoid a positive cumulative fluid balance in
the critically ill or injured patient with, or at
risk of, IAH, after the acute resuscitation has
been completed and the inciting issues/source
control have been addressed [GRADE 2C]
41. Consensus Management
Statements - Suggestions
• 5) We suggest use of an enhanced ratio of
plasma/packed red blood cells for
resuscitation of massive hemorrhage versus
low or no attention to plasma/packed red
blood cell ratios [GRADE 2D]
42. Consensus Management
Statements - Suggestions
• We suggest use of PCD to remove fluid (in the setting
of obvious intraperitoneal fluid) in those with
IAH/ACS when this is technically possible compared
to doing nothing [GRADE 2C].
• We also suggest using PCD to remove fluid (in the
setting of obvious intraperitoneal fluid) in those with
IAH/ACS when this is technically possible compared
to immediate decompressive laparotomy as this may
alleviate the need for decompressive laparotomy
[GRADE 2D]
43. Consensus Management
Statements - Suggestions
• 7) We suggest that patients undergoing
laparotomy for trauma suffering from
physiologic exhaustion be treated with the
prophylactic use of the open abdomen versus
closure and expectant IAP management
[GRADE 2D]
44. Consensus Management
Statements - Suggestions
• 8) We suggest not to routinely utilize the open
abdomen for patients with severe
intraperitoneal contamination undergoing
emergency laparotomy for intra-abdominal
sepsis unless IAH is a specific concern [GRADE
2B]
45. Consensus Management
Statements - Suggestions
• 9) We suggest that bioprosthetic meshes
should not be routinely used in the early
closure of the open abdomen compared to
alternative strategies [GRADE 2D]
46. No Recommendations
• Updated consensus definitions and management
statements were then derived using a modified
Delphi method and the Grading of
Recommendations, Assessment, Development,
and Evaluation (GRADE) methodology. Quality of
evidence was graded from high (A) to very low
(D) and management statements from strong
RECOMMENDATIONS (desirable effects clearly
outweigh potential undesirable ones) to weaker
SUGGESTIONS (potential risks and benefits of the
intervention are less clear).
47. Consensus Management
Statements
• 1) We could make no recommendation
regarding use of abdominal perfusion pressure
in the resuscitation/management of the
critically ill/injured
48. Consensus Management
Statements
• 2) We could make no recommendation
regarding use of diuretics to mobilize fluids in
hemodynamically stable patients with IAH
after the acute resuscitation has been
completed and the inciting issues/source
control have been addressed
49. Consensus Management
Statements
• 3) We could make no recommendation
regarding the use of renal replacement
therapies to mobilize fluid in
hemodynamically stable patients with IAH
after the acute resuscitation has been
completed and the inciting issues/source
control have been addressed
50. Consensus Management
Statements
• 4) We could make n o recommendation
regarding the administration of albumin
versus not, to mobilize fluid in
hemodynamically stable patients with IAH
after the acute resuscitation has been
completed and the inciting issues/source
control have been addressed
51. Consensus Management
Statements
• 5) We could make no recommendation
regarding the prophylactic use of the open
abdomen in non-trauma acute care surgery
patients with physiologic exhaustion versus
closing and expectant IAP management
52. Consensus Management
Statements
• 6) We could make no recommendation
regarding use of the component separation
technique to facilitate early fascial closure
versus not