Kimball Edward J, Rollins Michael D, Mone Mary C, Hansen Heidi J, Baraghoshi Gabriele K, Johnston Cory, Day Evan S, Jackson Peter R, Payne Marielle, Barton Richard G
University of Utah Health Sciences Center, Salt Lake City, 84132, USA.
Crit Care Med. 2006 Sep;34(9):2340-8. doi: 10.1097/01.CCM.0000233874.88032.1C.
To assess current understanding and clinical management of intra-abdominal hypertension and abdominal compartment syndrome among critical care physicians.
A ten-question, written survey.
University health sciences center.
Physician members of the Society of Critical Care Medicine (SCCM).
The survey was sent to 4,538 SCCM members with a response rate of 35.7% (1622).
Primary training, intensive care unit type, and methods for management of abdominal compartment syndrome were assessed. Surgically trained intensivists managed the highest number of abdominal compartment syndrome cases (47% managed 4-10 cases, 16% managed >10 cases). No cases were seen by 25% of medically trained and pediatric trained intensivists. Respondents agreed that bladder pressures and clinical variables were needed to diagnose abdominal compartment syndrome (70%) vs. bladder pressure (7%) or clinical variables (20%) alone. Two percent of surgical intensivists were unaware of a bladder pressure measurement procedure compared with 24% (p < .0001) of pediatric and 23% (p < .0001) of medical intensivists. Forty-two percent of respondents believed bladder pressures of 20-27 mm Hg may cause physiologic compromise. However, 25-27% of pediatric, medicine, or anesthesia trained intensivists believed that compromise occurs between 12 and 19 mm Hg compared with 18% of surgeons. No respondent believed that physiologic compromise occurred at <8 mm Hg. Thirty-eight percent of pediatric intensivists believed that physiologic compromise was patient dependent vs. 7-17% from other specialties (p < .0001; all comparisons). In managing intra-abdominal hypertension, 33% of pediatric intensivists and 19.6% of medical intensivists would never use decompression laparotomy to treat abdominal compartment syndrome compared with 3.6% of intensivists with surgical training (p < .0001; both comparisons).
Significant variation across medical training exists in the management of intra-abdominal hypertension and abdominal compartment syndrome. A significant percentage of intensivists may be unaware of current approaches to abdominal compartment syndrome management including monitoring bladder pressures and decompression laparotomy. Future research and education are necessary to establish clear diagnostic criteria and standards for treatment of this relatively common life-threatening disease process.
评估重症监护医师对腹腔内高压和腹腔间隔室综合征的当前认识及临床管理情况。
一项包含10个问题的书面调查。
大学健康科学中心。
危重病医学会（SCCM）的医师成员。
向4538名SCCM成员发放调查问卷，回复率为35.7%（1622人）。
评估主要培训经历、重症监护病房类型以及腹腔间隔室综合征的管理方法。接受过外科培训的重症监护医师处理的腹腔间隔室综合征病例数量最多（47%处理4 - 10例，16%处理超过10例）。25%接受过内科培训和儿科培训的重症监护医师未见过相关病例。受访者一致认为诊断腹腔间隔室综合征需要膀胱压力和临床变量（70%），而单独依靠膀胱压力（7%）或临床变量（20%）的情况较少。2%的外科重症监护医师不了解膀胱压力测量程序，相比之下，儿科重症监护医师中有24%（p <.0001），内科重症监护医师中有23%（p <.0001）不了解。42%的受访者认为膀胱压力在20 - 27 mmHg可能导致生理功能受损。然而，25 - 27%接受过儿科、内科或麻醉培训的重症监护医师认为在12 - 19 mmHg之间会出现生理功能受损，而外科医师中这一比例为18%。没有受访者认为在<8 mmHg时会出现生理功能受损。38%的儿科重症监护医师认为生理功能受损情况因患者而异，相比之下其他专科的比例为7 - 17%（p <.0001；所有比较）。在处理腹腔内高压时，33%的儿科重症监护医师和19.6%的内科重症监护医师从未使用减压剖腹术治疗腹腔间隔室综合征，而接受过外科培训的重症监护医师中这一比例为3.6%（p <.0001；两项比较）。
在腹腔内高压和腹腔间隔室综合征的管理方面，医学培训背景存在显著差异。相当比例的重症监护医师可能不了解腹腔间隔室综合征的当前管理方法，包括监测膀胱压力和减压剖腹术。未来有必要进行研究和开展教育，以建立针对这种相对常见的危及生命的疾病过程的明确诊断标准和治疗规范。
