Malbrain M L N G, De laet I, Cheatham M
Intensive Care Unit, ZiekenhuisNetwerk Antwerpen, campus Stuivenberg, Antwerpen, Belgium.
Acta Clin Belg. 2007;62 Suppl 1:44-59.
There has been an exponentially increasing interest in intraabdominal hypertension (IAH) and the abdominal compartment syndrome (ACS) over the last decade, and different definitions have been suggested. Nevertheless, there has been an impetus from experts in the field to modify these definitions to reflect our current understanding of the pathophysiology of these syndromes. An international multidisciplinary group of interested doctors met with the goal of agreeing on a set of definitions that could be applied to patients with IAH and ACS. The goal of this consensus group was to provide a conceptual and practical framework to further define ACS, a progressive injurious process that falls under the generalized term 'IAH' and that includes IAH-associated organ dysfunction.
In total, 21 North American, Australasian and European surgical, trauma and critical care specialists agreed to standardize the current definitions for IAH, ACS and related conditions in preparation for the second World Congress on Abdominal Compartment Syndrome (WCACS). The WCACS-meeting was endorsed by the European Society of Intensive Care Medicine (ESICM) and the World Society on Abdominal Compartment Syndrome (WSACS).
The consensus conference (Noosa, Australia; December 7, 2004) was attended by 21 specialists from Europe, Australasia and North America and approximately 70 other congress participants. In advance of the conference, a blueprint for the various definitions was suggested. After the conference the participants corresponded electronically with feedback. A writing committee was formed at the conference and developed the final manuscript based on executive summary documents generated by each participant. The final report of the 2004 International ACS Consensus Definitions Conference has recently been published. This article will describe the long road towards this final publication with the evolution of the different definitions and recommendations from the initial suggestions in 2004 to the further refinement and final publications in 2006 and 2007. It will try to explain how we got there and will also give the percentage of agreement with each proposed definition by the participants.
New definitions were offered for some terms, while others were discarded and not kept in the final manuscript. Different cut-offs for defining IAH and ACS were given, as well as broad definitions of primary, secondary and recurrent IAH/ACS. A classification system was introduced taking into account the duration, origin, and etiology of IAH. The use of an organ severity scoring method, by means of the Sequential Organ Failure Assessment (SOFA) score when dealing with ACS patients was not recommended as an adjunctive tool to assess morbidity in the final publication.
This document reflects a process whereby a group of experts and opinion leaders suggested definitions for IAH and ACS. This document should be used as a reference for the next consensus definitions conference in March 2007.
在过去十年中，人们对腹腔内高压（IAH）和腹腔间隔室综合征（ACS）的兴趣呈指数级增长，并且提出了不同的定义。然而，该领域的专家一直推动修改这些定义，以反映我们目前对这些综合征病理生理学的理解。一个由感兴趣的医生组成的国际多学科小组会面，目标是就一套可应用于IAH和ACS患者的定义达成一致。这个共识小组的目标是提供一个概念性和实用性的框架，以进一步定义ACS，这是一个属于广义术语“IAH”的进行性损伤过程，包括与IAH相关的器官功能障碍。
总共21位来自北美、澳大利亚和欧洲的外科、创伤和重症监护专家同意标准化IAH、ACS及相关病症的当前定义，为第二届腹腔间隔室综合征世界大会（WCACS）做准备。WCACS会议得到了欧洲重症监护医学学会（ESICM）和世界腹腔间隔室综合征协会（WSACS）的认可。
2004年12月7日在澳大利亚努萨举行的共识会议有来自欧洲、澳大利亚和北美的21位专家以及约70名其他会议参与者出席。在会议之前，提出了各种定义的蓝图。会议之后，参与者通过电子方式进行反馈交流。会议上成立了一个写作委员会，并根据每位参与者生成的执行摘要文件编写了最终稿件。2004年国际ACS共识定义会议的最终报告最近已发表。本文将描述迈向这一最终出版物的漫长历程，包括不同定义的演变以及从2004年的初步建议到2006年和2007年进一步完善及最终出版的建议。它将试图解释我们是如何达成这些成果的，还将给出参与者对每个提议定义的同意百分比。
为一些术语提供了新定义，而其他一些定义被舍弃，未保留在最终稿件中。给出了定义IAH和ACS的不同临界值，以及原发性、继发性和复发性IAH/ACS的宽泛定义。引入了一个考虑IAH持续时间、起源和病因的分类系统。在最终出版物中，不建议在处理ACS患者时使用器官严重程度评分方法，即序贯器官衰竭评估（SOFA）评分作为评估发病率的辅助工具。
本文档反映了一组专家和意见领袖为IAH和ACS建议定义的过程。本文档应用作2007年3月下一次共识定义会议的参考。
