The Departments of Surgery and Critical Care Medicine and Regional Trauma Services Foothills Medical Centre, Calgary, Alberta, T2N 2T9, Canada.
Intensive Care Med. 2013 Jul;39(7):1190-206. doi: 10.1007/s00134-013-2906-z. Epub 2013 May 15.
To update the World Society of the Abdominal Compartment Syndrome (WSACS) consensus definitions and management statements relating to intra-abdominal hypertension (IAH) and the abdominal compartment syndrome (ACS).
We conducted systematic or structured reviews to identify relevant studies relating to IAH or ACS. Updated consensus definitions and management statements were then derived using a modified Delphi method and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) guidelines, respectively. 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).
In addition to reviewing the consensus definitions proposed in 2006, the WSACS defined the open abdomen, lateralization of the abdominal musculature, polycompartment syndrome, and abdominal compliance, and proposed an open abdomen classification system. RECOMMENDATIONS included intra-abdominal pressure (IAP) measurement, avoidance of sustained IAH, protocolized IAP monitoring and management, decompressive laparotomy for overt ACS, and negative pressure wound therapy and efforts to achieve same-hospital-stay fascial closure among patients with an open abdomen. SUGGESTIONS included use of medical therapies and percutaneous catheter drainage for treatment of IAH/ACS, considering the association between body position and IAP, attempts to avoid a positive fluid balance after initial patient resuscitation, use of enhanced ratios of plasma to red blood cells and prophylactic open abdominal strategies, and avoidance of routine early biologic mesh use among patients with open abdominal wounds. NO RECOMMENDATIONS were possible regarding monitoring of abdominal perfusion pressure or the use of diuretics, renal replacement therapies, albumin, or acute component-parts separation.
Although IAH and ACS are common and frequently associated with poor outcomes, the overall quality of evidence available to guide development of RECOMMENDATIONS was generally low. Appropriately designed intervention trials are urgently needed for patients with IAH and ACS.
更新与腹腔内高压（IAH）和腹腔间隔室综合征（ACS）相关的世界腹腔间隔室综合征协会（WSACS）共识定义和管理声明。
我们进行了系统或结构化的综述，以确定与 IAH 或 ACS 相关的研究。然后，使用改良 Delphi 方法和分级评估、制定与评价（GRADE）指南分别得出更新的共识定义和管理声明。证据质量从高（A）到极低（D）进行分级，管理声明从强烈的建议（有利效果明显超过潜在不利效果）到较弱的建议（干预的潜在风险和收益不太清楚）。
除了审查 2006 年提出的共识定义外，WSACS 还定义了开放性腹部、腹部肌肉的侧化、多腔室综合征和腹部顺应性，并提出了一种开放性腹部分类系统。建议包括腹腔内压（IAP）测量、避免持续 IAH、方案化 IAP 监测和管理、明显 ACS 的减压剖腹术，以及负压伤口治疗和努力实现开放性腹部患者的同院筋膜闭合。建议包括使用医疗疗法和经皮导管引流治疗 IAH/ACS，考虑体位与 IAP 之间的关系，试图避免初始患者复苏后的正液体平衡，使用增强的血浆与红细胞比和预防性开放性腹部策略，以及避免常规早期生物网片在开放性腹部伤口患者中的使用。关于监测腹部灌注压或使用利尿剂、肾脏替代疗法、白蛋白或急性成分分离，没有建议。
尽管 IAH 和 ACS 很常见，并且经常与不良结局相关，但指导建议制定的总体证据质量通常较低。迫切需要为 IAH 和 ACS 患者设计适当的干预试验。
