Wise Robert, Roberts Derek J, Vandervelden Stefanie, Debergh Dieter, De Waele Jan J, De Laet Inneke, Kirkpatrick Andrew W, De Keulenaer Bart L, Malbrain Manu Lng
ICU Department and High Care Burn Unit, Ziekenhuis Netwerk Antwerpen, ZNA Stuivenberg, Lange Beeldekensstraat 267, B-2060 Antwerpen, Belgium.
Anaesthesiol Intensive Ther. 2015;47(1):14-29. doi: 10.5603/AIT.2014.0051. Epub 2014 Sep 24.
Surveys have demonstrated a lack of physician awareness of intra-abdominal hypertension and abdominal compartment syndrome (IAH/ACS) and wide variations in management of these conditions, with many intensive care units (ICUs) reporting that they do not measure intra-abdominal pressure (IAP). We sought to determine the association between publication of the 2006/2007 World Society of the Abdominal Compartment Syndrome (WSACS) Consensus Definitions and Guidelines and IAH/ACS clinical awareness and management.
The WSACS Executive Committee created an interactive online survey with 53 questions, accessible from November 2006 until December 2008. The survey was endorsed by the WSACS, the European Society of Intensive Care Medicine (ESICM) and the Society of Critical Care Medicine (SCCM). A link to the survey was emailed to all members of the supporting societies. Participants of the 3rd World Congress on Abdominal Compartment Syndrome meeting (March 2007, Antwerp, Belgium) were also asked to complete the questionnaire. No reminders were sent. Based on 13 knowledge questions an overall score was calculated (expressed as percentage).
A total of 2244 of the approximately 10,000 clinicians sent the survey responded (response rate, 22.4%). Most of the 2244 respondents (79.2%) completing the survey were physicians or physicians in training and the majority were residing in North America (53.0%). The majority of responders (85%) were familiar with IAP/IAH/ACS, but only 28% were aware of the WSACS consensus definitions for IAH/ACS. Three quarters of respondents considered the cut-off for IAH to be at least 15 mm Hg, and nearly two thirds believed the cut-off for ACS was higher than the currently suggested consensus definition (20 mm Hg). In 67.8% of respondents, organ dysfunction was only considered a problem with IAP of 20 mm Hg or higher. IAP was measured most frequently via the bladder (91.9%), but the majority reported that they instilled volumes well above the current guidelines. Surgical decompression was frequently used to treat IAH/ACS, whereas medical management was only attempted by about half of the respondents. Decisions to decompress the abdomen were predominantly based on the severity of IAP elevation and presence of organ dysfunction (74.4%). Overall knowledge scores were low (43 ± 15%), respondents that were aware of the WSACS had a better score compared to those who were not (49.6% vs. 38.6%, P < 0.001).
This survey showed that although most responding clinicians claim to be familiar with IAH and ACS, knowledge of published consensus definitions, measurement techniques, and clinical management are inadequate.
调查显示，医生对腹腔内高压和腹腔间隔室综合征（IAH/ACS）认识不足，且这些病症的治疗方法存在很大差异，许多重症监护病房（ICU）报告称他们不测量腹腔内压力（IAP）。我们试图确定2006/2007年世界腹腔间隔室综合征协会（WSACS）共识定义和指南的发布与IAH/ACS临床认知及治疗之间的关联。
WSACS执行委员会创建了一个包含53个问题的交互式在线调查，从2006年11月至2008年12月均可访问。该调查得到了WSACS、欧洲重症监护医学学会（ESICM）和危重病医学学会（SCCM）的认可。调查链接通过电子邮件发送给了各支持协会的所有成员。第三届世界腹腔间隔室综合征大会（2007年3月，比利时安特卫普）的参会者也被要求填写问卷。未发送提醒。根据13个知识问题计算出总体得分（以百分比表示）。
在大约10000名收到调查的临床医生中，共有2244人回复（回复率为22.4%）。在完成调查的2244名受访者中，大多数（79.2%）是医生或正在接受培训的医生，且大多数居住在北美（53.0%）。大多数受访者（85%）熟悉IAP/IAH/ACS，但只有28%的人知晓WSACS关于IAH/ACS的共识定义。四分之三的受访者认为IAH的临界值至少为15 mmHg，近三分之二的人认为ACS的临界值高于目前建议的共识定义（20 mmHg）。在67.8%的受访者中，只有当IAP达到20 mmHg或更高时，才会认为存在器官功能障碍。IAP最常通过膀胱测量（91.9%），但大多数人报告称他们注入的液体量远高于当前指南。手术减压常用于治疗IAH/ACS，而只有约一半的受访者尝试过药物治疗。决定进行腹部减压主要基于IAP升高的严重程度和器官功能障碍的存在（74.4%）。总体知识得分较低（43±15%），知晓WSACS的受访者得分高于不知晓的受访者（49.6%对38.6%，P<0.001）。
这项调查表明，尽管大多数回复的临床医生声称熟悉IAH和ACS，但对已发表的共识定义、测量技术和临床治疗的了解并不充分。
