Archived Comments for:
The duration of intra-abdominal hypertension strongly predicts outcomes for the critically ill surgical patients: a prospective observational study
Comment on Kyu-Hyouck and Suk-Kyung Hong's article, "The duration of intra-abdominal hypertension strongly predicts outcomes for the critically ill surgical patients: a prospective observational study"
Yucel Gultekin, Hacettepe University Faculty of Medicine
22 October 2015
We read the Kyu-Hyouck and Suk-Kyung Hong's article, "The duration of intra-abdominal hypertension strongly predicts outcomes for the critically ill surgical patients: a prospective observational study" with great interest (1).
In the article, apart from the other studies the effect of duration of intraabdominal hypertension (IAH) on patient's clinical status and outcome is concerned. Especially in 60 days mortality, duration of IAH is detected as an independent predictor.
In other studies related to IAH, researchers are mostly concerned about the IAH clinical status and treatment of IAH. As a result of these studies, the mortality of abdominal compartment syndrome is decreased two folds (2,3), but still there is uncertainity between 12 and 20 mm Hg of abdominal hypertension. In this 'gray zone', the outcome of IAH is not certain and the management is unclear. Kyu-Hyouck and Suk-Kyung Hong's study presented the clinical outcome and mortality in connection with the duration of IAH in this 'gray zone'.
The treshold values of intraabdominal tension and tension duration in the subclinical period prior to organ failure has not been cleared yet. The markers that can detect the progression to organ failure during İAH in subclinical period are needed. As a contribution, we want to mention about the microdialysis method that can demonstrate the IAH induced metabolic alterations earlier.
Microdialysis is a technology used in experimental and clinical researches for monitoring energy metabolism (4). Continuing microdialysis procedure can be used for the early detection of IAH-induced metabolic disturbances. Microdialysis procedure is used experimentally and clinically in liver transplantations, head traumas, plastic and cardiovascular surgeries for monitorization of hypoperfusion (5).
In a study (5), the association of anaerobic metabolism in rectus abdominis muscle (RAM) with IAH in critical patients is presented. Intraabdominal hypoperfusion can be detected early with the microdialysis of RAM, measuring lactate, pyruvate, glyserol, glutamate and glucose (4). Especially increase in lactate /pyruvate ratio is detected in intraabdominal hypoperfusion related microdialysis of RAM (6). Thus during critical IAH, subclinical organ dysfunction can be detected before abdominal compartment syndrome develops (5).
In conclusion, Kyu-Hyouck and Suk-Kyung Hong's study is remarkable apart from the other studies on this subject because they evaluated the effects of duration on clinical outcome in IAH. On the other hand, we suggest that between the 12-20 mm Hg intraabdominal pressures (gray zone), microdialysis of RAM can reveal more clear information about the intraabdominal hypoperfusion. By using microdialysis technology, early intervention in the subclinincal period before the organ failure due to abdominal compartment syndrome and extended IAH can be possible. We speculate that in cases of 'gray zone' IAH, monitoring with microdialysis of RAM is beneficial and should be considered.
References
Kyu-Hyouck Kyoung and Suk-Kyung Hong: The duration of intra-abdominal hypertension strongly predicts outcomes for the critically ill surgical patients: a prospective observational study. World J Emerg Surg 2015, 10:22.
Carr JA: Abdominal compartment syndrome: a decade of progress, J Am Coll Surgeons 2013, 216:135–146.
W. Kirkpatrick, D. J. Roberts, J. De Waele et al.: Intraabdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from theWorld Society of the Abdominal Compartment Syndrome, Intensive Care Med 2013, 39:1190–1206.
L. Maddison, J. Karjagin, J. Tenhunen, and J. Starkopf: Moderate intra-abdominal hypertension is associated with an increased lactate-pyruvate ratio in the rectus abdominismuscle tissue: a pilot study during laparoscopic surgery. Ann Intensive Care 2012, 2:14.
World Journal of Emergency Surgery
Comment on Kyu-Hyouck and Suk-Kyung Hong's article, "The duration of intra-abdominal hypertension strongly predicts outcomes for the critically ill surgical patients: a prospective observational study"
22 October 2015
We read the Kyu-Hyouck and Suk-Kyung Hong's article, "The duration of intra-abdominal hypertension strongly predicts outcomes for the critically ill surgical patients: a prospective observational study" with great interest (1).
In the article, apart from the other studies the effect of duration of intraabdominal hypertension (IAH) on patient's clinical status and outcome is concerned. Especially in 60 days mortality, duration of IAH is detected as an independent predictor.
In other studies related to IAH, researchers are mostly concerned about the IAH clinical status and treatment of IAH. As a result of these studies, the mortality of abdominal compartment syndrome is decreased two folds (2,3), but still there is uncertainity between 12 and 20 mm Hg of abdominal hypertension. In this 'gray zone', the outcome of IAH is not certain and the management is unclear. Kyu-Hyouck and Suk-Kyung Hong's study presented the clinical outcome and mortality in connection with the duration of IAH in this 'gray zone'.
The treshold values of intraabdominal tension and tension duration in the subclinical period prior to organ failure has not been cleared yet. The markers that can detect the progression to organ failure during İAH in subclinical period are needed. As a contribution, we want to mention about the microdialysis method that can demonstrate the IAH induced metabolic alterations earlier.
Microdialysis is a technology used in experimental and clinical researches for monitoring energy metabolism (4). Continuing microdialysis procedure can be used for the early detection of IAH-induced metabolic disturbances. Microdialysis procedure is used experimentally and clinically in liver transplantations, head traumas, plastic and cardiovascular surgeries for monitorization of hypoperfusion (5).
In a study (5), the association of anaerobic metabolism in rectus abdominis muscle (RAM) with IAH in critical patients is presented. Intraabdominal hypoperfusion can be detected early with the microdialysis of RAM, measuring lactate, pyruvate, glyserol, glutamate and glucose (4). Especially increase in lactate /pyruvate ratio is detected in intraabdominal hypoperfusion related microdialysis of RAM (6). Thus during critical IAH, subclinical organ dysfunction can be detected before abdominal compartment syndrome develops (5).
In conclusion, Kyu-Hyouck and Suk-Kyung Hong's study is remarkable apart from the other studies on this subject because they evaluated the effects of duration on clinical outcome in IAH. On the other hand, we suggest that between the 12-20 mm Hg intraabdominal pressures (gray zone), microdialysis of RAM can reveal more clear information about the intraabdominal hypoperfusion. By using microdialysis technology, early intervention in the subclinincal period before the organ failure due to abdominal compartment syndrome and extended IAH can be possible. We speculate that in cases of 'gray zone' IAH, monitoring with microdialysis of RAM is beneficial and should be considered.
References
Competing interests
No conflict of interest