Abdominal Compartment Syndrome : Diagnostic and Prognostic Value of CT Findings - a Prospective Study
试验速览
- 阶段
- 不适用
- 入组人数
- 140
- 主要终点
- Intra abdominal hypertension (HIA)
研究概览
简要总结
Abdominal Compartment Syndrome (ACS) is a well known condition occuring in critically ill patients in intensive care units.
This syndrome features a sustained intra abdominal hypertension (IAH) above 20 mmHg and a multiple organ failure due to the raise of the intra abdominal pressure.
Several reviews described CT findings linked to these conditions, but most of them suffer an insufficient statistical method.
Furthermore, the main CT feature described as specific in ACS, Round Belly Sign (RBS), has been highly debated since.
This study is aimed to evaluate, in a prospective way, the diagnostic and prognostic value of CT findings in abdominal hypertension and abdominal compartment syndrome patients hosted in intensive care units, based on previous reviews and adding three new CT features described for the first time.
详细描述
Abdominal compartment syndrome (ACS) is a well known condition, occurring in patients hosted in intensive care units and suffering from acute abdominal disease (such as severe acute pancreatitis, trauma, hemoperitoneum, surgery, infectious disease), large volume fluid resuscitation (over 2,5L), and systemic disease such as severe sepsis or major burns.
This syndrome features a sustained intra abdominal hypertension (IAH) above 20 mmHg, measured indirectly by intra-vesical pressure, and a multiple organ failure due to the raise of the intra abdominal pressure.
IAH, which is defined as an abdominal pressure rise above 12 mmHg, does not systematically lead to ACS, and is often successfully cured with medical therapy.
When medial management fails, or ACS is present, surgical management is appropriate and consists in a decompressive laparotomy.
CT examination is not ordered for ACS diagnostic, but radiologists should be aware of this condition and CT findings in patients with IAH, as these critically ill patients are likely to have multiple CT examinations in a diagnostic purpose for the initial condition, its complications or its surveillance.
研究设计
- 研究类型
- Observational
- 观察模型
- Cohort
- 时间视角
- Prospective
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Critically ill patients requiring ICU hosting
- •State of shock requiring vasopressive drugs
- •State of shock requiring mechanical ventilation
- •Abdominal CT examination ordered
- •Intra abdominal pressure measurement
排除标准
- •Age under 18 years
- •Pregnancy
- •Contraindication to urethral catheter
- •Decompressive laparotomy before CT examination
- •Absolute contraindication to CT enhancement agent
- •Cystectomy
- •Trusteeship/guardianship
结局指标
主要结局
Intra abdominal hypertension (HIA)
时间窗: Within four hours before or after the abdominal CT examination
Incidence of intra-abdominal hypertension in patients included, defined by the raise above 12 mmHg of the intra-vesical pressure measured in a standardized way
Round Belly Sign
时间窗: At the time of CT examination
Increased ratio of anteroposterior/transverse diameter of the abdomen (ratio \>0.80), measured at the level where left renal vein crosses the aorta, excluding subcutaneous fat.
次要结局
- Bowel wall thickening with contrast enhancement(At the time of CT examination)
- Increase of the peritoneal/abdominal ratio(At the time of CT examination)
- Compression or displacement of solid abdominal viscera(At the time of CT examination)
- Abdominal Compartment Syndrome (ACS)(From the time of inclusion to 28 days after)
- Bilateral inguinal herniation(At the time of CT examination)
- Semi lunar line distension(At the time of CT examination)
- Concavity of the upper side of the para renal fascia(At the time of CT examination)
- Narrowing of abdomen large veins(At the time of CT examination)
- Elevation of the diaphragm(At the time of CT examination)