It's high time for intra-abdominal hypertension guidelines in pregnancy after more than 100 years of measuring pressures.
It's high time for intra-abdominal hypertension guidelines in pregnancy after more than 100 years of measuring pressures.
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经过 100 多年的压力测量，现在是时候制定妊娠期腹内高压指南了。
DOI：
10.1111/aogs.13697
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发表时间：
2019
影响因子：
4.3
通讯作者：
Malbrain,ManuLNG
中科院分区：
文献类型：
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作者：
Lozada,MJames;Goyal,Varun;Osmundson,SarahS;Pacheco,LuisD;Malbrain,ManuLNG
Garg和Tyagi提出的问题说明了与已发表的妊娠期腹内压（IAP）原始研究的局限性和异质性相关的根本挑战。我们试图将这些数据整合成有临床意义的建议，用于诊断和治疗妊娠期腹腔内高压（IAH）和腹腔间隔室综合征（ACS）。2将IAH定义为产前IAP≥ 14 mm Hg或产后IAP≥ 12 mm Hg。Tyagi等人3支持这些临界值，他们在危重产科患者中进行了唯一已知的IAP研究。每例IAH患者在诊断时均已妊娠，且IAP≥ 14 mm Hg。产后，4名患者的IAP降至< 12 mm Hg，但2名死亡的妇女在分娩后仍持续≥ 12 mm Hg。我们的定义涵盖了Tyagi研究中的所有IAH患者，同时排除了生理学IAP升高的患者。Tyagi等人发现IAP对器官功能或死亡率没有影响。3中位序贯器官衰竭评估（SOFA）心血管、肾脏和肝脏分项评分为0。较高的神经系统分项评分对器官功能障碍的贡献最大，但这些可能容易导致错误计算（例如使用镇静剂时）。因此，该病例组合可能与之前在重症患者中获得的数据不具有可比性。4此外，尚不清楚有多少患者需要> 24小时的机械通气、血管加压药/正性肌力药支持或肾脏替代治疗，也不清楚急性生理学和慢性
The questions raised by Garg & Tyagi1 illustrate a fundamental challenge related to the limitations and heterogeneity of published original research on intra-abdominal pressure (IAP) in pregnancy. We sought to coalesce data into clinically meaningful recommendations for the diagnosis and management of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) in pregnancy. 2 We defined IAH as pre-delivery IAP≥ 14 mm Hg or postpartum IAP≥ 12 mm Hg. These cutoffs are supported by Tyagi et al3, who performed the only known study of IAP in critically ill obstetric patients. Each patient with IAH was pregnant when diagnosed and had an IAP≥ 14 mm Hg. Postpartum, IAP decreased to< 12 mm Hg in four patients, but persisted≥ 12 mm Hg despite delivery in two women who died. Our definitions would have captured all IAH patients in the Tyagi study, while excluding patients with phys iologic IAP elevations.Tyagi et al found IAP had no impact on organ function or mortality. 3 The median sequential organ failure assessment (SOFA) cardiovascular, renal and hepatic sub-scores were zero. Higher neurologic sub-scores contributed most to organ dysfunction, but these may be susceptible to false calculation (such as when seda tives were used). Therefore, this case mix may not be comparable to previous data obtained in critically ill patients. 4 Furthermore, it is unclear how many patients required mechanical ventilation for> 24 hours, vasopressor/inotrope support or renal replacement therapy, nor were Acute Physiology and Chronic