By F. Kan. Davis College. 2019.
Leave the tube in situ for another minute (or two) until the child is definitely in the late or third phase of emergence buy 500mg amoxil with amex. Complications do not occur from leaving a tube in for an extra minute 250mg amoxil fast delivery, they only occur when the tube is removed prematurely cheap amoxil 500 mg on line. As the inhaled concentration decreases below these values, the child opens his/her eyes spontaneously and reaches for the tracheal tube, gags, and grimaces, all of which are consistent with a successful extubation. In contrast, with the direct stimulating technique, the anesthetic concentration decreases toward the same concentrations (sevoflurane <0. The child becomes highly aroused and gags on the tracheal98 tube for several seconds, but then falls back to a semiconscious state when the stimulation abates. During this quiescent period, the child may breathe shallowly or breath-hold, but if desaturation occurs, positive pressure ventilation with 100% oxygen must be instituted. When the child resumes coughing and gagging, opens their eyes, their respirations are sustained and regular, and they make purposeful movement (e. Both the no-touch and the direct stimulation strategies provide similar outcomes with safe and protected airways in children in experienced hands. If the tube has been removed prematurely, breath-holding, upper airway obstruction, and laryngospasm may ensue. The child’s face mask should be immediately available in order to deliver 100% oxygen through a tight fit to the face with 100% oxygen and dial 10- to 20-cm H O continuous positive2 airway pressure on the adjustable pressure limiting valve. To force the child through this “light” phase of anesthesia, pressure should be applied to the condyle of the mandible (see jaw thrust) in 3- to 5-second intermittent applications until the child begins to breathe. In order to extubate the trachea deep, the depth of inhalational anesthesia must be at least 1. Some prefer to inspect the larynx at that time for foreign substances and fluids by performing laryngoscopy. The absence of a response and the continuation of regular respirations 3114 indicate an adequate depth of anesthesia is present to remove the tube. If, however, the child coughs or breath-holds, then either a further period of anesthesia is required before a trial laryngoscopy is attempted or the deep extubation approach is abandoned and the child is awakened. Appropriate airway equipment should be available to transfer the child once the trachea has been extubated. Either a self-inflating Laerdal bag or a T- piece should be available with a source of oxygen. In children, the primary focus during emergence from anesthesia is the airway, the child’s ability to breathe, and whether the child can protect his/her airway should bleeding or regurgitation occur during or after extubation. There are very few surgical or medical indications to remove the airway during a deep level of anesthesia, although opinion varies on this matter. In the vast majority of children, emergence from anesthesia progresses smoothly as described earlier. However, children who do not emerge from anesthesia in a timely fashion must be assessed for possible causes for delayed emergence from anesthesia (Table 43-14). The most common causes of delayed emergence include drug overdoses, increased sensitivity to drugs (e. Other, less frequent but potentially catastrophic events should also be considered including hypoglycemia, increased intracranial pressure, and metabolic causes including hyponatremia. The child must be accompanied by an expert who has been trained to diagnose and manage postoperative problems, most notably airway obstruction. The optimal position for transfer of a child after surgery is the lateral decubitus position, known as the “recovery position. This position facilitates drainage of secretions, blood, or vomitus out of the mouth rather than onto the larynx, and the tongue falls to the lower cheek or out of the mouth rather than posteriorly onto the larynx. This position permits direct airway monitoring and intervention should the need arise. This is known as the “recovery position” with the child lying in the lateral decubitus position, neck extended and mouth opened. In this position, oropharyngeal secretions, blood, or vomitus will drain onto the gurney rather than collect in the parapharyngeal region and trigger upper airway reflex responses. However, in the absence of nitrous oxide and in children whose lungs are normal, the most common reason for desaturation during transport is upper airway obstruction, an emergency that is difficult to detect by pulse oximetry when supplemental oxygen is administered. The reason for this difficulty is that the large reserve of oxygen maintains the oxygen desaturation several minutes even in the presence of complete airway obstruction or hypopnea. Therefore, this author places the child in the recovery position, extends the child’s neck with the base of his hand (thenar and hypothenar eminences) and positions his fingertips over the mouth/nose to feel the warm temperature in the exhaled gases to monitor respiration (but never closes the child’s mouth). Transporting the recovering child in the supine position predisposes to airway obstruction from posterior displacement of the tongue and facilitates the accumulation of secretions or other fluids in the supraglottic region. Furthermore, opioids depress the hypoglossal motor nuclei centrally, which relaxes the genioglossus muscle allowing the tongue to fall back and potentially obstruct the airway in the supine position. The age distribution of the complications showed that children above 3118 8 years of age vomited more than twice as frequently as those under 8 years, whereas respiratory complications in infants under 1 year of age occurred twice as frequently as in those above 1 year of age. Laryngospasm, Postoperative Stridor, and Negative Pressure Pulmonary Edema Laryngospasm, postoperative stridor, and negative pressure pulmonary edema occur both during induction of anesthesia and during or after emergence from anesthesia. Stridor usually results from the epithelium within the cricoid ring swelling after the tracheal tube is removed. The swelling reduces the internal cross-sectional diameter of the cricoid ring and increases the pressure gradient (and therefore work of breathing) across the ring. Because airflow in the upper airway is turbulent, the resistance to air flow increases as the fifth power of the radius of the cricoid ring decreases. That is, if the radius of the airway within the cricoid ring decreases by 50%, the resistance to airflow increases 32-fold (based on the Fanning equation). In infants with increased oxygen requirements and metabolic rates, residual opioids, muscle weakness, and anesthesia may further compromise their ability to maintain an increased work of breathing during stridor, which could hasten fatigue and respiratory failure. Heliox has been effective in reducing the work of breathing, oxygen consumption, and distress although it limits the inspired oxygen fraction. If hypoxemia or respiratory failure occurs, the trachea should be reintubated with a smaller size tube than the one originally used. To avoid further irritating the epithelium, an audible leak should be present after intubation. Negative pressure pulmonary edema or postextubation pulmonary edema is an infrequent complication that usually occurs immediately or within several minutes after tracheal extubation in healthy, muscular adolescents and young adults, although it has been reported in infants. The presumptive diagnosis is laryngospasm, which may range in severity from very mild (i. Ventilation by mask with 100% oxygen 3119 may be ineffective in restoring vital signs, necessitating tracheal reintubation using propofol and a muscle relaxant. As soon as the tube passes the vocal cords, pink frothy pulmonary edema fluid may appear in the tube or appear upon suctioning the tube. SaO can be restored to more than 94% using2 positive pressure ventilation with positive end-expiratory pressure and 100% oxygen. Although some may recover from the pulmonary edema very rapidly, others require sedation and tracheal intubation for 12 to 24 hours or more, until the pulmonary edema resolves. Oxygen Desaturation Failure to maintain adequate SaO in the recovery room is a common2 problem.
The high mortality of candida septic shock is explained by excessive delays in initiation of antifungal therapy buy generic amoxil 250mg on-line. Any delay in the fve management steps will inexorably translate into increased morbidity and mortality amoxil 500mg discount. History-taking and a detailed physical examination will often provide important clues to the identifcation of the most likely site of infec- tion and help to quickly assess the severity of the infectious process and the need for hemodynamic and organ support discount amoxil 500 mg on-line. Judicious diagnostic tests, frst and foremost sampling of blood, biological fuids, and relevant tissue for microbiological stud- ies, should be performed expeditiously and followed by the prompt administration of broad-spectrum antimicrobial agents. Imaging studies may help ruling in the most likely source of infection and decide whether source control actions are needed, such as percutaneous or surgical drainage of an abscess or debridement of infected tissue. The 2016 update of the international guidelines for the manage- ment of sepsis and septic shock of the Surviving Sepsis Campaign provides a very useful framework guiding physicians into the multifaceted elements of the man- agement of the septic patient. The aim of this chapter is to review the rationale, the basic concepts, and the modalities of antimicrobial therapy for patients with sepsis or septic shock. Guery Infectious Diseases Service, Department of Medicine, University Hospital and University of Lausanne, Lausanne, Switzerland e-mail: Thierry. Over the last 50 years, numerous retrospective studies of patients with Gram-negative bacteremia indicated that appropriate antibiotic therapy reduced mortality when compared with inappropriate therapy, which was defned as the use of at least one agent active in vitro against the infecting pathogen [4–16]. More recently, similar fndings have also been made in patients with Gram-positive bacte- remia [17–19] or candidemia [20–23]. However, one should acknowledge that sev- eral studies did not found an association between the appropriateness of antibiotic therapy and patient’s outcome [24–28]. A number of potential confounding factors or selection biases may account for these conficting fndings. These studies were characterized by a great deal of hetero- geneity in terms of study design (retrospective vs. Methodological recommendations have been proposed to improve the quality of studies, to facilitate the comparisons of results, and to ease the generalizability of the fndings . Studies that have integrated these methodological recommendations have confrmed that inappropriate therapy was associated with increased mortality. For example, in a multicenter prospective study that included 801 episodes of blood- stream infections in 756 patients, inadequate empirical therapy increased mortality at day 14 and day 30 (odds ratios 2. A systematic review and meta-analysis of 70 studies on the effcacy of appropriate antibiotic therapy for sepsis showed that patients with inappropriate therapy had higher unadjusted (univariate analysis) and adjusted (multivariate analysis) all-cause mortality (odds ratios 2. A high level of heteroge- neity was noted, and study sample size had an important infuence on the observed effect of the appropriateness of therapy. Septic shock was the only confounding factor positively associated with odds ratios in a meta-regression analysis. The existence of statistically signifcant relationships between hourly delays in the administration of appropriate antibiotics and outcome of severe sepsis and septic shock has been reported in several studies [7, 8, 15, 16, 32]. A strong association was noted between a longer time until the administration of antibiotics and an increased risk-adjusted in-hospital mortality (odds ratio 1. In a meta-analysis of 11 studies that included 16,178 patients, administration of anti- biotic within 3 h of emergency department triage or within 1 h of shock recognition was not associated with improved outcome . As mentioned above, many studies are of low quality for a variety of reasons such as the retrospective nature of the analyses, the pooling of patient cohorts, an imprecise or lack of information regard- ing the appropriateness of therapy, or issues about selection of zero time points. However, one should also acknowledge that specifc recommendations on antibiotic timing as a metric of quality of care are not supported by very robust data. Factors to be taken into account when choosing the initial antimicrobial regimen to be used empirically in patients with suspected infection are presented in Table 12. The basic principles guiding the selection of antimicrobial agents are well established. The spectrum of activity should be suff- ciently broad to cover all likely pathogens with a reasonable margin of security. Given the large range of elements to be taken into account in the process of selecting an empirical antimicrobial regimen, it is diffcult to make specifc recommendations. The most appropriate choice may consist of one (monotherapy) or more (multidrug or combination therapy) antimicrobial agents chosen among various classes of anti- biotics. These are typically extended-spectrum penicillins with or without a beta- lactamase inhibitor, third- or fourth-generation cephalosporins, carbapenems, fuoroquinolones, aminoglycosides, glycopeptides, lipopeptides, or oxazolidinones. Guery Facing the increase in resistance , carbapenems should however be considered as second-line drugs [36, 37]. Whenever possible, one should start therapy with micro- bicidal rather than microbiostatic antimicrobial agents. To ensure broad-spectrum empirical coverage against the most likely pathogens, it is often necessary to opt for a multidrug therapy. In theory, combinations of antibiotics provide broad-spectrum coverage, may exert additive or synergistic effects, and may reduce the risk of emer- gence of resistant strains. Some classes of antibiotics may also exert immune modulatory effects (macrolides). An increased risk of toxicity, superinfections with resistant bacteria or fungi, and higher costs are classical trade-offs of multidrug therapies. Historically, combination ther- apy consisted of an association of a beta-lactam with an aminoglycoside. Today empirical triple- or quadruple-agent therapy is often required to make sure that all potential pathogens are covered particularly in an environment where antimicrobial resistance is a major concern. Antibiotics could be classifed according to their solubility characteristics as hydrophilic or lipophilic . Hydrophilic molecules like beta-lactams, aminogly- cosides, or glycopeptides are affected by changes of the volumes of distribution and of renal function which occur frequently in critically ill patients. On the contrary, lipophilic molecules (fuoroquinolones and macrolides) are less infuenced by the volumes of distribution but more often by renal clearance. Antibiotics could also be artifcially divided in two groups, concentration-dependent or time-dependent mol- ecules, although some molecules share properties of both groups. A seminal paper published in 1987 analyzed the clinical response to aminoglycosides in 236 patients with Gram-negative bacterial infections . Once-daily dosing resulted in high peak concentration exposure and was associated with both an extended post-antibi- otic effect and a greater bacterial killing when compared to multiple-daily dosing . Initially described in vitro, this phenomenon of adaptive resistance was then confrmed in vivo in a rabbit endocarditis model . It seems therefore important to use high dosage of aminoglycosides especially in critically ill patients. Guery severe sepsis or septic shock, a frst dose of 11 mg/kg of gentamicin was required to reach a peak plasma concentration equal to or greater than 30 mg/L . This increase of dose is related to the modifcation of the volume of distribution (Vd) in septic patients. In septic patients, gentamicin intra-patient pharmacokinetics showed that Vd decreased from 0. Even with a loading dose of 25 mg/kg of amikacin (the classic dose is 15 mg/kg), a therapeutic target was achieved in only 70% of 74 patients with severe sepsis and septic shock .
Two immune-mediated diseases 500mg amoxil, and show segmental and global sclerosis on repeat biopsy discount amoxil 250mg without a prescription. On immunoﬂuorescence amoxil 250 mg discount, there is an absence of IgG and IgA immune reactants, but mesangial deposition of IgM and 6. Electron microscopy shows podocyte foot process effacement and mesangial hypercellularity and Several major glomerular diseases have in common the for- increased matrix. The course is variable, with remission, progression, and prolonged proteinuria occurring in equal proportions. The capillary loops are diffusely thickened by the presence of numerous immune deposits forming in the subepithelial space. The immunoﬂuorescence pattern created is distinctive; thus, the diagnosis is straightforward on direct immunoﬂuorescence. Over time, the deposits elicit basement membrane response by podocytes that can be visualized by light microscopy, especially in silver-stained sections. Autoantibodies form that bind to the phospholipase A2 receptor on podocyte cell membranes and are shed into the subpodocyte space, forming subepithelial immune complex deposits. Immunoﬂuorescence showed 1–2+ mesangial IgM and C3 secondary causes include hepatitis B, systemic lupus erythe- deposition (scale, 1–3+). The term membranous was coined to describe the uniform The capillary loops therefore would appear thicker on hematoxylin and thickening of the capillary loops identiﬁed prior to understanding its eosin stain than in the previous case. Notice that a distinct width is apparent in most of the capillary loops in this glomerulus Fig. Over time, basement membrane formation around deposits may cover their surface, giving rise to an alteration known as bridging or “tram tracking. Note the short delicate projections, known as “spikes,” extending perpendicular to the capillary loop basement membrane along its outer aspect. These spikes represent podocyte basement mem- brane response to subepithelial immune complex deposits. Electron microscopy allows visualization of both the the diffuse granular quality of the capillary loop immune complex deposits and the spikes. Notice that the deposits are separated by gray-appearing base- Direct immuno ﬂ uorescence, IgG ment membrane material that would be visualized on silver stain as the spikes Fig. Not only has basement membrane material tial or “en face” fashion, allowing appreciation of the individual depos- formed between the immune deposits (the spikes), it also has covered its. The dark spaces between deposits are where the basement membrane many deposits that would appear on silver stain as bridging or tram spikes would be located. However, both adults and children may develop mesangial hypercellularity) proliferation, which may be the same lesion, associated with many bacterial, viral, para- global or segmental, and crescents may be seen. There are infrequent large subepithe- Although the convention is to use postinfectious terminol- lial (“hump-like”) deposits containing IgG, C3, and light ogy, use of the qualiﬁer post- should be considered carefully chains in the classic pediatric case, but subendothelial and because the possibility always exists that the infectious mesangial deposits are not uncommon, especially in adult cause may be ongoing and not past, that is, infection associ- cases. The clinical course in children usually is favorable and cal infections also occurs; when this develops in diabetics, self-limited. Adults do more poorly, and a progressive the prognosis for renal recovery is very poor. Although neutrophils may occur in other causes of diffuse proliferative glomerulonephritis, they are particularly common in this disease. Note that in addition to numerous cells ﬁlling the glomerulus, this glomeru- lus contains many neutrophils 216 6 Glomerular Diseases Fig. Immunoﬂuorescence shows immune deposits along the capillary loops and in the mesangium that stain for IgG, C3, kappa, and lambda. Approximately 80 % of adult cases are secondary to hepatitis C and may be associated with circulating cryoglobulins. Silver stain shows duplication of the capil- lary loop basement membrane along its inner aspect, a deﬁning morphologic ﬁnding. The capillary loop is ﬁlled with cells that include both a neu- strate many immune complex deposits involving the capil- trophil in the center and several monocytes (arrows). No subepithelial lary loops and mesangium that contain IgG, C3, and light deposits are present in this portion of the glomerulus. Electron microscopy demonstrates that the capillary lower left are electron-dense mesangial immune deposits loop deposits are subendothelial and mesangial, associated with capillary loop basement membrane duplication. Mesangial cells may extend into the subendothelial space, complicating the electron microscopic appearance. In chronic thrombotic microangiopathies and chronic transplant glom- erulopathy, immune reactants are absent, leaving a lucent appearance to the subendothelial space on electron microscopy. There is a single large, Quartan malaria rounded subepithelial deposit on the right upper portion Schistosomiasis Complement deﬁciencies (C2 or C3) Diffuse proliferative glomerulonephritis with membranoproliferative features, immune complex negative Chronic thrombotic microangiopathies Chronic transplant glomerulopathy 218 6 Glomerular Diseases Fig. They are located along the capillary loops and often involve the mesangium, as in this example. There is a capillary loop, so-called hyaline thrombus, at the lower right, suggesting cryoglobulins as the etiologic factor Fig. The subendothelial deposits elicit basement membrane response along its inner aspect, creating a double–basement membrane contour (arrows) along many capillary loops. There are numerous subendothelial electron- dense immune deposits as well as multiple layers of gray new basement membrane along the inner aspect of the dense deposits. In addition to dense deposits, cell processes of mesangial cells have extended into the space between the basement membrane layers. It shows global hypercellularity in a lobular pattern as a result of electron micrograph, the capillary loop is patent. There is a row of sub- prominent mesangial cell proliferation endothelial electron-dense immune deposits on the right with an inner layer of new basement membrane. There is expanded mesangial matrix and segmental capillary loop basement membrane duplication (arrow ). Cryoglobulins occasionally demonstrate an organized substructure on electron micros- Endocapillary E0 or E1 E1: hypercellularity involving copy. Most often, the deposits look like other interstitial ﬁ brosis T2 > 50 % cortical area immune complex deposits and lack substructure affected 6. Segmental capillary loop proliferation (E1) and seg- mesangium may be minimally expanded or show only mild hypercel- mental sclerosis (S1) commonly occur in IgA nephropathy. In this case, there is mild mesangial hypercellularity with a erulus shows a capsular adhesion on the left with segmental capillary mild increase in matrix loop hypercellularity. The cellularity within the glomerulus is only mildly increased and primarily involves capillary loops. It is a rare disease primarily affecting children and young adults, and occasionally older patients. Some patients have partial lipodystrophy and retinal alterations referred to as drusen. The clinical course is similar to that of pediatric dominant IgA immune deposits on direct immunoﬂuorescence. The etiology Therefore, without immunoﬂuorescence, the diagnosis cannot be estab- lished deﬁnitively. In is defective complement regulation leading to a lack of some cases, deposits also involve the capillary loops.
Chasing 100%: the use of hypertonic saline to improve early amoxil 250 mg amex, primary fascial closure after damage control laparotomy purchase 500mg amoxil otc. Adjunctive treatment of abdominal catastrophes and sepsis with a direct peritoneal resuscitation: indications for use in acute care surgery generic amoxil 250mg on line. Damage control resuscitation is associated with a reduction in resuscitation volumes and improvements in survival in 390 damage control lapa- rotomy patients. Direct peritoneal resuscitation accelerates primary abdominal wall closure after damage control surgery. Mechanisms of direct peritoneal resuscitation-mediated splanchnic hyperperfusion following hemorrhagic shock. A novel method of peritoneal resuscitation improves organ perfusion after hemorrhagic shock. Direct peritoneal resuscitation from hemorrhagic shock: effect of time delay in therapy initiation. Fluid resuscitation in septic shock: a positive fuid balance and elevated central venous pressure are associated with increased mortality. The Open Abdomen in Infants 12 and Children Davide Corbella, Oliviero Fochi, and Mirco Nacoti Key Points Despite the long-standing experience in staged closure and open abdomen treat- ment, there is a wide spread reluctance to implement these treatments in the pediatric pediatric patients. Whereas the open abdomen has a sound and recog- nized role in the adult literature, the pediatric one lags behind showing that: • Intra-abdominal pressure is not measured on a routine basis. This society was the frst to undertake a systematic review of the literature and to produce evidence-based recommendations as well as the frst set of guidelines for diagnosis and man- agement. In 2013 they produced the frst specifc pediatric recommendations and defnitions. Staged abdominal wall closure and open abdomen treatment were part of the routine practice of neonatal surgery since the frst work of Gross in the late 1940s, which showed a better outcome when the abdomen was closed without pressure in a staged manner. The low confdence with this topic is refected, and infuenced, by the low amount of specifc pediatric data. Moreover the general quality is low with a total lack of multicentric prospective studies or implementation of national registries. The arteriovenous pressure gradient theory is the most widely accepted pathophysiologic mechanism to explain the hit during compartment syndrome. When the intra-compartment pressure exceeds the venous pressure, it becomes the limit- ing factor to blood fow. The decrease of end-organ perfusion leads to ischemia and subsequently swelling, capillary leak, cellular edema, and more intra-compartment pressure that eventually ends in cellular death. Pediatric patients are peculiar from this point of view as compliance of the compartment is different from adults and perfusion pressure (i. This syndrome and the possible treatment with decompressive laparotomy and decompressive craniot- omy have been described by Scalea  in 2007 when he treated 102 trauma patients with multiple compartment decompression. The abdominal compartment plays a cornerstone role being upstream to the lower limb and downstream to the thorax. This explains the predominant cardiovascular effect when this compartment is affected. The effects of intra- abdominal hypertension are not limited just to the intra-abdominal organs, but rather have an impact either directly or indirectly on every organ system in the body. However, the pathophysiologic model developed in the adult population and in the animal studies is sound. We are legitimated to translate it in the pediatric cohort of patients keeping in mind some distinctive features as the differences in compartment compliance and perfusion pressure. Once abdominal contrac- tion is ruled out by sedation or neuromuscular block, the volume of instillation inside the bladder is the main source of bias. The correct volume of instillation in the adult population has been investigated by several papers as a volume too great Table 12. Eijke  estimated the best volume to infuse in the bladder by an analysis of the bladder compliance curve with an increasing volume of normal saline. Considering the bladder compliance as a sigmoid curve, they defned the optimal volume as the one used to reach the lower infection point. Pressure bag Pressure transducer F/F adapter Anti-bacterial filter 3-ways stopcock 3-ways stopcock Abdominal 3-ways Pz. This system is essentially made by a regular urinary catheter, a three-way stopcock with attached on one end to the Foley catheter and on the others to a pressure transducer zeroed at midaxillary line and an infusion bag. The lack of awareness of this syndrome in the pediatric intensivist community has been already discussed [5, 6]. In 1948 Gross proposed a staged closure of the abdomen, and since then the concept of “abdominal domain” or better to “regain abdominal 148 D. Rizzo  proposed in 1996 the intraoperative vesical pressure to guide wall closure. They had no difference between the staged and primary closure groups in terms of frequency of complications, time to begin oral feeding, and length of parenteral nutrition or hospital stay. The ideas at the basis of the use of a staged abdominal closure are to gain space by allowing graft or bowel edema to reabsorb or to wait for the abdominal cavity to stretch around the organs with a second-intention closure without compromising graft perfusion. Gupte  reports that since 2005 staged closure of the abdomen and pre-transplant abdominal tissue expanders were applied routinely whenever a mismatch between donor and 12 The Open Abdomen in Infants and Children 149 recipient was found. Delayed primary closure of the abdomen in pediatric liver transplantation was con- sidered an emergency therapy when important bowel edema, massive transfusion, great donor graft mismatch, or bowel distension were detected . Staged closure of the abdominal cavity was reported as routinely performed by 25% of European pediatric surgeons  if a “tense clo- sure” was suspected. Interestingly, important abdominal impairment was detected for pressures as low as 10 mmHg [30, 32], questioning the value of 20 mmHg that is currently felt as a safe threshold for closing the abdomen in other neonatal diseases (i. Rollins  in his cohort of seven patients that underwent laparotomy had no survival, whereas Prodhan  had two survivors out of four patients treated with peritoneal catheters. However, Rollins sug- gests possibly better results had decompressive laparotomies been performed earlier. Results from the international conference of experts on intra-abdominal hypertension and abdominal compartment syndrome. Results from the international conference of experts on intra-abdominal hypertension and abdominal compartment syndrome. Intra-abdominal hypertension and the abdominal compartment syndrome: updated con- sensus defnitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome. Survey of intensive care physicians on the recognition and management of intra-abdominal hypertension and abdominal compartment syndrome. Recognition and man- agement of abdominal compartment syndrome among German pediatric intensivists: results of a national survey. The polycompartment syndrome: towards an understanding of the interactions between different compartments! Increased intra-abdominal, intrathoracic, and intracranial pressure after severe brain injury: multiple compartment syndrome.
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