title: Percutaneous catheter decompression in the treatment of elevated intraabdominal pressure.
abstract: BACKGROUND
  Intraabdominal hypertension (IAH) and abdominal compartment syndrome (ACS) traditionally have been treated surgically through emergent laparotomy. Intensivist-performed bedside drainage of free intraperitoneal fluid or blood (percutaneous catheter decompression [PCD]) has been advocated as a less-invasive alternative to open abdominal decompression (OAD).
  
  
  METHODS
  A single-center disease and severity of illness-matched case-control comparison of 62 patients with IAH/ACS treated with PCD vs traditional OAD was performed. The relative efficacy of each treatment in reducing elevated intraabdominal pressure (IAP) and improving organ dysfunction was assessed. Physiologic and demographic predictors of successful PCD therapy were determined.
  
  
  RESULTS
  PCD and OAD both were effective in significantly decreasing IAP and peak inspiratory pressure as well as in increasing abdominal perfusion pressure. PCD potentially avoided the need for subsequent OAD in 25 of 31 patients (81%) treated. Successful PCD therapy was associated with fluid drainage of > 1,000 mL or a decrease in IAP of > 9 mm Hg in the first 4 h postdecompression.
  
  
  CONCLUSIONS
  Intensivist-performed PCD is an effective and less-invasive technique for treating patients with IAH/ACS where free intraperitoneal fluid or blood is present as determined by bedside ultrasonography. Failure to drain at least 1,000 mL of fluid and decrease IAP by at least 9 mm Hg in the first 4 h postdecompression is associated with PCD failure and should prompt urgent OAD.
authors: Department of Surgical Education, Orlando Regional Medical Center, Orlando, FL. Electronic address: michael.cheatham@orlandohealth.com.
authors: Michael L
authors: ML
authors: Cheatham
authors: Department of Surgical Education, Orlando Regional Medical Center, Orlando, FL.
authors: Karen
authors: K
authors: Safcsak
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D002404:Catheterization / Q000379:methods*; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D059325:Intra-Abdominal Hypertension / Q000175:diagnosis / Q000601:surgery*; D007813:Laparotomy / Q000379:methods*; D008150:Lower Body Negative Pressure / Q000379:methods; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D011182:Postoperative Care / Q000379:methods; D012016:Reference Values; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016896:Treatment Outcome