title: Recognition and management of intra-abdominal hypertension and abdominal compartment syndrome; a survey among Dutch surgeons.
abstract: OBJECTIVE
  Intra-abdominal hypertension (IAH) and Abdominal compartment syndrome (ACS) are relatively rare, but severe complications. Although many advances were made in recent years, the recognition and management remain subject of debate. The aim of this study was to determine the current state of awareness, knowledge and use of evidence-based medicine regarding IAH and ACS among Dutch surgeons.
  
  
  METHODS
  A literature-based and expert consensus survey was developed. One surgeon in every hospital in The Netherlands was asked to complete the online questionnaire.
  
  
  RESULTS
  Sixty of 87 (69 %) invited surgeons completed the questionnaire. Intra-abdominal pressure (IAP) was measured using intra-vesical methods by 55 (98 %) respondents. Diuretics (N = 38; 63 %) and laparotomy (N = 33; 55 %) were considered useful treatments for IAH or prevention of ACS by a majority. Only 16 (27 %) respondents used these guidelines in daily practice, and 37 (62 %) respondents are willing to do so. Although 35 (58 %) surgeons agreed that IAH is only a symptom, not requiring treatment. Forty-one percent of experienced respondents suggested that prevalence of ACS remained unchanged. Nearly all respondents (N = 59; 98 %) believed that open abdomen management improves patient outcomes, many (N = 46; 77 %) confirm the high complications rate of this treatment.
  
  
  CONCLUSIONS
  The definitions of IAH and ACS and the related diagnostic and therapeutic challenges are relatively well known by Dutch surgeons. Despite limited use of the evidence-based guidelines, the willingness to do so is high. Most respondents favor open abdomen treatment for patients with imminent ACS, despite the high complication rates associated with this treatment.
authors.affiliation: Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands.
authors.forename: Steven G
authors.initials: SG
authors.lastname: Strang
authors.affiliation: Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands.
authors.forename: Esther M M
authors.initials: EM
authors.lastname: Van Lieshout
authors.affiliation: Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands.
authors.forename: Roelof A
authors.initials: RA
authors.lastname: Verhoeven
authors.affiliation: Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands. o.vanwaes@erasmusmc.nl.
authors.forename: Oscar J F
authors.initials: OJ
authors.lastname: Van Waes
authors.affiliation: Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands.
authors.forename: Michael H J
authors.initials: MH
authors.lastname: Verhofstad
mesh_terms: D019317:Evidence-Based Medicine; D019983:Guideline Adherence; D006801:Humans; D059325:Intra-Abdominal Hypertension / Q000175:diagnosis* / Q000601:surgery*; D009426:Netherlands; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012307:Risk Factors; D011795:Surveys and Questionnaires
keywords: Abdominal compartment syndrome; Intra-abdominal hypertension; Intra-abdominal pressure; Management; Questionnaire