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PO-0350 The D-a-ch Experience (ii): Recognition And Management Of Iah And Acs Is Highly Dependent On The Size Of Department And Number Of Cases At Nicu And Picu
  1. H Steinherr1,
  2. T Kaussen1,
  3. M Boehne1,
  4. B Mitzlaff1,
  5. G Steinau2,
  6. A Schachtrupp2,
  7. P Beerbaum1,
  8. M Sasse1
  1. 1Department of Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
  2. 2Department of Surgery, RWTH Aachen University Hospital, Aachen, Germany

Abstract

Background Some paediatricians seem to take Intra-abdominal Hypertension (IAH) and Abdominal Compartment Syndrome (ACS) for epiphenomenons of disorders which exclusively accompany illnesses that are treated only in specialised centres. Since the majority of ACS results from inflammation and capillary leakage, also disorders can lead to IAH/ACS, which superficially seem to be harmless paediatric entities. Thereby, the majority of IAH/ACS might be overseen and not be treated adequately.

Aims The present study looks at the recognition and knowledge of IAH/ACS among paediatric intensivists of different sizes of ICU´s and number of cases per year.

Methods In June 2010, a questionnaire was mailed to the heads of ICU´s of 265 German, Austrian and Swiss paediatric hospitals.

Results Response rate was 59%. The more specialised departments are, the more often IAH/ACS is diagnosed. Predominantly, small ICU (s-ICU; <350 patients/a) underestimated critical IAP-thresholds and did not recognise IAH-/ACS-definitions. 2/3 of large ICUs (l-ICU; >700 pat./a) at least diagnosed one case of IAH; >40% at least one ACS (s-ICU: 16% and 13%). Prevalence of IAH/ACS at intermediate ICU´s (i-ICU; 350–700 pat./a) and l-ICU´s was stated to be more than twice as high. Stated underlying risk factors only marginally varied between s-ICU´s, i-ICU´s and l-ICU´s. Regular IAP-measurements are performed by 13% of s-ICU´s in contrast to 20% and 35% of larger ones. Main reason is the lack of equipment. At least one decompressive laparotomy was performed by 41% of l-ICU´s in contrast to 7% of s-ICU´s.

Conclusions Definitions and guidelines regarding diagnosis and management of IAH/ACS are not applied uniformly. This variability could express an ever present lack of awareness and solid prospective data.

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