期刊
JOURNAL OF PEDIATRIC SURGERY
卷 57, 期 2, 页码 199-202出版社
W B SAUNDERS CO-ELSEVIER INC
DOI: 10.1016/j.jpedsurg.2021.10.029
关键词
Congenital diaphragmatic hernia (CDH); Intra-abdominal pressure (IAP); Intra-abdominal hypertension (IAH); Intra vesical Pressure
The aim of this study was to determine the incidence of intra-abdominal hypertension (IAH) after congenital diaphragmatic hernia (CDH) repair and its relationship with duration of ventilatory support and gastrointestinal function. The study found that IAH occurred within the first 3 days post surgery, with a strong correlation between the duration of IAH and the duration of ventilation, as well as a moderate correlation between the duration of IAH and the time taken to achieve full enteral feeding.
Background: Increased intra-abdominal pressure (IAP) is seen in patients after congenital diaphragmatic hernia (CDH) repair owing to reduction of thoracic contents into the relatively smaller abdominal cavity. In infants, IAP >= 11 mmHg is considered intra-abdominal hypertension (IAH). We aim to determine the incidence of IAH and its relationship with duration of ventilatory support, and gastrointestinal function post CDH repair. Methods: We prospectively recruited all neonates who had CDH repair in four hospitals in Malaysia from June 2018 to October 2020. Intra vesical pressure was used as a proxy for IAP and was measured for 5 consecutive days post surgery. The daily median value was used for analysis. We categorized IAP as < 11 mmHg (no IAH), 11-15 mmHg (IAH), and > 15 mmHg (severe IAH). Incidence of IAH, its effects on the duration of ventilatory support, and gastrointestinal function were studied. Results: There were 24 neonates included in this study. They were operated between day 1 and 6 of life (median: 4 days old). IAH was detected within the first 3 days post surgery, with 83% occurring on day one. Those requiring ventilatory support for more than 3 days contributed the largest proportion of IAH ( n = 17, 71%). There was strong correlation between days of IAH and duration of ventilation ( p < 0.001, r = 0.70). There was moderate correlation between days of IAH and duration taken to achieve full enteral feeding ( p < 0.005, r = 0.70). Conclusion: IAP measurement is a safe and useful adjunct in post CDH monitoring and in predicting ventilatory support requirements and the time needed to establish feeding. (c) 2021 Elsevier Inc. All rights reserved.
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