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Title: A study of raised intra-abdominal pressure and the abdominal compartment syndrome in liver intensive care
Author: Cresswell, Ben
Awarding Body: King's College London (University of London)
Current Institution: King's College London (University of London)
Date of Award: 2013
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Introduction: Interest in intra-abdominal pressure (IAP) measurement has increased significantly, with evidence of its deleterious effects demonstrated on every organ. Despite the volume of publications – several assumptions relating to the measurement of IAP remain unproven and there is a paucity of data relating to patients in a specialised liver Intensive Therapy Unit (ITU). Methods: This thesis encompasses a survey of the available literature and national attitudes / practice with several clinical experiments; Generic Questions 1. IAP measurement technique – validation of current gold-standard against alternatives. 2. Identification of potential sources of error in measurement of IAP 3. Impact of body position and zero-reference point on IAP Specialty Specific Questions. 1. Incidence of raised IAP in specialised liver ITU and its link to complications/length of stay. 2. Identification of early predictors of raised IAP 3. Study of regional abdominal compartmental variation in IAP Results & Conclusions: • IAP is widely accepted by UK anaesthetists and surgeons, especially amongst those more recently graduated. Knowledge and practice is variable however and requires better education. • The Foley Catheter Manometer represents a reliable and valid tool for the measurement of IAP, with excellent agreement to measurements obtained by other devices and directly transduced intra-peritoneal pressure. • Body-position and bladder priming volumes both introduce significant clinical error in the measurement of IAP. • Patients in liver ITU are at higher risk of developing elevated IAP than those in a general ITU. Within this patient cohort, complications are associated with elevated IAP and IAP is a better predictor of length of stay than other severity scores. A normal Day 1 IAP reliably predicts that abdominal compartment syndrome will not occur during the admission. • Significant variation in upper and lower IAP occurs following liver transplantation and this regional variation can be manipulated by body positioning.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available