POCUS excels in management of intra-abdominal hypertension

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Point-of-care ultrasound has shown notable prowess as an adjuvant tool for aiding both diagnosis and treatment of intra-abdominal hypertension (IAH), a common complication in critically ill patients, according to a study published online Nov. 28 in Anaesthesiology Intensive Therapy.

An international team of researchers led by Bruno Pereira, MD, MHSc, PhD, of the University of Campinas in Brazil enrolled 73 consecutive critically ill adults who were admitted to the surgical ICU with suspected IAH and/or abdominal compartment syndrome.

Fifty of the 73 patients met the study’s inclusion criteria and were included in the study. The most common reason for the ICU admission was postoperative care following abdominal surgery or other intervention, and all these patients presented with some degree of IAH while in the ICU.

Treating clinicians used ultrasound for nasogastric tube placement, confirmation of correct positioning and evaluation of stomach contents.

On review, the researchers found the ultrasound comparable to abdominal X-ray—and superior in determining the gastric content (fluid vs. solid).

What’s more, POCUS allowed faster determination of correct nasogastric tube positioning in the stomach (antrum), avoiding bedside radiation exposure, the authors report.

The technology also proved useful in evaluation of bowel activity, identification of large bowel contents and identification of patients who would benefit from bowel evacuation (enema) as an adjuvant to lower intra-abdominal pressure.

Plus it helped in the diagnosis of moderate to large amounts of free intra-abdominal fluid.

“POCUS is a powerful systematic ultrasound technique that can be used as an adjuvant in intra-abdominal hypertension management,” the authors write. “It has the potential to be used in both diagnosis and treatment during the course of IAH.”

Journal publisher Via Medica has posted the study in full for free.