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Original Research |

Percutaneous Catheter Decompression in the Treatment of Elevated Intraabdominal PressurePercutaneous Catheter Decompression

Michael L. Cheatham, MD; Karen Safcsak, RN
Author and Funding Information

From the Department of Surgical Education, Orlando Regional Medical Center, Orlando, FL.

Correspondence to: Michael L. Cheatham, MD, Department of Surgical Education, Orlando Regional Medical Center, 86 W Underwood St, Ste 201, Orlando, FL 32806; e-mail: michael.cheatham@orlandohealth.com

Data are presented as mean ± SD or %, unless otherwise indicated. ACS = abdominal compartment syndrome; APACHE = Acute Physiology and Chronic Health Evaluation; IAH = intraabdominal hypertension; SAPS = Simplified Acute Physiology; SOFA = Sequential Organ Failure Assessment.

Data are presented as mean ± SD, unless otherwise indicated. Predecompression measurements were performed immediately before intervention. Postdecompression measurements were performed 4 h postintervention, whereas UOP measurements were performed 1 h postdecompression. APP = abdominal perfusion pressure; Cdyn = dynamic pulmonary compliance; IAP = intraabdominal pressure; MAP = mean arterial pressure; PIP = peak inspiratory pressure; UOP = urinary output.

Data are presented as mean ± SD or %, unless otherwise indicated. PCD = percutaneous catheter decompression. See Table 1 legend for expansion of other abbreviations.

Data are presented as mean ± SD, unless otherwise indicated. Predecompression measurements were performed immediately before intervention. Postdecompression measurements were performed 4 h postintervention, whereas UOP measurements were performed 1 h postdecompression. See Table 1 and 3 legends for expansion of abbreviations.

For editorial comment see page 1396

Funding/Support: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


For editorial comment see page 1396

For editorial comment see page 1396

Funding/Support: The authors have reported to CHEST that no funding was received for this study.

Funding/Support: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


Chest. 2011;140(6):1428-1435. doi:10.1378/chest.10-2789
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Background:  Intraabdominal hypertension (IAH) and abdominal compartment syndrome (ACS) traditionally have been treated surgically through emergent laparotomy. Intensivist-performed bedside drainage of free intraperitoneal fluid or blood (percutaneous catheter decompression [PCD]) has been advocated as a less-invasive alternative to open abdominal decompression (OAD).

Methods:  A single-center disease and severity of illness-matched case-control comparison of 62 patients with IAH/ACS treated with PCD vs traditional OAD was performed. The relative efficacy of each treatment in reducing elevated intraabdominal pressure (IAP) and improving organ dysfunction was assessed. Physiologic and demographic predictors of successful PCD therapy were determined.

Results:  PCD and OAD both were effective in significantly decreasing IAP and peak inspiratory pressure as well as in increasing abdominal perfusion pressure. PCD potentially avoided the need for subsequent OAD in 25 of 31 patients (81%) treated. Successful PCD therapy was associated with fluid drainage of > 1,000 mL or a decrease in IAP of > 9 mm Hg in the first 4 h postdecompression.

Conclusions:  Intensivist-performed PCD is an effective and less-invasive technique for treating patients with IAH/ACS where free intraperitoneal fluid or blood is present as determined by bedside ultrasonography. Failure to drain at least 1,000 mL of fluid and decrease IAP by at least 9 mm Hg in the first 4 h postdecompression is associated with PCD failure and should prompt urgent OAD.

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