Chapters authored
Abdominal Compartment Syndrome among Medical Patients
Abdominal compartment syndrome and intra-abdominal hypertension (IAH) has been widely studied in surgical and trauma patients, even though the incidence of IAH in medical intensive care unit (MICU) remains high. Studies have shown that the time to decision making regarding diagnosis and management of IAH is twice in MICU compared to the corresponding surgical side. MICU patients often require large volume resuscitation such as in sepsis, hemorrhage, or an inflammatory condition such as acute pancreatitis, which increases the risk of development of IAH. It is often underdiagnosed and undertreated in MICU due to a lack of awareness of the consequences and mortality associated with it. Elevated intra-abdominal pressure has systemic effects causing atelectatic lungs, decreased cardiac output, and renal insufficiency. IAH, if not recognized early, can quickly progress to compartment syndrome causing multiorgan failure and death. Approach to ACS management between medical and surgical intensivists varies largely because of lack of experience with surgical decompression. This article provides an overview of definitions, incidence, pathophysiology, clinical presentation, diagnosis, and management of IAH and abdominal compartment syndrome in critically in medical patients.
Part of the book: A Comprehensive Review of Compartment Syndrome
Classification and Clinical Features of Pulmonary Hypertension in Adults
This chapter explores the clinical manifestations and initial diagnostic findings associated with pulmonary hypertension (PHTN) at different stages. The definition of PHTN, as proposed in the 6th World Symposium, considers a mean pulmonary arterial pressure at rest (mPAP) of greater than 20 mmHg (previously 25 mmHg) and a pulmonary vascular resistance equal to or exceeding 3 WU. PHTN is clinically classified into five groups: Group 1 includes idiopathic, hereditary, and other forms; Group 2 comprises PHTN due to left heart disease; Group 3 consists of PHTN associated with pulmonary diseases or hypoxia; Group 4 pertains to PHTN caused by pulmonary artery obstruction; and Group 5 encompasses cases with unclear or multifactorial etiologies. The classification of PHTN into these groups holds significant clinical value as it contributes to determining survival rates and treatment responses. The chapter elaborates on the clinical features observed throughout various stages of PHTN and highlights the abnormalities detected during initial diagnostic assessments. The in-depth details will also be outlined in subsequent chapters of the book.
Part of the book: New Insights on Pulmonary Hypertension [Working title]