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A S Staelens, S Vonck, G Molenberghs, M Lng Malbrain, W Gyselaers
INTRODUCTION: Body fluid composition (BFC) changes during the course of pregnancy and evidence is growing that these changes are different in uncomplicated pregnancies compared to hypertensive pregnancies. METHODS: The aim of this study was to evaluate the changes in maternal BFC during the course of uncomplicated pregnancy (UP) using bioimpedance analysis, as a reference to measurements in hypertensive pregnancies. BFC was assessed using a multiple frequency bioelectrical impedance analyser...
August 2016: Journal of Maternal-fetal & Neonatal Medicine
Anneleen S Staelens, Sharona Vonck, Geert Molenberghs, Manu L N G Malbrain, Wilfried Gyselaers
OBJECTIVES: Body fluid composition changes during the course of pregnancy and there is evidence to suggest that these changes are different in uncomplicated pregnancies compared to hypertensive pregnancies. The aim of this study was to evaluate the changes in maternal body fluid composition during the course of an uncomplicated pregnancy and to assess differences in uncomplicated pregnancies versus hypertensive pregnancies by using a bio-impedance analysis technique. STUDY DESIGN: Body fluid composition of each patient was assessed using a multiple frequency bioelectrical impedance analyser...
September 2016: European Journal of Obstetrics, Gynecology, and Reproductive Biology
Matthew J Douma, Domhnall O'Dochartaigh, Peter G Brindley
BACKGROUND: Minimizing haemorrhage using direct pressure is intuitive and widely taught. In contrast, this study examines the use of indirect-pressure, specifically external aortic compression (EAC). Indirect pressure has great potential for temporizing bleeds not amenable to direct tamponade i.e. abdominal-pelvic, junctional, and multi-site trauma. However, it is currently unclear how to optimize this technique. METHODS: We designed a model of central vessel compression using the Malbrain intra-abdominal pressure monitor and digital weigh scale...
September 2016: Injury
Manu L N G Malbrain, Yannick Peeters, Robert Wise
This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency medicine 2016. Other selected articles can be found online at Further information about the Annual Update in Intensive Care and Emergency Medicine is available from
2016: Critical Care: the Official Journal of the Critical Care Forum
J J De Waele, E Kimball, M Malbrain, I Nesbitt, J Cohen, V Kaloiani, R Ivatury, M Mone, D Debergh, M Björck
BACKGROUND: The effect of decompressive laparotomy on outcomes in patients with abdominal compartment syndrome has been poorly investigated. The aim of this prospective cohort study was to describe the effect of decompressive laparotomy for abdominal compartment syndrome on organ function and outcomes. METHODS: This was a prospective cohort study in adult patients who underwent decompressive laparotomy for abdominal compartment syndrome. The primary endpoints were 28-day and 1-year all-cause mortality...
February 18, 2016: British Journal of Surgery
L Correa-Martín, E Párraga, F M Sánchez-Margallo, R Latorre, O López-Albors, R Wise, M L N G Malbrain, G Castellanos
INTRODUCTION: Mechanical intestinal obstruction is a disorder associated with intra-abdominal hypertension and abdominal compartment syndrome. As the large intestine intraluminal and intra-abdominal pressures are increased, so the patient's risk for intestinal ischaemia. Previous studies have focused on hypoperfusion and bacterial translocation without considering the concomitant effect of intra-abdominal hypertension. The objective of this study was to design and evaluate a mechanical intestinal obstruction model in pigs similar to the human pathophysiology...
2016: PloS One
Azriel Perel, Bernd Saugel, Jean-Louis Teboul, Manu L N G Malbrain, Francisco Javier Belda, Enrique Fernández-Mondéjar, Mikhail Kirov, Julia Wendon, Roger Lussmann, Marco Maggiorini
In critically ill patients, many decisions depend on accurate assessment of the hemodynamic status. We evaluated the accuracy of physicians' conventional hemodynamic assessment and the impact that additional advanced monitoring had on therapeutic decisions. Physicians from seven European countries filled in a questionnaire in patients in whom advanced hemodynamic monitoring using transpulmonary thermodilution (PiCCO system; Pulsion Medical Systems SE, Feldkirchen, Germany) was going to be initialized as part of routine care...
October 2016: Journal of Clinical Monitoring and Computing
Guy L J Vermeiren, Manu L N G Malbrain, Jeroen M J B Walpot
Cardiac ultrasonography has become an indispensible tool in the management of hemodynamically unstable critically ill patients. Some consider it as the modern stethoscope. Echocardiography is non-invasive and safe while the modern portable devices allow to be used at the bedside in order to provide fast, specific and vital information regarding the hemodynamic status, as well as the function, structure and anatomy of the heart. In this review, we will give an overview of cardiac function in general followed by an assessment of left ventricular function using echocardiography with calculation of cardiac output, left ventricular ejection fraction (EF), fractional shortening, fractional area contraction, M mode EF, 2D planimetry and 3D volumetry...
2015: Anaesthesiology Intensive Therapy
Thomas Langer, Alessandro Santini, Eleonora Scotti, Niels Van Regenmortel, Manu L N G Malbrain, Pietro Caironi
"Balanced" solutions are commonly defined as intravenous fluids having an electrolyte composition close to that of plasma. As such, they should minimally affect acid-base equilibrium, as compared to the commonly reported 0.9% NaCl-related hyperchloremic metabolic acidosis. Recently, the term "balanced" solution has been also employed to indicate intravenous fluids with low chloride content, being the concentration of this electrolyte the most altered and supra-physiologic in 0.9% NaCl as compared to plasma, and based upon a suggested detrimental effect on renal function associated with hyperchloremia...
2015: Anaesthesiology Intensive Therapy
Andrew W Kirkpatrick, Derek J Roberts, Roman Jaeschke, Jan J De Waele, Bart L De Keulenaer, Juan Duchesne, Martin Bjorck, Ari Leppäniemi, Janeth C Ejike, Michael Sugrue, Michael L Cheatham, Rao Ivatury, Chad G Ball, Annika Reintam Blaser, Adrian Regli, Zsolt Balogh, Scott D'Amours, Inneke De Laet, Manu L N G Malbrain
The Abdominal Compartment Society ( previously created highly cited Consensus Definitions/Management Guidelines related to intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS). Implicit in this previous work, was a commitment to regularly reassess and update in relation to evolving research. Two years preceding the Fifth World Congress on Abdominal Compartment Syndrome, an International Guidelines committee began preparation. An oversight/steering committee formulated key clinical questions regarding IAH/ /ACS based on polling of the Executive to redundancy, structured according to the Patient, Intervention, Comparator, and Outcome (PICO) format...
2015: Anaesthesiology Intensive Therapy
Hollmann D Aya, Andrea Carsetti, Simone Bazurro, Davide Bastoni, Manu L N G Malbrain, Maurizio Cecconi
Shock is defined as a state in which the circulation is unable to deliver sufficient oxygen to meet the demands of the tissues, resulting in cellular dysoxia and organ failure. In this process, the factors that govern the circulation at a haemodynamic level and oxygen delivery at a microcirculatory level play a major role. This manuscript aims to review the blood flow regulation from macro- and micro-haemodynamic point of view and to discuss new potential therapeutic approaches for cardiovascular instability in patients in cardiovascular shock...
2015: Anaesthesiology Intensive Therapy
Robert Wise, Jimmy Jacobs, Sylvain Pilate, Ann Jacobs, Yannick Peeters, Stefanie Vandervelden, Niels Van Regenmortel, Inneke De Laet, Karen Schoonheydt, Hilde Dits, Manu L N G Malbrain
BACKGROUND: Burn patients are at high risk for secondary intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) due to capillary leak and large volume fluid resuscitation. Our objective was to examine the incidence the incidence of IAH and ACS and their relation to outcome in mechanically ventilated (MV) burn patients. METHODS: This observational study included all MV burn patients admitted between April 2007 and December 2009. Various physiological parameters, intra-abdominal pressure (IAP) measurements and severity scoring indices were recorded on admission and/or each day in ICU...
2016: Anaesthesiology Intensive Therapy
Jiřina Martínková, Manu L N G Malbrain, Eduard Havel, Petr Šafránek, Jan Bezouška, Milan Kaška
BACKGROUND: In critically ill patients, multi-trauma and intensive therapy can influence the pharmacokinetics (PK) and pharmacodynamics (PD) of antibiotics with time-dependent bacterial killing. Consequently, PK/PD targets (%fT>MIC) - crucial for antimicrobial effects -may not be attained. METHODS: Two patients admitted to the surgical ICU of the University Hospital in Hradec Králove for multiple-trauma were given piperacillin/tazobactam by 1-hour IV infusion 4/0...
2016: Anaesthesiology Intensive Therapy
Hans-Joachim Priebe, Manu L N G Malbrain, Paul Elbers
No abstract text is available yet for this article.
2015: Anaesthesiology Intensive Therapy
J J De Waele, I De Laet, M L N G Malbrain
No abstract text is available yet for this article.
June 2016: Intensive Care Medicine
Paul W G Elbers, Armand Girbes, Manu L N G Malbrain, Rob Bosman
Antibiotics save lives and are essential for the practice of intensive care medicine. Adequate antibiotic treatment is closely related to outcome. However this is challenging in the critically ill, as their pharmacokinetic profile is markedly altered. Therefore, it is surprising that critical care physicians continue to rely on standard dosing regimens for every patient, regardless of the actual clinical situation. This review outlines the pharmacokinetic and pharmacodynamic principles that underlie the need for individualized and personalized drug dosing...
2015: Anaesthesiology Intensive Therapy
Zhenghao Cai, Manu L N G Malbrain, Jing Sun, Ruijun Pan, Junjun Ma, Bo Feng, Feng Dong, Minhua Zheng
INTRODUCTION: The incidence of acute gastrointestinal injury (AGI) after colorectal surgery is low when laparoscopic techniques are used. While elevated intra-abdominal pressure (IAP) and intra-abdominal hypertension (IAH) are associated with AGI grade II, little is known about the relation between increased IAP during laparoscopy and subsequent AGI. AIM: To assess the impact of increased IAP during laparoscopic colorectal surgery on the incidence of postoperative AGI...
July 2015: Wideochirurgia i Inne Techniki Mało Inwazyjne, Videosurgery and Other Miniinvasive Techniques
Yannick Mallédant, Manu L N G Malbrain, Daniel A Reuter
No abstract text is available yet for this article.
November 2015: Intensive Care Medicine
Annika Reintam Blaser, Joel Starkopf, Manu L N G Malbrain
Abdominal problems, both as a primary reason for admission or developing as a part of multiple organ dysfunction syndrome during an ICU stay, are common in critically ill patients. The definitions, assessment, incidence and outcome of different abdominal signs, symptoms and syndromes are assessed in the current review. General abdominal signs and symptoms include abdominal pain and distension, as well as other signs assessed during the physical examination (e.g. palpation, percussion). Gastrointestinal (GI) symptoms include vomiting, high gastric residual volumes, diarrhoea, GI bleeding, paralysis of the lower GI tract, bowel dilatation and absent bowel sounds...
2015: Anaesthesiology Intensive Therapy
Manu L N G Malbrain, Jan J De Waele, Bart L De Keulenaer
The effects of increased intra-abdominal pressure (IAP) on cardiovascular function are well recognized and include a combined negative effect on preload, afterload and contractility. The aim of this review is to summarize the current knowledge on this topic. The presence of intra-abdominal hypertension (IAH) erroneously increases barometric filling pressures like central venous (CVP) and pulmonary artery occlusion pressure (PAOP) (since these are zeroed against atmospheric pressure). Transmural filling pressures (calculated by subtracting the pleural pressure from the end-expiratory CVP value) may better reflect the true preload status but are difficult to obtain at the bedside...
2015: Anaesthesiology Intensive Therapy
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