Ignite Creation Date:
2024-05-06 @ 8:45 AM
Last Modification Date:
2024-10-26 @ 12:04 PM
Study NCT ID:
NCT02814734
Status:
UNKNOWN
Last Update Posted:
2016-07-21
First Post:
2016-06-16
Brief Title:
Abdominal Compartment Syndrome Diagnostic and Prognostic Value of CT Findings - a Prospective Study
Sponsor:
Centre Hospitalier Universitaire de Besancon
Organization:
Centre Hospitalier Universitaire de Besancon
Study Overview
Official Title:
Abdominal Compartment Syndrome Diagnostic and Prognostic Value of CT Findings - a Prospective Study
Status:
UNKNOWN
Status Verified Date:
2016-07
Last Known Status:
NOT_YET_RECRUITING
Delayed Posting:
No
If Stopped, Why?:
Not Stopped
Has Expanded Access:
False
If Expanded Access, NCT#:
N/A
Has Expanded Access, NCT# Status:
N/A
Acronym:
SCANAPIV
Brief Summary:
Abdominal Compartment Syndrome ACS is a well known condition occuring in critically ill patients in intensive care units
This syndrome features a sustained intra abdominal hypertension IAH above 20 mmHg and a multiple organ failure due to the raise of the intra abdominal pressure
Several reviews described CT findings linked to these conditions but most of them suffer an insufficient statistical method
Furthermore the main CT feature described as specific in ACS Round Belly Sign RBS has been highly debated since
This study is aimed to evaluate in a prospective way the diagnostic and prognostic value of CT findings in abdominal hypertension and abdominal compartment syndrome patients hosted in intensive care units based on previous reviews and adding three new CT features described for the first time
This syndrome features a sustained intra abdominal hypertension IAH above 20 mmHg and a multiple organ failure due to the raise of the intra abdominal pressure
Several reviews described CT findings linked to these conditions but most of them suffer an insufficient statistical method
Furthermore the main CT feature described as specific in ACS Round Belly Sign RBS has been highly debated since
This study is aimed to evaluate in a prospective way the diagnostic and prognostic value of CT findings in abdominal hypertension and abdominal compartment syndrome patients hosted in intensive care units based on previous reviews and adding three new CT features described for the first time
Detailed Description:
Abdominal compartment syndrome ACS is a well known condition occurring in patients hosted in intensive care units and suffering from acute abdominal disease such as severe acute pancreatitis trauma hemoperitoneum surgery infectious disease large volume fluid resuscitation over 25L and systemic disease such as severe sepsis or major burns
This syndrome features a sustained intra abdominal hypertension IAH above 20 mmHg measured indirectly by intra-vesical pressure and a multiple organ failure due to the raise of the intra abdominal pressure
IAH which is defined as an abdominal pressure rise above 12 mmHg does not systematically lead to ACS and is often successfully cured with medical therapy
When medial management fails or ACS is present surgical management is appropriate and consists in a decompressive laparotomy
CT examination is not ordered for ACS diagnostic but radiologists should be aware of this condition and CT findings in patients with IAH as these critically ill patients are likely to have multiple CT examinations in a diagnostic purpose for the initial condition its complications or its surveillance
Several radiological studies have determined CT findings of IAH and ACS Most of them failed to establish a specific and sensitive semiology of IAH due to weak methodology except Al-Bahrani and al The diagnostic significance of the Round Belly Sign RBS first described by Pickhardt and al has been debated since None of these studies evaluated the prognostic value of IAH CT findings
Some of IAH CT findings may have a prognostic value and being statistically linked to a raised risk of ACS overcome when found in at-risk patients population with proven IAH
The aim of this study is to evaluate diagnostic and prognostic value of CT findings in IAH in a prospective way with a high statistic value
These CT findings are the ones previously described in previous reviews round belly sign narrowing of abdominal veins elevation of the diaphragm bilateral inguinal herniation bowel wall thickening with enhancement direct visceral compression and the ones studied here for the first time increase of the peritonealabdominal ratio semi-lunar line distension concavity of the upper side of the para renal fascia
Design
For each included patient when an abdominal CT is ordered an intra-abdominal pressure measure is performed simultaneously to the CT examination Presence or absence of IAH or ACS is noted
Two radiologists one junior and one senior specialized in abdominal emergencies imaging review the CT examinations and note the presence or absence of the ten CT features studied without knowing the intra-abdominal pressure value
Patient follow-up
5 days follow-up
intra-abdominal pressure measurements
Incidence of ACS from the time of inclusion to 28 days after
Evolution of organ failures
Vital status at 28 days
Medical and surgical therapy applied
Analysis
Diagnostic value of CT findings in IAH
Prognostic value of CT findings in IAH defining CT features statistically linked to ACS overcome and mortality at 28 days
Prevalence of IAH is expected to be about 40 to 50 in patients in state of shock hosted in ICU Among them about 20 are expected to suffer from ACS
Sensitivity of RBS in IAH is about 80 according to Al-Bahrani and al To evaluate the diagnostic value of RBS with CI 068 - 088 68 cases of IAH and about 140 patients included are needed
Based on imaging habits in our center length of this study is expected to be about 10 months
This syndrome features a sustained intra abdominal hypertension IAH above 20 mmHg measured indirectly by intra-vesical pressure and a multiple organ failure due to the raise of the intra abdominal pressure
IAH which is defined as an abdominal pressure rise above 12 mmHg does not systematically lead to ACS and is often successfully cured with medical therapy
When medial management fails or ACS is present surgical management is appropriate and consists in a decompressive laparotomy
CT examination is not ordered for ACS diagnostic but radiologists should be aware of this condition and CT findings in patients with IAH as these critically ill patients are likely to have multiple CT examinations in a diagnostic purpose for the initial condition its complications or its surveillance
Several radiological studies have determined CT findings of IAH and ACS Most of them failed to establish a specific and sensitive semiology of IAH due to weak methodology except Al-Bahrani and al The diagnostic significance of the Round Belly Sign RBS first described by Pickhardt and al has been debated since None of these studies evaluated the prognostic value of IAH CT findings
Some of IAH CT findings may have a prognostic value and being statistically linked to a raised risk of ACS overcome when found in at-risk patients population with proven IAH
The aim of this study is to evaluate diagnostic and prognostic value of CT findings in IAH in a prospective way with a high statistic value
These CT findings are the ones previously described in previous reviews round belly sign narrowing of abdominal veins elevation of the diaphragm bilateral inguinal herniation bowel wall thickening with enhancement direct visceral compression and the ones studied here for the first time increase of the peritonealabdominal ratio semi-lunar line distension concavity of the upper side of the para renal fascia
Design
For each included patient when an abdominal CT is ordered an intra-abdominal pressure measure is performed simultaneously to the CT examination Presence or absence of IAH or ACS is noted
Two radiologists one junior and one senior specialized in abdominal emergencies imaging review the CT examinations and note the presence or absence of the ten CT features studied without knowing the intra-abdominal pressure value
Patient follow-up
5 days follow-up
intra-abdominal pressure measurements
Incidence of ACS from the time of inclusion to 28 days after
Evolution of organ failures
Vital status at 28 days
Medical and surgical therapy applied
Analysis
Diagnostic value of CT findings in IAH
Prognostic value of CT findings in IAH defining CT features statistically linked to ACS overcome and mortality at 28 days
Prevalence of IAH is expected to be about 40 to 50 in patients in state of shock hosted in ICU Among them about 20 are expected to suffer from ACS
Sensitivity of RBS in IAH is about 80 according to Al-Bahrani and al To evaluate the diagnostic value of RBS with CI 068 - 088 68 cases of IAH and about 140 patients included are needed
Based on imaging habits in our center length of this study is expected to be about 10 months
Study Oversight
Has Oversight DMC:
None
Is a FDA Regulated Drug?:
None
Is a FDA Regulated Device?:
None
Is an Unapproved Device?:
None
Is a PPSD?:
None
Is a US Export?:
None
Is an FDA AA801 Violation?:
None