Pediatric critical care nurses' experience with abdominal compartment syndrome
Jennifer Newcombe1, Mudit Mathur, Khaled Bahjri
1Division of Pediatric Critical Care, Department of Pediatrics, School of Medicine, Loma Linda University, 11175 Campus Street, Suite A1117, Loma Linda, CA 92354, USA. jejike@llu.edu.
Insights
Pediatric critical care nurses show increased awareness of abdominal compartment syndrome (ACS) but lack understanding of its definition. Further education is crucial for early recognition and intervention in critically ill children.
Area of Science:
- Pediatric Critical Care Medicine
- Surgical Critical Care
- Nursing Education
Background:
- Abdominal compartment syndrome (ACS) is a life-threatening condition in critically ill children caused by elevated intra-abdominal pressure (IAP).
- Prompt recognition and management of intra-abdominal hypertension (IAH) are vital to prevent progression to ACS and reduce high mortality rates.
- Pediatric critical care nurses (PCCN) are pivotal in monitoring patients and identifying conditions like ACS.
Purpose of the Study:
- To evaluate the awareness and knowledge levels of PCCN regarding ACS.
- To identify trends in ACS awareness and management practices among PCCN over time.
Main Methods:
- A ten-item questionnaire was administered to PCCN at a National Critical Care Conference in 2006 and 2010.
- Data from 691 completed surveys were analyzed, comparing results between the two conference years.
- Factors such as years in practice and hands-on experience were assessed for their influence on awareness.
Main Results:
- ACS awareness significantly increased among PCCN from 69.3% in 2006 to 87.8% in 2010.
- Nurses with more years of practice demonstrated higher awareness of ACS.
- Despite improved awareness and management experience, knowledge of the ACS definition, specifically its association with organ dysfunction, remained critically low.
Conclusions:
- While awareness and management experience for ACS are growing among PCCN, a significant gap exists in understanding its definition.
- Targeted educational initiatives are necessary to enhance PCCN's knowledge of ACS definition and recognition.
- Improved understanding and early intervention by PCCN can decrease morbidity and mortality in critically ill pediatric patients.
Background:
Abdominal compartment syndrome (ACS) is a syndrome associated with multi-system effects of elevated intra-abdominal pressure (IAP) in critically ill children. It has a 90-100% mortality rate if not recognized and treated promptly. Measuring IAP helps identify patients developing intra-abdominal hypertension (IAH) which allows for timely intervention before progression to ACS. IAP helps identify ACS and guides its medical and surgical management. IAP is often measured by the bedside nurse in the intensive care unit. Pediatric critical care nurses (PCCN) play a key role in managing critically ill patients and recognizing potential causes for clinical deterioration such as ACS therefore should be knowledgeable about this entity.
Objective:
The aim of this study was to assess the awareness and current knowledge of ACS among PCCN.
Methods:
A ten-item written questionnaire was distributed at a National Critical Care Conference in 2006 and again in 2010. Participants of the conference voluntarily completed and immediately returned the survey. Results from the two questionnaires were compared.
Results:
Sixty-two percent of 691 questionnaires were completed. The awareness of ACS improved from 69.3% in 2006 to 87.8% in 2010 (p < 0.001) among PCCN. "Years in practice" influenced awareness of ACS. Nurses working for 5-10 and > 10 years were, respectively, 2.34 and 1.89 times more likely to be aware of ACS than those working for < 5 years. Hands-on experience managing a child with ACS by PCCN also improved from 49.1% to 67.9% (p < 0.001) but remains low. The number of participants who never measured IAP fell from 27.3% to 19.1% (p = 0.101). The most common method being used to measure IAP is the bladder method. Knowledge of the definition of ACS remains poor with only 13.2% associating the definition of ACS with organ dysfunction in 2010 which was even lower than in 2006.
Conclusions:
There is increasing awareness of ACS and experience in its management among PCCN. However, few PCCN correctly understand the definition of ACS. Since recognition of IAH and early intervention can reduce morbidity and mortality in critically ill patients, further educational efforts should be directed toward improving the knowledge and recognition of ACS by PCCN.
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