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Racial and Ethnic Disparities in Pediatric Congenital Heart Disease

October 2023 OA-SPA Ask the Expert

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Bronchial Blockers for One-Lung Ventilation

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Question of the Day

A 55-year-old woman is evaluated in the intensive care unit on postoperative day 2 following an emergent exploratory laparotomy for a ruptured viscus after a motor vehicle accident. Her abdomen was packed and left open. Her BP is 74/35 mmHg and her SpO2 has decreased to 87% over the past hour despite FiO2 1.0. Her bladder pressure is 38 mmHg. Which of the following interventions is MOST appropriate in the management of this patient?

Question of the Day


This trauma patient with an open abdomen that has been packed is at risk for abdominal compartment syndrome. Risk factors for the development of abdominal compartment syndrome include high dose vasopressor and fluid requirement, abdominal packing, and visceral or vascular abdominal injuries. Presentation includes hypotension due to decreased venous return from the increased intra-abdominal pressure as well as hypoxia due to increased airway pressures. Measuring bladder pressure can help to determine if there is elevated intra-abdominal pressure. Patients with intra-abdominal pressures between 25-35 mmHg will likely require an urgent decompression, while patients with intra-abdominal pressures greater than 35 mmHg require emergent decompression in order to prevent cardiovascular collapse. Decompression includes opening the temporary closure and removing the packing followed by placement of a temporary abdominal closure with sterile mesh or plastic bags to allow for expansion.

OA Series October 2023

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OA-SPA Ask the Expert

Racial and Ethnic Disparities in Pediatric Congenital Heart Disease

Elisha Peterson, MD, FAAP, Children's National Hospital