Incidence and prognosis of intra-abdominal hypertension in critically ill medical patients: a prospective epidemiological study

Abstract

IntroductionThe aim of this study was to determine the incidence of intra-abdominal hypertension (IAH) in patients with two or more categorized risk factors (CRF) for IAH, and their morbidity and mortality during their intensive care unit (ICU) stay.MethodsProspective cohort study carried out at a medical ICU. A total of 151 medical patients were enrolled during a period of 3 months. After ICU whole staff training, we conducted daily screening of the four CRF for IAH based on the World Society of Abdominal Compartment Syndrome (WSACS) guidelines (namely, diminished abdominal wall compliance, increased intraluminal content, increased abdominal content, and capillary leak syndrome or fluid resuscitation). In those patients with risk factors of at least two different categories (≥2 CRF), intra-abdominal pressure (IAP) was measured every 8 h during ICU stay. Data included demographics, main diagnosis on admission, severity scores, cumulative fluid balance, daily mean IAP, resolution of IAH, days of ICU and hospital stay, and mortality.ResultsEighty-seven patients (57.6%) had ≥2 CRF for IAH, 59 (67.8%) out of whom developed IAH. Patients with ≥2 CRF had a significantly higher mortality rate (41.4 vs. 14.3%, p < 0.001). Patients with IAH had higher body mass index, severity scores, organ dysfunctions/failures, number of CRF for IAH, days of ICU/hospital stay and hospital mortality rate (45.8 vs. 32.1%, p = 0.22). Non-resolution of IAH was associated with a higher mortality rate (64.7 vs. 35.3%, p = 0.001). None of the cohort patients developed abdominal compartment syndrome. The multivariate analysis showed that IAH development (odds ratio (OR) 4.09; 95% confidence interval (CI) 0.83-20.12) was a non-independent risk factor for mortality, and its non-resolution (OR 13.15; 95% CI 22.13-81.92) was an independent risk factor for mortality.ConclusionsCritically ill medical patients admitted to ICU with ≥2 CRF have high morbidity, mortality rate, and incidence of IAH, so IAP should be measured and monitored as recommended by the WSACS. Our study highlights the importance of implementing screening and assessment protocols for an early diagnosis of IAH.

Aki in Icu Patients and Its Possible Relation to Intra-Abdominal Hypertension.

“…Sepsis syndrome, the most common cause of admission to a medical ICU, requires massive fluid resuscitation to maintain hemodynamic stability, or mechanical ventilation to treat combined pneumonia or adult respiratory distress syndrome. All these measures are likely to increase IAH and can lead to the development of AKI in critically ill patients (11), (12). Some studies have reported that increased IAP is associated with increased frequency of Intraabdominal pressure as a predictor of acute kidney injury AKI (1, 3, 5, 6, 13-16), however, for the best of our knowledge, no Egyptian study reported the predictive value of measurement of intra-vesical pressure to further development of AKI.…”

Intra-abdominal Hypertension in Medical Critically Ill Patients

“…Despite their diagnosis, no patient received laparotomy because of an inappropriately high surgical risk. Santa-Teresa and colleagues (14) published data in which medical patients were consecutively screened for IAH/ACS risk factors (92). Fifty-seven percent of the cohort had IAH/ ACS on admission to ICU, and 100% developed it subsequently.…”

Investigation of İntraabdominal Pressure İncrease and Related Risk Factors in İntensive Care Patients

“…Çalışmamızda, ileus görülen hastalarda daha yüksek İAH ve AKS oranları saptadık ve ileusun doğrudan etki ederek lümen basıncında artışa ve barsak duvarında iskemiye neden olarak İAH oluşmasına neden olduğunu düşünmekteyiz. Asidoz durumunun İAH/AKS ile ilişkisi ile ilgili de değişik yayınlar mevcuttur (5,9,12,13). Reintam Blaser ve ark.…”

“…(12) çalışmalarında ise asidozun İAH gelişmesi için önemli risk faktörlerin biri olarak bildirilmiştir. Diğer bir çalışmada ise asidoz durumu İAH saptanan hastalarda daha sıklıkla görülmüştür (13). Biz çalışmamızda pH <7,2 olan hastaların ise %66,7'sinde İAH saptarken, %50'sinde AKS saptadık.…”

“…İAH saptanan hastalarda total mortalite oranı %40 olarak bildirilirken, hastalar sınıflandırıldığında AKS gelişen hastalarda mortalite oranı %66 olarak bildirilmiştir (5). Bir diğer çalışmada İAH tanılı hastalarda daha yüksek APACHE II ve SOFA skorları, daha uzun mekanik ventilatör, yoğun bakımda kalış süresi ve daha yüksek mortalite saptanmıştır (13). Araştırıcılar karın içi basınç artışının vücuda olan zararlı etkilerinin bu sonuçlara neden olduğunu bildirmişlerdir.…”