Intra-abdominal hypertension and abdominal compartment syndrome in patients admitted to the ICU

Abstract

Background Intra-abdominal hypertension is frequently present in critically ill patients and is an independent predictor for mortality. Risk factors for intra-abdominal hypertension and abdominal compartment syndrome have been widely investigated. However, data are lacking on prevalence and outcome in high-risk patients. Our objectives in this study were to investigate prevalence and outcome of intra-abdominal hypertension and abdominal compartment syndrome in high-risk patients in a prospective, observational, single-center cohort study. Results Between March 2014 and March 2016, we included 503 patients, 307 males (61%) and 196 females (39%). Patients admitted to the intensive care unit with a diagnosis of pancreatitis, elective or emergency open abdominal aorta surgery, orthotopic liver transplantation, other elective or emergency major abdominal surgery and trauma were enrolled. One hundred and sixty four (33%) patients developed intra-abdominal hypertension and 18 (3.6%) patients developed abdominal compartment syndrome. Highest prevalence of abdominal compartment syndrome occurred in pancreatitis (57%) followed by orthotopic liver transplantation (7%) and abdominal aorta surgery (5%). Length of intensive care stay increased by a factor 4 in patients with intra-abdominal hypertension and a factor 9 in abdominal compartment syndrome, compared to patients with normal intra-abdominal pressure. Rate of renal replacement therapy was higher in abdominal compartment syndrome (38.9%) and intra-abdominal hypertension (8.2%) compared to patients with normal intra-abdominal pressure (1.2%). Both intensive care mortality and 90-day mortality were significantly higher in intra-abdominal hypertension (4.8% and 15.2%) and abdominal compartment syndrome (16.7% and 38.9%) compared to normal intra-abdominal pressure (1.2% and 7.1%). Body mass index (odds ratio 1.08, 95% confidence interval 1.03–1.13), mechanical ventilation at admission (OR 3.52, 95% CI 2.08–5.96) and Apache IV score (OR 1.03, 95% CI 1.02–1.04) were independent risk factors for the development of intra-abdominal hypertension or abdominal compartment syndrome. Conclusions The prevalence of abdominal compartment syndrome was 3.6% and the prevalence of intra-abdominal hypertension was 33% in this cohort of high-risk patients. Morbidity and mortality increased when intra-abdominal hypertension or abdominal compartment syndrome was present. The patient most at risk of IAH or ACS in this high-risk cohort has a BMI > 30 kg/m2 and was admitted to the ICU after emergency abdominal surgery or with a diagnosis of pancreatitis.

Abdominal Compartment Syndrome

“…The rate of renal replacement therapy was much higher in ACS (38.9%) than in patients with normal intra-abdominal pressure (1.2%). Both intensive care and 90-day mortality were also significantly higher in ACS (16.7% and 38.9%) than regular IAP patients (1.2% and 7.1%) [5].…”

“…In a systemic review, the reported prevalence of Intra-Abdominal Hypertension (IAH) and ACS is about 30% to 49% [4]. The prevalence is exceptionally high in pancreatitis (57%), orthotopic liver transplantation (7%), and abdominal aorta surgery (5%) [5]. It is reported that Body mass index (odds ratio 1.08, 95% confidence interval 1.03-1.13), mechanical ventilation (OR 3.52, 95% CI 2.08-5.96), and APACHE IV score at ICU admission (OR 1.03, 95% CI 1.02-1.04) are risk factors for IAH or ACS occurrence [5].…”

Abdominal compartment syndrome among surgical patients

“…ACS was reported in 3% and was most common in medical patients[ 17 ]. The highest prevalence of ACS development has been noted in patients with acute pancreatitis, orthotopic liver transplantation, and abdominal aorta surgery[ 18 ]. A prospective study with 503 patients admitted to a mixed ICU found an increased risk for IAH/ACS development in patients with emergency abdominal surgery (56.7%) and non-surgical patients (highest prevalence in acute pancreatitis) compared with elective abdominal surgery (18%)[ 18 ].…”

“…Any abdominal surgery or abdominal trauma has the possibility to increase IAP, however, the procedures reported with a higher risk for IAH development are orthotopic liver transplantation, damage control surgery, abdominal aortic aneurysm repair, and massive incisional hernia repair[ 2 , 18 , 23 ].…”

Abdominelles Kompartmentsyndrom

“…Der richtige Zeitpunkt für eine chirurgische Dekompression ist nicht eindeutig, wobei nachgewiesenermaßen eine verspätete Dekompression die Letalität und Morbidität deutlich erhöht[5,16,23,24]. Auch lässt sich nicht eindeutig zeigen, welche Patienten von einer chirurgischen Dekompression profitieren[6,14].Die effektivste Methode der chirurgischen Dekompression ist die komplette mediane Laparotomie vom Xiphoid bis zur Symphyse mit einer temporären Deckung. Eine chirurgische Dekompression birgt aber auch weitere Risi-Risikofaktoren für ein abdominelles Kompartmentsyndrom[19].…”