Intra-abdominal hypertension in cardiac surgery patients: a multicenter observational sub-study of the Accuryn registry

Abstract

Intra-abdominal hypertension (IAH) is frequently present in the critically ill and is associated with increased morbidity and mortality. Conventionally, intermittent ‘spot-check’ manual measurements of bladder pressure in those perceived as high risk are used as surrogates for intra-abdominal pressure (IAP). True patterns of IAH remain unknown. We explored the incidence of IAH in cardiac surgery patients and describe the intra-and postoperative course of IAP using a novel, high frequency, automated bladder pressure measurement system. Sub-analysis of a prospective, multicenter, observational study (NCT04669548) conducted in three large academic medical centers. Continuous urinary output (CUO) and IAP measurements were observed using the Accuryn Monitoring System (Potrero Medical, Hayward, CA). Data collected included demographics, hemodynamic support, and high-frequency IAP and CUO. One Hundred Thirty-Seven cardiac surgery patients were analyzed intraoperatively and followed 48 h postoperatively in the intensive care unit. Median age was 66.4 [58.3, 72.0] years, and 61% were men. Median Foley catheter dwell time was 56.0 [46.8, 77.5] hours, and median baseline IAP was 6.3 [4.0, 8.1] mmHg. 93% (128/137) of patients were in IAH grade I, 82% (113/137) in grade II, 39% (53/137) in grade III, and 5% (7/137) in grade IV for at least 12 cumulative hours. For maximum consecutive duration of IAH, 84% (115/137) of patients spent at least 12 h in grade I, 62% (85/137) in grade II, 18% (25/137) in grade III, and 2% (3/137) in grade IV IAH. During the first 48 h after cardiac surgery, IAH is common and persistent. Improved and automated monitoring of IAP will increase the detection of IAH—which normally would remain undetected using traditional intermittent monitoring methods.

A Retrospective, Observational Study of Catheter-associated Urinary Tract Infection Events Post-implementation of a Novel Urinary Catheter System with Active Drain Line Clearance and Automated Intra-abdominal Pressure Monitoring

“…The use of continuous IAP monitoring will, in the future, likely detect higher rates of IAH and has many benefits beyond that are detailed elsewhere [41]. This is exemplified by the recent finding that IAH detected by continuous IAP monitoring in cardiac surgery patients was above 90% in the first 48 hours after surgery [42].…”

Continuous intra-abdominal pressure: is it ready for prime time?

“…Recently, the Accuryn Monitoring System (Potrero Medical, Hayward, California, USA) using a special urinary catheter with an extra air-filled balloon at the tip has been FDA cleared for measuring IAP, urinary output (UO), and core body temperature. A significant advantage of this system is near-continuous, high-fidelity and high-resolution IAP monitoring as shown in a recent study in cardiac surgery patients observing persistent increases in IAP that had previously not been shown with traditional spot-check measurements [ 10 ]. One more consideration when measuring IAP at high frequency is the signal to noise factor.…”

“…One more consideration when measuring IAP at high frequency is the signal to noise factor. Applying a 10-min running median and resampling data at longer intervals every 15 min may help mitigate the effect of patient position and factors that induce rapid sudden changes in IAP such as diaphragmatic contraction with a coughing [ 10 ].…”

Pre-Clinical Validation of A Novel Continuous Intra-Abdominal Pressure Measurement Equipment (SERENNO)

“…Although some studies show a lower incidence of ACS (approximately 3–5%) in general ICU patients [ 7 ], the risk of ACS in critically ill patients should not be underestimated. For instance, a recent study that included 138 post-cardiac surgery patients showed an IAH occurrence rate of 100% during the first 24 h post-operatively, with a sustained IAP pressure above 20 mmHg for approximately 5 h [ 8 ]. Therefore, continuous IAP monitoring is of great importance to prevent late detection of IAH, development of ACS, and potentially contribute to a reduced length of ICU stay.…”