Prevalence and Outcome of Intraabdominal Hypertension in Medicalintensive Care Unit, Buriram Hospital
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Abstract
Background: Intraabdominal hypertension (IAH) and abdominal compartment syndrome (ACS) had been recognized in both medical and surgical intensive care patients. Intraabdominal hypertension was defined as a sustained or repeated pathological elevation in intra-abdominal pressure (IAP). IAH affected multiple organ systems in a graded and survival outcomes.
Objective: To establish the prevalence of IAH and ACS in a population of medical critically ill patients and to determine the effect of IAH to organ dysfunction, clinical outcomes, risk factors among those patients.
Methods: Study patients included all those consecutively admitted during prospective 1 year periods, staying in intensive care unit > 24 hours. Intermittent bladder pressure measured once daily for 3 consecutive days. Epidemiological data and risk factors were studied then daily and cumulative fluid balances, sequential organ failure assessment score were registered. Length of mechanical ventilation, ICU stay, ICU mortality were calculated.
Results: Of 66 patients, considering maximum IAP 33.3% had intraabdominal hypertension on admission during the study period. Overall mean IAP was 10.7 ทาทาHg (standard deviation [SD], 6.1) Main risk factors were coagulopathy, severe metabolic acidosis, cirrhosis and ascites, sepsis and septic shock (relative risk(RR)) 2.09, 1.82, 1.76, 1.63 respectively). Patients with more than 4 risk factors to develop IAH had higher sequential organ failure assessment (SOFA) score and higher mortality. Patients with IAH also exhibited significantly lower values of abdominal perfusion pressure (APP), central venous oxygen (SCV02), base excess and diuresis, higher values of lactate and creatinine, and consistently showed higher total SOFA, acute physiology and chronic health evaluation, version II score (APACHEII), simplified acute physiology score, version II (SAPII), daily and cumulative fluid balances (p <0.05 for all).
Conclusion: Intraabdominal hypertension was significantly associated with more organ failures, particularly renal and respiratory, and prolonged intensive care unit stay. Intraabdominal pressure,
Keywords: intraabdominal hypertension, abdominal compartment syndrome, abdominal perfusion pressure
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References
2. Malbrain ML, De laet I, Cheatham M. Consensus conference definitions and recommendations on intra-abdominal hypertension (IAH) and the abdominal compartment syndrome (ACS) the long road to the final publications, how did we get there?. Acta Clin Belg Suppl 2007;62:44-59.
3. Malbrain ML, Cheatham ML, Kirkpatrick A, Sugrue M, De Waele J, IvaturyR. Abdominal compartment syndrome: it’s time topay attention! Intensive. Care Med 2006;32:1912-4.
4. Malbrain M, Jones F. Intra-abdominal pressure measurement techniques. In: Ivatury R,Cheatham M, Malbrain M, Sugrue M, editors. Abdominal compartment syndrome.Georgetown(TX): Landes Bioscience; 2006: p. 19-68.
5. Sanchez NC, Tenofsky PL, Dort JM, Shen LY, Helmer SD, Smith RS. What is normal intra-abdominal pressure? Am Surg 2001;67:243-8.
6. Davis PJ, Koottayi S, Taylor A, Butt WW. Comparison of indirect methods of measuring intra-abdominal pressure inchildren. Intensive Care Med 2005;31:471-5.
7. De Waele J, Pletinckx P, Blot S, Hoste E.Saline volume in transvesical intra-abdominal pressure measurement: enough is enough. Intensive Care Med 2006;32:455-9.
8. Malbrain ML, Deeren DH. Effect of bladder volume on measured intravesical pressure: a prospectivecohort study. Crit Care 2006;10:R98.
9. Malbrain ML, Chiumello D, Pelosi P, Bihari D, Innes R, Ranieri VM, et al. Incidence and prognosis of intra-abdominal hypertension ina mixed population of critically ill patients: a multiple-center epidemiological study. Crit Care Med 2005;33:315-22.
10. Malbrain ML, Chiumello D, Pelosi P, Wilmer A, Brienza N, Malcangi V, et al. Prevalence of intra-abdominal hypertension in critically ill patients: a multicentre epidemiological study. Intensive Care Med 2004;30:822-9.
11. Cheatham ML, Malbrain ML, Kirkpatrick A, Sugrue M, Parr M, De Waele J, et al. Results from the International Conference of experts on intra-abdominal hypertension and abdominal compartment syndrome. II. Recommendation Intensive Care Med 2007;33:951-62.
12. Malbrain ML, De laet IE. Intra-Abdominal Hypertension : Evolving Concepts. Clin Chest Med 2009; 30:45-70.
13. Cheatham ML, Safcsak K. Is the evolving management of intra-abdominal hypertension and abdominal compartment syndrome improving survival. Crit Care Med 2010;38:402-7.
