EComment. A significance of intra-abdominal pressure in cardiovascular patients

Abstract

Intra-abdominal hypertension (IAH) is a lethal yet under-appreciated complication of cardiovascular surgery. Dalfino et al. [1] stated that the baseline value of intra-abdominal pressure (IAP) may be an early warning parameter for IAH occurrence. To investigate this statement, last year, we conducted a study in which we assessed correlations among the values of IAP, abdominal perfusion pressure (APP) and clinical scoring systems including the systemic inflammatory response syndrome (SIRS), multiple organ dysfunction score (MODS) and Acute Physiology and Chronic Health Evaluation (APACHE II) in patients after open surgical repair of abdominal aneurysms. The IAP was measured in a non-invasive manner via the urinary bladder filled up with 100 ml saline solution, through the previously drained and clamped standard urinary catheter [2]. The actual pressure was transmitted to a manometer into the mid-axillary line. A pressure above 15 mmHg is considered elevated [3]. Of 50 studied patients with a survival rate of 50%, we found IAP values over 15 mmHg in 26 patients (52%). The non-parametric statistical Kruskal-Wallis test was used for comparison of survivors and non-survivors distribution of IAP values. The median for non-survivors was 18 (range 6-30), and for survivors the median was 15 (range 6-36) with significance P < 0.009. The same statistic was applied for MODS values where the median for non-survivors was 3 (range 0-6), and for survivors 1 (range 0-3), P < 0.0072. For the APACHE II score the non-survivors median was 18 (range 0-34), and survivors 9 (range 2-23), P < 0.0067. We did not find any significance in relation to the IAP values and disease severity scores in linear regression statistics. On the other hand, the linear regression correlation demonstrated the comparison of APP with disease severity scores as follows: a) APP versus SIRS-correlation coefficient (r = -0.43, P < 0.05); b) APP versus MODS (r = -0.49, P < 0.05); c) APP versus APACHE II (r = -0.47, P < 0.05). According to our results, we conclude that the measurement of IAP might have a predictive value in cardiovascular surgical patient's survival rates, but the APP may be a better indicator of IAH severity. Measurement of IAP is widely accepted, inexpensive and a simple monitoring tool for IAH [4]. However, it is an intermittent measurement and therefore not always appropriate as an indicator for the organ dysfunction that typifies IAH. The other problem with IAP is that it is an indicator of the syndrome (defined by IAP as abdominal compartment syndrome), not a real predictor: when IAP is pathologically elevated and organ dysfunctions are imminent, prevention of the syndrome is a faint hope. Authors stated that their findings encourage further studies to define the role of continuous IAP monitoring and therapeutic strategies. According to the results presented by Dalfino et al., which support our results we could conclude that further investigations of the predictors of IAH in cardiovascular patients must include both physiological measurements and resuscitative interventions. Conflict of interest: none declared