Intraabdominal Pressure in Children After Cardiothoracic Surgery

Abstract

Intraabdominal Pressure in Children After Cardiothoracic Surgery Introduction. Intraabdominal pressure (IAP) now is widely recognized as an important variable and its monitoring is used in a variety of critically ill patients. Aim of the study. The aim of this study was to measure and to recognize the influence of various factors on IAP in children after surgical correction of congenital heart disease. Materials and methods. We conducted non-randomized, prospective observational study in Pediatric intensive care unitat a University Children's hospital. Study protocol was approved by Hospital Ethics commision. Measurements of IAP were performed in 15 children with mean body weight 8±5,83 kg, (Range 3,1-28 kg), mean age of 18,01 months (range 8 days-8 years) after cardiothoracic surgery. Cardiopulmonary bypass (CPB) was used in 12 patients. IAP was measured during first 24 hours postoperatively at 12 hour intervals via indwelling urinary catheter with bladder volumes of 1 ml/kg of normal saline. Of the 15 patients, 12 were mechanically ventilated at the time of the IAP measurements. Ventilation pressures: PIP (peak inspiratory pressure), MAP (mean airway pressure), PEEP (positive end expiratory pressure) and central venous pressure (CVP) via femoral vein were recorded. In some patients (6 from 15) amount of fluid evacuated via intraperitoneal drain from peritoneal cavity in first 24 hours was measured. Results. IAP was 12,24±3,54 mm Hg (Range 5,44-20,4 mm Hg), CVP 13±2,19, PIP 20±2,48 cm H2O, MAP 9±2,3 cm H2O, PEEP 5±1,35 cm H2O. Amount of fluid removed from peritoneal cavity during first 24 hours was 0,8±0,54 ml/kg/h (Range 0,04-1,7 ml/kg/h). Conclusions. We find elevated intraabdominal pressure (IAP> 12 mm Hg) in 10 from 15 (66,67%) pediatric patients in the first 24 hours after cardiothoracic surgery. There was a difference in IAP in patients with abdominal paracenthesis versus patients without the drain. The difference between groups was not statistically significant (P=0,4). We did not find a correlation between IAP, MAP and CVP. We, however, did not observe development of abdominal compartment syndrome (ACS).