Abstract
BackgroundIntra-abdominal hypertension (IAH) affects almost every organ sytem.If it is not detected early and corrected, mortality would be high. The prevalence of IAH and abdominal compartment syndrome (ACS) at Kenyatta National Hospital (KNH) critical care units is not known. The aim of this sudy was to determine the prevalence and factors associated with development of IAH/ACS among critically ill surgical patients.MethodsThis was a cross sectional descriptive study involving surgical patients in critical care units at KNH, carried out from March 2015 to October 2015.One hundred and thirteen critically ill and ventilated patients 13 years or older were recruited into the study.Krohn’s intravesical method was used to measure intra- abdominal pressure (IAP). Measurements were done at first contact, then at 12 and 24 h. Additional parameters recorded included: laboratory tests such as serum bilirubin and total blood count as well as clinical parameters such as urine output, vital signs and peak airway pressure, among others.Frequency, means and standard deviation were used to describe the data. Categorical variables e.g. age, were analysed using Chi square test and continous variables using student ‘t’ test and Mann Whitney test as appropriateResultA total of 113 consecutive surgical patients admitted to the critical care units were recruited. Of our study population, 71.7% (by IAP max) and 67.3% (by IAP mean) had IAH. Abdominal compartment syndrome (ACS) developed in 4.4% of the population. The following factors were significant determinants of risk of IAH : amount of IV fluids over 24 h (3949.6 vs 2931.1, p = 0.003, adjusted OR 1.0 [1.0-1.002]), haemoglobin values at admission (9.9 vs 12.0, p = <0.012, adjusted OR 0.6 [0.4-0.9]), peak airway pressure (28.4 vs 17.3; p = 0.018, adjusted OR 1.6 [1.1-2.4]) and synchronised intermittent mandatory ventilation (SIMV) (60 vs 32; p = 0.041, adjusted OR 1.4 [0.78-2.04]).Of those who had IAH; age, amount of iv fluids over 24 h, fluid balance and ventilator mode were significant determinants of risk of progression to ACS .ConclusionThe prevalence of intraabdominal hypertension and abdominal compartment syndrome at KNH is high. Clinical parameters pertaining to fluids administration and ventilator mode are siginificant determinants.Electronic supplementary materialThe online version of this article (doi:10.1186/s12873-017-0120-y) contains supplementary material, which is available to authorized users.
Highlights
Intra-abdominal hypertension (IAH) affects almost every organ sytem.If it is not detected early and corrected, mortality would be high
To be able to estimate the magnitude of IAH and abdominal compartment syndrome (ACS), three intraabdominal pressure (IAP) measurements were done, that is, at admission, at 12 h and at 24 h
Non surgical interventions including insertion or repositioning of nasogastric tube, insertion of flatus tube, careful titration of IV fluid requirements and appropriate adjustments of Discussion The main aims of this study were to document the prevalence of intraabdominal hypertension and abdominal compartment syndrome and factors significantly associated with development of the same
Summary
Intra-abdominal hypertension (IAH) affects almost every organ sytem.If it is not detected early and corrected, mortality would be high. The prevalence of IAH and abdominal compartment syndrome (ACS) at Kenyatta National Hospital (KNH) critical care units is not known. The aim of this sudy was to determine the prevalence and factors associated with development of IAH/ACS among critically ill surgical patients. Intraabdomninal hypertension (IAH) refers to elevated intraabdominal pressure (IAP) >12 mmHg, while abdominal compartment syndrome(ACS) is defined as IAP >20 mmHg with atleast one new organ dysfunction [1]. The predisposing factors include conditions that results in reduced abdominal wall compliance, increased abdominal contents, and increased capillary leakage and fluid resuscitation [4] These causes reduced cardiac output, restricted chest wall compliance, reduced visceral perfusion and lead to elevated intracranial pressure [4]. Intraabdominal hypertension and ACS can be prevented by regular measurement of IAP, and optimising physiological parameters such as fluid balance, acid–base status, haemodynamic status, respiratory parameters among other factors [4,5,6]
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