Relationship of body mass index (BMI), lactate and intra-abdominal pressure (IAP) to subsequent mortality in ICU patients

Mlng Malbrain

doi:10.1186/cc414

Abstract

Excess body weight increases the risk of death from any cause and from cardiovascular disease in adults [1]. In the majority of population studies, the relationship of BMI to mortality is a U-shaped curve, with increased risk in the lowest and highest percentiles of the distribution. In acutely ill patients however BMI below the 15th percentile remains an independent predictor of mortality whereas a high BMI (>85th percentile) was not significantly related to risk of mortality [2]. We wanted to study in a prospective clinical trial the relationship between IAP and lactate and BMI and their relationship to subsequent mortality in ICU patients. The results of an interim analysis are presented in this abstract.

Highlights

Ill patients requiring intensive care are at risk of iatrogenic ocular damage
Intensive Care Unit (ICU) management of critically ill patients often includes the requirement for tracheostomy and feeding access, most often a pecutaneous endoscopic gastrostomy (PEG)
Percutaneous tracheostomy is performed routinely in many medical intensive care unit (ICU) settings, in high risk surgical and trauma patients who often have unstable cervical spine injury and tissue edema, direct visualization of the cervical structures and trachea is imperative during tracheostomy

Summary

Introduction

Ill patients requiring intensive care are at risk of iatrogenic ocular damage. We designed an experimental situation where external cardiac pressure conditions were controlled and adjusted to physiological extremes to mimic clinically relevant situations, while cardiac performance was assessed using left ventricular pressure–volume relationships (LVPVR) which are relatively preload and afterload independent This prospective, controlled study was undertaken to evaluate the response to therapy aimed at achieving supranormal cardiac and oxygen transport values (cardiac index >4.5 l/min/m2, oxygen delivery >600 l/min/m2, and oxygen consumption >170 l/min/m2) in patients older than 60 or with previous severe cardiorespiratory illnesses, who have undergone elective extensive ablative surgery planned for carcinoma or abdominal aortic aneurism. Whilst some human studies conducted in the critically ill and in high risk surgical patients have suggested that dopexamine may cause an increase in tonometrically measured gastric intra-mucosal pH (pHi) and an improvement in clinical outcome, this has not been confirmed in other randomised trials. In the present study the association of platelet function to inflammatory markers indicating disease severity was investigated

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