The prevalence, incidence and mortality associated with intra-abdominal hypertension among patients in intensive care units of a low-income country: a cohort study

Phiona Nansubuga,Samuel Kizito,Cornelius Sendagire,Daniel Obua,Arthur Kavuma Mwanje,Arthur Kwizera

doi:10.12688/aasopenres.13101.1

Phiona Nansubuga, Samuel Kizito + Show 4 more

Open Access

https://doi.org/10.12688/aasopenres.13101.1

Copy DOI

Abstract

Background: Intra-abdominal hypertension (IAH) is sustained increase in intra-abdominal pressure (IAP) ≥12 mmHg in adults and ≥10 mmHg in children. IAH has been noted to be associated with increased morbidity and mortality among critically ill patients. Measurement of IAP is common among at risk patients in the developed world. However, it has not received due attention in the majority of intensive care units (ICUs) in low-income countries, Uganda being one of these. This is evidenced by paucity of data and lack of protocols from the Ugandan Ministry of Health. This multi-center study was thus conducted to assess the prevalence, incidence and mortality associated with IAH among patients admitted to Ugandan ICUs.Methods:A multi-center prospective cohort study was conducted from September 2017 to February 2018 at three ICUs in Uganda. We consecutively enrolled 126 patients into the study. IAP was measured using the Harrahil manometer technique. Categorical variables were analyzed using the Chi square test and continuous variables analyzed using the t-test and Man Whitney test. The prevalence and incidence were determined using proportions and mortality was determined using survival analysis.Results:The median age was 33 years (26-48.5) for the patients without IAH and 42 years (29-55) for those with IAH. The majority of the patients were male and 9.6% of the patients were below 18 years. The prevalence of IAH was 62.7 (CI 54.1-71.3), whereas the 24 hour and 72 hour incidence of IAH was 9.3% (CI 1.3-17.2) and 14.3 % (CI 4.1-24.4), respectively. Mortality was higher in patients with IAH compared to those without (p-value 0.003 and 0.028, mean and maximum IAP, respectively). Conclusion:We found a high prevalence and incidence of IAH among critically ill patients, associated with a high mortality. Routine screening for IAH can preempt management strategies to mitigate this.

Highlights

Intra-abdominal pressure (IAP) is defined as the steady state pressure within the abdominal cavity bounded by the abdominal muscles and diaphragm[1]
Physicians responsible for the care of patients in the intensive care units (ICUs) were informed once Intra-abdominal hypertension (IAH) was diagnosed in a study participant and management of IAH was left to the discretion of the physician
Sample size and eligibility criteria We consecutively included all patients admitted to the three intensive care units during the study period who were above one year of age and were admitted for more than 24 hours

Summary

Introduction

Intra-abdominal pressure (IAP) is defined as the steady state pressure within the abdominal cavity bounded by the abdominal muscles and diaphragm[1]. IAH has been noted to be associated with increased morbidity and mortality among critically ill patients. Measurement of IAP is common among at risk patients in the developed world It has not received due attention in the majority of intensive care units (ICUs) in low-income countries, Uganda being one of these. This is evidenced by paucity of data and lack of protocols from the Ugandan Ministry of Health. This multi-center study was conducted to assess the prevalence, incidence and mortality associated with IAH among patients admitted to Ugandan ICUs

Methods

Results

Conclusion