Incidence Of Intra-abdominal Hypertension Research Articles

In Vitro Validation of a Novel Continuous Intra-Abdominal Pressure Measurement System (TraumaGuard).

Introduction: Intra-abdominal pressure (IAP) has been recognized as an important vital sign in critically ill patients. Due to the high prevalence and incidence of intra-abdominal hypertension in surgical (trauma, burns, cardiac) and medical (sepsis, liver cirrhosis, acute kidney injury) patients, continuous IAP (CIAP) monitoring has been proposed. This research was aimed at validating a new CIAP monitoring device, the TraumaGuard from Sentinel Medical Technologies, against the gold standard (height of a water column) in an in vitro setting and performing a comparative analysis among different CIAP measurement technologies (including two intra-gastric and two intra-bladder measurement devices). A technical and clinical guideline addressing the strengths and weaknesses of each device is provided as well. Methods: Five different CIAP measurement devices (two intra-gastric and three intra-vesical), including the former CiMON, Spiegelberg, Serenno, TraumaGuard, and Accuryn, were validated against the gold standard water column pressure in a bench-top abdominal phantom. The impacts of body temperature and bladder fill volume (for the intra-vesical methods) were evaluated for each system. Subsequently, 48 h of continuous monitoring (n = 2880) on top of intermittent IAP (n = 300) readings were captured for each device. Using Pearson's and Lin's correlations, concordance, and Bland and Altman analyses, the accuracy, precision, percentage error, correlation and concordance coefficients, bias, and limits of agreement were calculated for all the different devices. We also performed error grid analysis on the CIAP measurements to provide an overview of the involved risk level due to wrong IAP measurements and calculated the area under the curve and time above a certain IAP threshold. Lastly, the robustness of each system in tracking the dynamic variations of the raw IAP signal due to respirations and heartbeats was evaluated as well. Results: The TraumaGuard was the only technology able to measure the IAP with an empty artificial bladder. No important temperature dependency was observed for the investigated devices except for the Spiegelberg, which displayed higher IAP values when the temperature was increased, but this could be adjusted through recalibration. All the studied devices showed excellent ability for IAP monitoring, although the intra-vesical IAP measurements seem more reliable. In general, the TraumaGuard, Accuryn, and Serenno showed better accuracy compared to intra-gastric measurement devices. On average, biases of +0.71, +0.93, +0.29, +0.25, and -0.06 mm Hg were observed for the CiMON, Spiegelberg, Serenno, TraumaGuard, and Accuryn, respectively. All of the equipment showed percentage errors smaller than 25%. Regarding the correlation and concordance coefficients, the Serenno and TraumaGuard showed the best results (R2 = 0.98, p = 0.001, concordance coefficient of 99.5%). Error grid analysis based on the Abdominal Compartment Society guidelines showed a very low associated risk level of inappropriate treatment strategies due to erroneous IAP measurements. Regarding the dynamic tracings of the raw IAP signal, all the systems can track respiratory variations and derived parameters; however, the CiMON was slightly superior compared to the other technologies. Conclusions: According to the research guidelines of the Abdominal Compartment Society (WSACS), this in vitro study shows that the TraumaGuard can be used interchangeably with the gold standard for measuring continuous IAP, even in an empty artificial bladder. Confirmation studies with the TraumaGuard in animals and humans are warranted to further validate these findings.

Predictive risk factors for intra-abdominal hypertension after cardiac surgery.

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was is it possible to identify predictive risk factors for the development of intra-abdominal hypertension (IAH) or abdominal compartment syndrome after cardiac surgery. Altogether 131 papers were found using the reported search, of which 7 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. A total of 755 patients were included, with the incidence of IAH between 26.9% and 83.3%. The limited evidence on IAH after cardiac surgery should be interpreted with caution. Obesity is a strong predictor of postoperative IAH, although not confined to a central pattern and body mass index is correlated with intra-abdominal pressure (IAP). Prolonged cardiopulmonary bypass and aortic cross-clamp time predisposed to IAH in 4 cohorts. IAH in cardiac surgery patients is associated with hepatic and renal impairment, and corresponding biochemical markers may be helpful in screening, although lacking specificity. In contrast to the development of IAH in other settings, the evidence for the role of fluid balance is poor. Accurate prediction of IAH remains elusive. Based on the available evidence, routine IAP measurement should be considered postoperatively in patients with obesity, particularly those with renal or hepatic impairment, prolonged cardiopulmonary bypass or operative time, requiring vasopressor support, to prevent the deleterious effects of IAH.

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

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.

Intraabdominal pressure and its relation with organ dysfunction in patients scheduled for elective cesarean section: Effect of supine vs left lateral tilt position.

Intraabdominal pressure (IAP) is related to clinical outcome of patients. It is measured as intravesical pressure through a Foley catheter in the supine position. During pregnancy, there are data showing elevated IAP and also a suggestion that it may be a false increase due to pressure on the urinary bladder by the gravid uterus in the supine position. Additionally, it is not known whether the elevated IAP during pregnancy is merely a physiological change or is associated with impairment of organ functions. We thus aimed to establish a normal value of IAP in supine (IAPsupine ) as well as 10° left lateral (IAPlateral-tilt ) positions, and their association with organ functions as well as certain maternal risk characteristics. This prospective cross-sectional cohort study included 100 consenting parturients with term gestation posted for elective cesarean section under single-shot subarachnoid block. IAP was measured via an indwelling Foley catheter with a transducer connected to it, as per the recommended technique. Organ dysfunction was defined as Sequential Organ Failure Assessment (SOFA) subscore≥1 for the particular system. ctri.gov.in (CTRI/2017/11/010527). The IAPsupine was significantly higher than IAPlateral-tilt (13.8±2.4 vs 12±2.3mm Hg) (P<.001). The incidence of intraabdominal hypertension as per conventional definition, that is, IAP≥12mm Hg, was also higher in the supine position (77% vs 55%) (P<.001). None of the patients had dysfunction of the cardiovascular, renal or central nervous system. The incidence of respiratory, hepatic and hematologic dysfunction was 2%, 15% and 32%, respectively. Receiver operating characteristic analysis showed insignificant association of IAPsupine and IAPlateral-tilt with various organ dysfunctions (P>.05). There was a significant correlation of intraabdominal hypertension when considering IAPsupine or IAPlateral-tilt , with obesity (P=.004 and .000, respectively), as well as preeclampsia (P=.006 and .000, respectively). In nonlaboring patients undergoing elective cesarean section, IAP is significantly higher in the supine vs 10° left lateral position. In neither position is IAP significantly associated with organ dysfunction. Thus, the usual recommendation of a supine position for measuring IAP to diagnose intraabdominal hypertension, formulated consequent to its pathological effects on organ functions, may not be applicable to pregnant patients and needs urgent validation studies.

Incidence of Intra-Abdominal Hypertension and Abdominal Compartment Syndrome: A Systematic Review

To determine the contemporary prevalence of intra-abdominal hypertension (IAH) and abdominal compartment syndrome in critically ill patients. Medline, Embase, and Central databases. Studies reporting on the prevalence of IAH in consecutively admitted critically ill patients using the World Society of Abdominal Compartment Syndrome (WSACS) consensus guidelines for intra-abdominal pressure (IAP) measurement. Duplicate independent review and data abstraction. The search identified 2428 titles with 6 eligible studies (n = 1965). Reported prevalence ranged from 30% to 49%. Despite abiding by the WSACS guidelines for IAP measurement, studies varied in their definition of IAH, frequency and duration of IAP measurement, and reporting of outcomes. Three of 6 studies reported that IAH, especially at higher grades, was an independent predictor of mortality. Intra-abdominal hypertension is a common finding in critically ill patients and may be associated with increased mortality, especially at higher grades. Further prospective research is required to examine the effect of screening and treatment of IAH on patient outcomes.

The Duration of Intra-abdominal Hypertension and Increased Serum Lactate Level are Important Prognostic Markers in Critically Ill Surgical Patient's Outcome: A Prospective, Observational Study.

Aim:The present study analyzed the clinical significance of duration of intra-abdominal hypertension (IAH) associated with increased serum lactate in critically ill patients with severe sepsis.Materials and Methods:Our study was an observational, prospective study carried out in the Surgical Intensive Care Unit (ICU) at J.L.N Medical College, Ajmer, Rajasthan, India. In our study, we included a total of 100 patients and intra-abdominal pressure (IAP) was measured through intravesical route at the time of admission and after 6, 12, 24, 48, and 72 h via a urinary catheter filled with 25 ml of saline. Duration of ICU and hospital stay, need for ventilator support, initiation of enteral feeding, serum lactate level at time of admission and after 48 h, and 30-day mortality were noted as outcomes.Results:In our study, an overall incidence of IAH was 60%. Patients with cardiovascular surgery and renal and pulmonary dysfunction were 93.3%, 55%, and 60%, respectively, at the time of admission and 65%, 10%, and 10%, respectively, after 72 h of admission in the surgical ICU. Nonsurvivors had statistically significant higher IAP and serum lactate levels than survivors. Patients with longer duration of IAH had longer ICU and hospital stay, longer duration of vasopressors and ventilator support, and delayed enteral feeding.Conclusion:There is a strong relationship “risk accumulation” between duration of IAH associated with increased serum lactate and organ dysfunction. The duration of IAH was an independent predictor of 30-day mortality. Early recognition and prompt intervention for IAH and severe sepsis are essential to improve the patient outcomes.

Septic shock patients admitted to the intensive care unit with higher SOFA score tend to have higher incidence of abdominal compartment syndrome - a preliminary analysis.

Intra-abdominal hypertension (IAH) is relatively frequent in critical patients. According to the most recent consensus of the World Society of Abdominal Compartment Society (WSACS), there are no predictive factors for IAH diagnosis. Risk factors are the only motivators to date for early IAH diagnosis. Abdominal compartment syndrome (ACS) is defined as sustained intra-abdominal pressure (IAP) maintained above 20 mm Hg (> 3 kPa), with or without abdominal perfusion pressure below 60 mm Hg (< 8 kPa), associated with a new organ dysfunction. Sepsis is a recognized cause of secondary ACS, but to date there is no correlation with admission SOFA (sequential organ failure assessment) score and ACS onset incidence. The objective of the present study is to determine the profile of extra-abdominal septic shock patients with IAH/ACS admitted to the intensive care unit (ICU) and correlating with admission SOFA score. Better understanding of this population may bring to light clinical predictive factors for IAH/ACS early diagnosis. In this observational study IAH/ACS incidence was correlated with SOFA score calculated at ICU admission. The study enrolled all critically ill patients more than 18 years old admitted to the Medical Intensive Care Unit (MICU) of a university teaching hospital between April and October 2016, who had been diagnosed with extra-abdominal septic shock, according to the Surviving Sepsis Campaign and SEPSIS-3. Twenty-five patients were evaluated during 10 hospitalization days. The average age was 51.13 ± 16.52 years, and 64% of the patients were male. Most patients (76%) had pneumonia. On admission, the SOFA score was 6.54 ± 2.71. Mortality rate in the population studied was 52%. The incidence of IAH was 43.5%, while the incidence of ACS in the IAH population was 28%. SOFA admission score in patients with the diagnosis of ACS was of 8.42 ± 1.27. In this study SOFA score higher than 7 is correlated with IAH, with an accuracy of 68.8% (P < 0.03). The incidence of ACS in patients with extra-abdominal septic shock admitted to a university teaching hospital MICU was higher than those found in the literature. Higher admission and consecutive SOFA score of more than 7 was associated with higher ACS incidence and higher mortality rate.

Analysis of Intra-Abdominal Pressure in Obstructive and Perforative Lesions of Gastro-Intestinal Tract

Introduction: Abdominal Compartment syndrome is an emerging problem in surgical patients with significant mortality reaching up to 100% in untreated patients. Intra abdominal hypertension (IAH) and abdominal compartment syndrome is common finding in traumatic and critically ill surgical patients. There are sporadic case reports in literature of intra abdominal hypertension &amp; abdominal compartment syndrome in general surgical patients, particularly in obstructive and perforative diseases of gastrointestinal tract (GIT). This study was done to know the pattern of intraabdominal pressure (IAP) and effect of intra abdominal hypertension (IAH) in obstructive and perforative lesions of gastrointestinal tract.&#x0D; Materials and Method: A total number of 145 cases were included between November 2016 to October 2017. These patients were from the department of Suregery, Nepalgunj Medical College, who underwent Surgery due to the Intestinal Obstruction or perforation.&#x0D; Result: There were total 145cases. The incidence of IAH in patients with intestinal obstruction and perforation peritonitis at presentation was 68.27%. 65 (66.32%) out of 98patients with perforation peritonitis had IAH and 34 (72.34%) with intestinal obstruction among 47 had IAH before surgery. There were 2.12% patients with abdominal compartment syndrome (ACS) in obstruction and 3.06% in perforation; ACS was highest amongst traumatic perforation population accounting for 13.33% of traumatic cases. There was statistically significant derangement (p-value&lt;0.05) of organ function with raised IAP which showed marked improvement following surgery. Four patients died, all these patients had ACS at the time of presentation.&#x0D; Conclusion: IAH is a significant entity in obstructive and perforative lesions of GIT. ACS can occur in obstructive and perforative lesions of GIT with significant mortality.

Determination of the diagnostic value of early symptoms in the prognosis of necrotizing enterocolitis in neonates of different gestational age

Necrotizing enterocolitis in newborns - non-specific inflammation of the intestine, predominantly in preterm infants, which puts a child's life at risk when it progresses. Despite the large number of studies of foreign and domestic scientists in the study of etiology and pathogenesis, clinical, laboratory and instrumental diagnosis of NEC, this disease remains one of the leading causes of infant mortality in intensive care units. Clinical symptoms of NEC can be manifested from intolerance to nutrition and intestinal paresis to severe peritonitis and multiple organ failure, and most diagnostic methods have high specificity but insufficient sensitivity or vice versa. The detection of early symptoms and progression symptoms of the NEC allows you to choose the best treatment tactics and improve your results. Therefore, differential diagnosis on the basis of clinical, instrumental and laboratory studies plays an important role in the diagnosis and determination of the stages of the NEC. The success of NEC treatment depends not only on timely diagnosis and evidence of surgical treatment, but also on the depth and distribution of bowel damage. Currently, there are no reliable non-invasive methods for diagnosis of the spread and depth of damage to the intestinal wall under the NEC. The terms of pre-operative preparation, the scope and type of surgical treatment remain controversial.Objective. The purpose of the study is to determine the diagnostic value of early symptoms in the development and progression of necrotizing enterocolitis in newborns of different gestational age.Materials and Methods. The work is based on studying the results of treatment of 94 newborns with NECs who were on treatment in the department of intensive care and pathology of newborns "Dniepropetrovsk Specialized Clinical Medical Center of Mother and Child. prof. MFRudneva "DOR" in 2015-2018. The diagnosis was established on the basis of clinical, instrumental (ultrasound, doppler, x-ray), laboratory and bacteriological studies. Patients were divided in terms of treatment tactics into two groups: the first group consisted of patients with NEC who did not require surgical intervention (uncomplicated NEC) (n = 71), the second group included patients requiring surgery (complicated by the NEC) ( n = 23). Additionally, patients in both groups performed intra-abdominal pressure measurements.Measurement of abdominal circumference in all patients with NECs was performed at the navel level in at least three measurements taken at intervals of 4-6 hours.Initial treatment was the same for patients in both groups and included: decompression of the stomach, complete parenteral nutrition, antibiotic therapy.Results and discussion. Increased symptoms of inability to enter into the stomach (inferiority syndrome), congestive growth in the stomach, auscultation of peristaltic bowel sounds, bloating, pain and / or tightness of the stomach accompanied the deterioration of the general condition of patients and the development of complicated forms of NEC.The appearance of a venous figure on the anterior abdominal wall and its pronounced nature over time, hyperemia and edema of the anterior abdominal wall and external genital organs revealed the presence of intraperitoneal hypertension and intra-abdominal circulation disturbance as a result of reduced perfusion pressure and inflammatory changes in the peritoneum.The increase in the abdominal circumference in patients of the I group was not more than 5 mm in the previous measurement, with the progression of the HEC and the development of complicated forms of NEC, the increase in abdominal circumference was 7 mm larger than the previous results.The main diagnostic tool for detecting progression and complications of NEC was the performance of X-ray of the abdominal cavity. X-ray of the abdominal cavity was performed for all patients with a suspicion on a NEC in a straight projection in an upright position. The most common X-ray symptoms of complicated NECs were the discovery of pneumoperitoneum, free fluid in the abdominal cavity and non-peristaltic static bowel loop. Also, the data obtained indicate that patients with complicated forms of NEC disease are accompanied by a significant increase in intraabdominal pressure, mainly due to sequestration of fluid in the third space, increasing intestinal paresis and its edema. If you do not diagnose and not eliminate a significant increase in intra-abdominal pressure, this leads to a violation of capillary perfusion of the internal organs, which leads to further ischemia and the development of abdominal compartment - a syndrome.When diagnosing pneumoperitoneum, ascites on the background of NEC or with the advent of clinical symptomatology, the progression of HEC (to exclude a hidden perforation) under ultrasound control was performed for all patients under local anesthesia abdominocentesis. In the case of a positive result of abdominocentesis, drainage of the abdominal cavity was performedConclusions. Among the early clinical syndromes that characterize the progression of the NEC, it is necessary to pay attention to the growth of the syndrome of enteral insufficiency. An increase in the incidence of intra-abdominal hypertension is an early symptom of the progression of the NEC.

Role of Intra-abdominal Pressure in Early Acute Kidney Injury: A Prospective Cohort Study in Critically Ill Obstetric Patients.

Aims:This prospective cohort study evaluated intra-abdominal pressure (IAP) and its role in causing acute kidney injury (AKI) in critically ill obstetric patients and utility of urinary neutrophil gelatinase-associated lipocalin (NGAL) to predict AKI.Methods:A total of 50 eligible obstetric patients admitted to our Intensive Care Unit were enrolled and daily IAP measured using indwelling Foley catheter. Early AKI was diagnosed as per the KDIGO criteria and urine assessed for NGAL using ELISA.Results:AKI was seen in 54% and intra-abdominal hypertension (IAH) in 21% patients. In patients with and without AKI, there was statistically similar IAP on day 1 (P = 0.542) and day 2 (P = 0.907) as well as incidence of IAH (19% vs. 23%) (P = 0.766). Area under receiver operating characteristic curve (AUC) for IAP to predict early AKI was 0.499 (95% confidence interval [CI]: 0.325–0.673) (P = 0.992). Urinary NGAL concentration was significantly greater in patients with early AKI compared to those without (P = 0.006); AUC for urinary NGAL to detect early AKI was 0.734 (95% CI: 0.583–0.884) (P = 0.006) and optimal cutoff was 53.7 ng/ml.Conclusions:IAH and AKI are common in critically ill obstetric patients. While IAP does not correlate with early AKI, NGAL is useful to predict AKI.

ABDOMINAL COMPARTMENT SYNDROME IN BURN PATIENTS

Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are consistently associated with morbidity and mortality among the critically ill or injured. Thus, avoiding or potentially treating these conditions may improve patient outcomes. Despite a large number of special publications devoted to this problem, very little attention is paid to the ACS in patients with severe burn injuries. Severe burns have been shown to be a risk factor for developing IAH. Fluid resuscitation practices used in burns management further predispose patients to increase intra-abdominal pressure. The incidence of intraabdominal hypertension in patients with severe thermal injury is, according to different authors, 57.8–82.6 %. The mortality associated with IAH in severe burns is very high once organ dysfunction occurs. The purpose of this work is to collect and analyze the problem of abdominal hypertension in burn patients, as well as to draw conclusions on the prevention of this condition and improve the results of treatment of patients with severe burn injury. Intra-abdominal hypertension is a frequent complication in severe burn patients requiring massive fluid resuscitation. Development of ACS in burn patients is associated with high mortality. Prevention, early detection and proper management may avoid this usually fatal complication. Fluid resuscitation volume is directly responsible for the development of ACS in severe burned patients. Thus, optimal fluid resuscitation can be the best prevention of IAH and ACS.

Negative Pressure Therapy in Abdominal Compartment Syndrome

The abdominal vacuum-assisted closure (VAC) system has been introduced, providing a new possibility to treat an open abdomen. Abdominal compartment syndrome has a great relevance in surgical practice and patient care in critical condition due to the effects of increased pressure in the enclosed space of the abdomen can lead to multiple organ failure. A prospective study was conducted on a sample of 15 patients with severe acute pancreatitis (SAP) was retrospectively analyzed, following the incidence of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS),the effectiveness of the therapeutic methods applied in reducing the intra-abdominal pressure (PIA), the evolution of severity scores, lenght of stay in intensive care unit between January 2014 - March 2017, following negative pressure therapy. There were used vacuum assisted closure devices (VAC � -Hartman) in order to apply negative pressure to the open abdomen, while complying with specified settings in accordance with patients� outcome. Surgery for abdominal decompression in PAS with SCA is an emergency and was imposed on 14 of the 15 patients . In the studied group, the first decompression procedure was performed on days 2 to 5 from intake, as PIA increased in evolution despite medical methods. Only 1 patient hospitalized with SAP PIA decreased by medical methods and after haemofiltration. Acute severe pancreatitis remains a serious pathology in spite of a maximum medical and surgical therapy.Continuous venous haemofiltration has contributed to lowering intraabdominal pressure. Surgery with decompression vacuum systems with negative pressure lead to a significant decrease in PIA.

Analyzing intra-abdominal pressures and outcomes in patients undergoing laparotomy

Background: Despite the abundance of knowledge, IAH still remains strangely under-diagnosed. A national postal questionnaire in United Kingdom reported that despite widespread awareness of IAH and the ACS, many intensive care units never measure the IAP. The aim was to evaluate the effects of intra-abdominal hypertension and to assess whether intra-abdominal pressure is a predictor of morbidity and mortality in patients undergoing laparotomy. Methods: This was a prospective observational study conducted in Department of General Surgery, Kamineni Hospitals, L. B. Nagar, Hyderabad, India on patients undergoing emergency and elective laparotomy, over a period of 2 years from October 2012 to October 2014. The study included 51 patients who underwent laparotomy. IAP was measured preoperatively and then post-operatively at 0, 6, 24, 48 and 72 hours. If IAP remained below 12 mmHg, measurement was discontinued after 24 hours. Duration of ICU and hospital stay, occurrence of burst abdomen, new organ function damage, need for ventilatory support and mortality in patients undergoing laparotomy were noted as outcomes. Results: At admission, an overall 65% incidence of intra-abdominal hypertension (IAH) was observed. In this group of 33 patients, CVS dysfunction was seen in 11 patients (33.3%), Respiratory dysfunction was seen in 9 patients (27.2%) and renal dysfunction was seen in 11 patients (33.3%). At 24 hours improvement was seen in all organ dysfunctions. Number of patients with CVS, respiratory and renal dysfunction in this group of 33 patients at 24 hours was 5 (15%), 4 (12%) and 6 (18%) respectively. This signifies that along with decrease in incidence of IAH, there is concomitant decrease in incidence of organ dysfunctions and morbidity. Conclusions: Raised intra-abdominal pressure (IAP) is associated with higher morbidity and mortality in patients undergoing laparotomy. Intra-abdominal hypertension (IAH) has detrimental effect on various organ systems and decompression leads to improvement in all the parameters.

Intra-abdominal hypertension; prevalence, incidence and outcomes in a low resource setting; a prospective observational study.

BackgroundIntra-abdominal hypertension (IAH) is defined as a sustained elevation in intra-abdominal pressure (IAP) greater than or equal to 12 mmHg. IAH has been shown to cause organ derangements and dysfunction in the body. Objective screening of IAH is neither done early enough nor at all thus leading to significant morbidity and mortality among surgical patients. The epidemiology and outcome of IAH among surgical patients has not been documented in Uganda. The aim of this study was to determine the prevalence, incidence and outcome of intra-abdominal hypertension among patients undergoing emergency laparotomy.MethodologyProspective observational study, conducted from January to April 2015 among patients undergoing emergency laparotomy. Inclusion criteria was; age >7 yrs, scheduled for emergency laparotomy, able to lie supine. Exclusion Criteria: pregnant, failed urethral catheterization, known cardiac, renal and respiratory disorders. Consecutive sampling was used. IAP, blood pressure, heart rate, respiratory rate, Sp02, Serum creatinine, Serum urea, and Urine output were measured preoperatively and postoperatively at 0, 6, 24 and 48 h. IAH was defined as IAP > 12 mmHg on three consecutive readings 3 min apart.ResultsIn total 192 patients were enrolled. Mean age ± SD was 14.25 (±3.16) yrs in the paediatrics and 34.4(±13.72) yrs in the adults with male preponderance 65 and 80.7 % respectively. The prevalence of IAH was 25 % paediatrics and 17.4 % adults and the cumulative incidence after surgery was 20 % paediatrics and 21 % adults. In paediatrics, IAH was associated with mortality at 0 h postoperatively, RRR = 1:24, 95 % CI (1.371–560.178), p-value 0.048. In adults, the statistically significant outcomes associated with IAH were respiratory system dysfunction RRR1:2.783, p-value 0.023, 95 % CI (1.148–6.744) preoperatively and mortality RRR 1:2.933, p-value 0.034, 95 % CI (1.017–8.464) at 6 h, RRR 1:3.769, p-value 0.033, 95 % CI (1.113–12.760) at 24 h postoperatively.ConclusionThe prevalence and incidence of IAH in the paediatrics and adults group in our study population were high. IAH was associated with mortality in both adult and paediatrics groups and respiratory system dysfunction in adult group. This calls for objective monitoring of intraabdominal pressure in patients undergoing emergency laparotomy with the aim of reducing associated mortality.

Intra-abdominal pressure in third trimester pregnancy complicated by acute pancreatitis: an observational study.

BackgroundIt is known that intra-abdominal hypertension has high morbidity in acute pancreatitis and has detrimental effects on patients. For third trimester pregnancy complicated by acute pancreatitis, the intra-abdominal pressure may have its own characteristic. This article will discuss this clinical scenario.MethodsThis observational study in a cohort group was performed in the surgical intensive care unit of a tertiary hospital. Medical records were reviewed from each acute pancreatitis exactly in third trimester pregnancy. The main statistical methods were Mann–Whitney U test and bivariate Pearson correlation analysis.ResultsDuring the study interval, there were totally 17 pregnancies complicated by acute pancreatitis in the third trimester. All cases with moderate or severe acute pancreatitis had intra-abdominal hypertension of mean value of 16.7 mm Hg (range, 12.9–22.0 mm Hg). The intra-abdominal pressure had significant correlation with APACHE II score (r = 0.7456, p = 0.0006), while a negative correlation was showed with the umbilical artery pH value and with 1-min Apgar score (r = −0.8232, p = 0.0005; r = −0.7465, p = 0.0034; respectively). The intra-abdominal pressure of those with live infants was lower than that of those with dead ones (13.78 ± 2.554 vs. 19.84 ± 1.695, p = 0.0019).ConclusionsThe incidence of intra-abdominal hypertension seems higher in moderate or severe acute pancreatitis in third trimester pregnancy than the non-pregnant cases but there’s no significance in this study. Acute elevated intra-abdominal pressure accounts for great association with mother’s serious scenario and fetal mortality.

Intra-abdominal hypertension and abdominal compartment syndrome in pancreatitis, paediatrics, and trauma.

Intra-abdominal hypertension (IAH) is an important contributor to early organ dysfunction among patients with trauma and sepsis. However, the impact of increased intra-abdominal pressure (IAP) among pediatric, pregnant, non-septic medical patients, and those with severe acute pancreatitis (SAP), obesity, and burns has been studied less extensively. The aim of this review is to outline the pathophysiologic implications and treatment options for IAH and abdominal compartment syndrome (ACS) for the above patient populations. We searched MEDLINE and PubMed to identify relevant studies. There is an increasing awareness of IAH in general medicine. The incidence of IAH and, to a lesser extent, ACS is high among patients with SAP. IAH should always be suspected and IAP measured routinely. In children, normal IAP in mechanically ventilated patients is approximately 7 ± 3 mm Hg. As an IAP of 10-15 mm Hg has been associated with organ damage in children, an IAP greater than 10 mm Hg should be considered IAH in these patients. Moreover, as ACS may occur in children at an IAP lower than 20 mm Hg, any elevation in IAP higher than 10 mm Hg associated with new organ dysfunction should be considered ACS in children until proven otherwise. Monitor IAP trends and be aware that specific interventions may need to be instituted at lower IAP than the current ACS definitions accommodate. Finally, IAH and ACS can occur both in abdominal trauma and extra-abdominal trauma patients. Early mechanical hemorrhage control and the avoidance of excessive fluid resuscitation are key elements in preventing IAH in trauma patients. IAH and ACS have been associated with many conditions beyond the general ICU patient. In adults and in children, the focus should be on the early recognition of IAH and the prevention of ACS. Patients at risk for IAH should be identified early during their treatment (with a low threshold to initiate IAP monitoring). Appropriate actions should be taken when IAP increases above 20 mm Hg, especially in patients developing difficulty with ventilation. Although on-operative measures should be instituted first, one should not hesitate to resort to surgical decompression if they fail.

Intra abdominal hypertension; incidence, prevalence and outcomes in a mixed intensive care unit: Prospective cohort study

BackgroundThis study was conducted primarily to determine the prevalence and incidence of intra-abdominal hypertension (IAH) in a mixed ICU (medical & surgical) population and, secondarily, to compare outcomes between patients with and without IAH. MethodsThe prospective cohort study was conducted from April to July 2011 on adult patients admitted in ICU, on mechanical ventilation and with an indwelling urinary catheter. Intra-vesicular pressure was measured. Primary endpoint was IAH and it was defined as Intra-abdominal pressure>12 mm Hg on two consecutive readings 6 h apart. ResultsTotal 83 patients were enrolled in the study; 61% from medical services and 39% from surgical services. Mean age in years±SD was 47 ± 17.5 with male preponderance (66%). IAH was detected in 23/83 (28%) at the time of admission, while six out of remaining 60 patients (10%) developed the condition during their ICU stay; the incidence and prevalence was 10% and 35%, respectively.Secondary end points of the study comparing outcomes between patients with and without IAH, though different in the two groups, did not achieve statistical significance. In-hospital mortality 65.5% vs. 44.4% p-value 0.054. New onset renal failure 34.5% vs. 16.7% p-value 0.054%. Difficulty in weaning from mechanical ventilation 37.9% vs. 25.9% p-value 0.008. ConclusionIAH is a poorly recognized clinical entity with potentially devastating impact on patient outcomes. Since majority of patients had IAH at the time of admission, all ICU patients especially on ventilator should have baseline intra-abdominal pressures measured at the time of admission and subjected to appropriate management to prevent them from developing abdominal compartment syndrome.

Intraabdominal pressure in critical burn patients

The aim was to study the evolution and incidence of intraabdominal hypertension in critical burn patients using a slightly restrictive fluid therapy protocol based on monitoring transpulmonary thermodilution and lactic acid.

Fluid overload, de-resuscitation, and outcomes in critically ill or injured patients: a systematic review with suggestions for clinical practice.

Sepsis is associated with generalised endothelial injury and capillary leak and has traditionally been treated with large volume fluid resuscitation. Some patients with sepsis will accumulate bodily fluids. The aim of this study was to systematically review the association between a positive fluid balance/fluid overload and outcomes in critically ill adults, and to determine whether interventions aimed at reducing fluid balance may be linked with improved outcomes. We searched MEDLINE, PubMed, EMBASE, Web of Science, The Cochrane Database, clinical trials registries, and bibliographies of included articles. Two authors independently reviewed citations and selected studies examining the association between fluid balance and outcomes or where the intervention was any strategy or protocol that attempted to obtain a negative or neutral cumulative fluid balance after the third day of intensive care compared to usual care. The primary outcomes of interest were the incidence of IAH and mortality. Among all identified citations, one individual patient meta-analysis, 11 randomised controlled clinical trials, seven interventional studies, 24 observational studies, and four case series met the inclusion criteria. Altogether, 19,902 critically ill patients were studied. The cumulative fluid balance after one week of ICU stay was 4.4 L more positive in non-survivors compared to survivors. A restrictive fluid management strategy resulted in a less positive cumulative fluid balance of 5.6 L compared to controls after one week of ICU stay. A restrictive fluid management was associated with a lower mortality compared to patients treated with a more liberal fluid management strategy (24.7% vs 33.2%; OR, 0.42; 95% CI 0.32-0.55; P < 0.0001). Patients with intra-abdominal hypertension (IAH) had a more positive cumulative fluid balance of 3.4 L after one week of ICU stay. Interventions to decrease fluid balance resulted in a decrease in intra-abdominal pressure (IAP): an average total body fluid removal of 4.9 L resulted in a drop in IAP from 19.3 ± 9.1 mm Hg to 11.5 ± 3.9 mm Hg. A positive cumulative fluid balance is associated with IAH and worse outcomes. Interventions to limit the development of a positive cumulative fluid balance are associated with improved outcomes. In patients not transgressing spontaneously from the Ebb to Flow phases of shock, late conservative fluid management and late goal directed fluid removal (de-resuscitation) should be considered.

A necessary evil? Intra-abdominal hypertension complicating burn patient resuscitation.

ObjectiveSevere burns are devastating injuries that result in considerable systemic inflammation and often require resuscitation with large volumes of fluid. The result of massive resuscitation is often raised intra-abdominal pressures leading to Intra-abdominal hypertension (IAH) and the secondary abdominal compartment syndrome. The objective of this study is to conduct (1) a 10 year retrospective study to investigate epidemiological factors contributing to burn injuries in Alberta, (2) to characterize fluid management and incidence of IAH and ACS and (3) to review fluid resuscitation with a goal to identify optimal strategies for fluid resuscitation.DesignA comprehensive 10-year retrospective review of burn injuries from 1999.Outcome MeasuresAge, sex, date, mechanism of injury, location of incident, on scene vitals and GCS, type of transport to hospital and routing, ISS, presenting vitals and GCS, diagnoses, procedures, complications, hospital LOS, ICU LOS, and events surrounding the injury.ResultsOne hundred and seventy five patients (79.4% M, 20.6% F) were identified as having traumatic burn injuries with a mean ISS score of 21.8 (±8.3). The mean age was 41.6 (±17.5) (range 14-94) years. Nearly half (49.7%) of patients suffered their injuries at home, 17.7% were related to industrial incidents and 14.3% were MVC related. One hundred and ten patients required ICU admission. ICU LOS 18.5 (±8.8) days. Hospital LOS 38.0 (±37.8) days. The mean extent of burn injury was 31.4 (±20.9) % TBSA. Nearly half of the patients suffered inhalational injuries (mild 12.5%, moderate 13.7%, severe 9.1%). Thirty-nine (22.2%) of patients died from their injuries. Routine IAP monitoring began in September, 2005 with 15 of 28 patients having at least two IAP measurements. The mean IAP was 16.5 (±5.7) cm H2O (range: 1-40) with an average of 58 (±97) IAP measurements per patient. Those patients with IAP monitoring had an average TBSA of 35.0 (±16.0)%, ISS of 47.5 (±7.5). The mean 48 hr fluid balance was 25.6 (±11.1)L exceeding predicted Parkland formula estimates by 86 (±32)%.ConclusionsFurther evaluation of IAP monitoring is needed to further characterize IAP and fluid resuscitation in patients with burn injuries.