Prevalence Of Intra-abdominal Hypertension Research Articles

Intra-abdominal hypertension in acute decompensated heart failure - an overlooked piece in the puzzle of diuretic resistance

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Wroclaw Medical University, Insitute of Heart Diseases, Wroclaw, Poland. Introduction Intra-abdominal pressure (IAP) is a frequently overlooked aspect in clinical assessment which can have a significant impact on organ dysfunction in patients with acute decompensated heart failure (ADHF). Purpose To investigate prevalence and dynamics of IAP in patients with ADHF and its impact on diuretic response. Methods 30 patients admitted for ADHF, class III or IV in New York Heart Association classification were enrolled into a prospective, observational pilot study. In every individual serial transurethral IAP measurements, blood and urine samples were taken upon admission, on the second and the third day of hospitalization. Results The study showed 63.3% prevalence of intra-abdominal hypertension (IAH) defined as IAP ≥ 12 mmHg upon admission, while only roughly 13% presented overt signs of abdominal congestion. Patients diagnosed with IAH upon admission had significantly poorer diuresis in the first day of hospitalization, despite receiving similar doses of loop diuretics (p = 0.038). Moreover, IAP was negatively correlated with urine output (p = 0.011) and positively correlated with urine osmolality (p = 0.033), while there was no relationship between IAP and natriuresis. There was a significant reduction of IAP among patients with IAH treated according to the European Society of Cardiology guidelines. Conclusions The investigation revealed an exepctionally high prevalence of elevated IAP among patients hospitalized for ADHF and highlights the limitations of physical examination in assessing abdominal congestion, as most patients remain asymptomatic. The observed poorer diuresis in patients diagnosed with IAH and the established association between IAP and the reduced urinary output, despite achieving target levels of natriuresis, add another piece to the puzzle of understanding the phenomenon of diuretic resistance in ADHF and set directions for future studies.

ASSESSMENT OF INTRA-ABDOMINAL HYPERTENSION AND ITS CORRELATION TO ORGAN FAILURE IN PATIENTS ADMITTED TO SURGICAL CRITICAL CARE UNIT

Background: Intra-abdominal hypertension (IAH) is the sustained elevation in intra-abdominal pressure (IAP) ≥ 12 mmHg. It has been shown to affect various organs of the body, causing derangement and dysfunction of different organ systems. However the problem remains unappreciated and this study was done to assess the problem of IAH among the ICU patients in our own environment and also to understand the signicance of elevated IAPas a marker of organ dysfunction. Objectives Ÿ To assess prevalence of intra-abdominal hypertension in a surgical critical care unit of a tertiary care hospital Ÿ To correlate intra-abdominal hypertension with organ failure in patients admitted to surgical critical care unit. Methodology: This was an observational prospective study done among 75 patients who were admitted for a minimum period of 3 consecutive days in the surgical critical care unit of JMMC&RI, Thrissur from April 2016 to March 2017. The IAP was measured thrice daily, and SOFAscore daily for 3 consecutive days. The results were analyzed using SPSS software. Results: The prevalence of IAH in patients admitted to surgical critical care unit is 46.7% based on mean IAPand 78.7% based on maximum IAP. The mean IAPand SOFAscore were 11.40 ± 4.37 mmHg and 4.55 ± 2.72 respectively. 34.7 % of patients had organ failure. 51.4% of patients with IAH had organ failure. The mortality was 22.9% in population with IAH. The mean ICU stay and hospital stay in patients with IAH were 6.77 ± 4.98 and 13.37 ± 8.09 days respectively Conclusion:The prevalence of IAH in patients admitted to surgical critical care unit is 46.7%. There is a signicantly higher incidence of organ failure, longer ICU stay and hospital stay in patients with IAH. No signicant association was found between IAH and mortality.

Intra-abdominal pressure during and after cardiac surgery: a single-centre prospective cohort study.

While intra-abdominal hypertension (IAH) has been associated with adverse outcomes in multiple settings, the epidemiology and clinical implications of IAH in the context of cardiac surgery are less known. In this study, we aimed to describe the prevalence of IAH in patients undergoing cardiac surgery and determine its association with patient characteristics and postoperative outcomes. We conducted a single-centre prospective cohort study in which intra-abdominal pressure was measured in the operating room after general anesthesia (T1), after the surgical procedure (T2), and two hours after intensive care unit (ICU) admission (T3) in a subset of patients. Intra-abdominal hypertension was defined as intra-abdominal pressure (IAP) ≥ 12 mm Hg. Postoperative outcomes included death, acute kidney injury (AKI), and length of stay in the ICU and hospital. A total of 513 IAP measurements were obtained from 191 participants in the operating room and 131 participants in the ICU. Intra-abdominal hypertension was present in 105/191 (55%) at T1, 115/191 (60%) at T2, and 31/131 (24%) at T3. Intra-abdominal pressure was independently associated with body mass index, central venous pressure, and mean pulmonary artery pressure but was not associated with cumulative fluid balance. Intraoperative IAH was not associated with adverse outcomes including AKI. Intra-abdominal hypertension is very common during cardiac surgery but its clinical implications are uncertain.

Intra-abdominal hypertension and abdominal compartment syndrome in the critically ill liver cirrhotic patient-prevalence and clinical outcomes. A multicentric retrospective cohort study in intensive care.

Liver cirrhosis and ascites are risk factors for intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS); however, data is scarce. We aimed to determine the prevalence of IAH/ACS in a population of critically ill cirrhotic patients with acute medical illness in intensive care and to assess for risk factors and clinical outcomes. This was a multicentric retrospective cohort study including two general ICUs and pooled data from a multicentric study between January 2009 and October 2019. A total of 9,345 patients were screened, and 95 were included in the analysis. Mean age was 56.7±1.3 years, and 79% were male. Liver cirrhosis etiology included alcohol in 45.3% and alcohol plus hepatitis C virus in 9.5%. Precipitating events included infection in 26% and bleeding in 21% of cases. Mean severity score MELD and SAPS II were 26.2±9.9 and 48.5±15.3, respectively, at ICU admission. The prevalence of IAH and ACS was respectively 82.1% and 23.2% with a mean value of maximum IAP of 16.0±5.7 mmHg and IAH grades: absent 17.9%, I 26.3%, II 33.7%, III 17.9%, and IV 4.2%. Independent risk factors for IAH were alcoholic cirrhosis (p = 0.01), West-Haven score (p = 0.01), and PaO2/FiO2 ratio (p = 0.02); as well as infection (p = 0.048) for ACS. Overall, 28-day mortality was 52.6% associated with higher IAP and ACS, and independent risk factors were MELD (p = 0.001), white blood cell count (p = 0.03), PaO2/FiO2 ratio (p = 0.03), and lactate concentration (p = 0.04) at ICU admission. This study demonstrates a very high prevalence of IAH/ACS in the critically ill cirrhotic patient in intensive care. Increased IAP and ACS were associated with severity of disease and adverse outcomes and independent risk factors for IAH were alcoholic cirrhosis, hepatic encephalopathy and PO2/FiO2 ratio, as well as infection for ACS. Early diagnosis, prevention, and treatment of IAH/ACS might improve outcome in critically ill cirrhotic patients.

Prevalence of intra-abdominal hypertension and markers for associated complications among severe burn patients: a multicenter prospective cohort study (BURNIAH study)

PurposeSeverely burned patients are at risk for intra-abdominal hypertension (IAH) and associated complications such as organ failure, abdominal compartment syndrome (ACS), and death. The aim of this study was to determine the prevalence of IAH among severely burned patients. The secondary aim was to determine the value of urinary intestinal fatty acid binding protein (I-FABP) as early marker for IAH-associated complications.MethodsA prospective observational study was performed in two burn centers in the Netherlands. Fifty-eight patients with burn injuries ≥ 15% of total body surface area (TBSA) were included. Intra-abdominal pressure (IAP) and urinary I-FABP, measured every 6 h during 72 h. Prevalence of IAH, new organ failure and ACS, and the value of urinary intestinal fatty acid binding protein (I-FABP) as early marker for IAH-associated complications were determined.ResultsThirty-one (53%) patients developed IAH, 17 (29%) patients developed new organ failure, but no patients developed ACS. Patients had burns of 29% (P25–P75 19–42%) TBSA. Ln-transformed levels of urinary I-FABP and IAP were inversely correlated with an estimate of − 0.06 (95% CI − 0.10 to − 0.02; p = 0.002). Maximal urinary I-FABP levels had a fair discriminatory ability for patients with IAH with an area under the ROC curve of 74% (p = 0.001). Urinary I-FABP levels had no predictive value for IAH or new organ failure in severe burn patients.ConclusionsThe prevalence of IAH among patients with ≥ 15% TBSA burned was 53%. None of the patients developed ACS. A relevant diagnostic or predictive value of I-FABP levels in identifying patients at risk for IAH-related complications, could not be demonstrated.Level of evidenceLevel III, epidemiologic and diagnostic prospective observational study.

The Correlation between Head of Bed Angle and Intra-Abdominal Pressure of Intubated Patients; a Pre-Post Clinical Trial

Introduction:The recommended position for measuring Intra-Abdominal Pressure (IAP) is the supine position. However, patients put in this position are prone to Ventilator-associated pneumonia. This study was done to evaluate the relationship between bed head angle and IAP measurements of intubated patients in the intensive care unit.Methods:In this clinical trial, seventy-six critically ill patients under mechanical ventilation were enrolled. IAP measurement was performed every 8 hours for 24 hours using the KORN method in three different degrees of the head of bed (HOB) elevation (0, 15, and 30). Bland-Altman analysis was performed to identify the bias and limits of agreement among the three HOBs. According to World Society of the Abdominal Compartment Syndrome (WSACS), we can consider two IAP techniques equivalent if a bias of <1 mmHg and limits of agreement of - 4 to +4 were found between them. Data were analyzed using SPSS statistical software (v. 19), and the significance level was considered as 0.05.Results:The prevalence of intra-abdominal hypertension was 18.42%. Mean ± standard deviation (SD) of IAP were 8.44 ± 4.02 mmHg for HOB angle 0°, 9.58 ± 4.52 for HOB angle 15 and 11.10 ± 4.73 for HOB angle 30o (p = 0.0001). The IAP measurement bias between HOB angle 0°and HOB angle 15° was 1.13 mmHg. This bias was 2.66 mmHg between HOB angle 0° and HOB angle 30°. Conclusion:Elevation of HOB angle from 0 to 30 degree significantly increases IAP. It seems that the measurement of IAP at HOB angle 15° was more reliable than 30°.

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.

Intra-abdominal hypertension and abdominal compartment syndrome in patients admitted to the ICU

BackgroundIntra-abdominal hypertension is frequently present in critically ill patients and is an independent predictor for mortality. Risk factors for intra-abdominal hypertension and abdominal compartment syndrome have been widely investigated. However, data are lacking on prevalence and outcome in high-risk patients. Our objectives in this study were to investigate prevalence and outcome of intra-abdominal hypertension and abdominal compartment syndrome in high-risk patients in a prospective, observational, single-center cohort study.ResultsBetween March 2014 and March 2016, we included 503 patients, 307 males (61%) and 196 females (39%). Patients admitted to the intensive care unit with a diagnosis of pancreatitis, elective or emergency open abdominal aorta surgery, orthotopic liver transplantation, other elective or emergency major abdominal surgery and trauma were enrolled. One hundred and sixty four (33%) patients developed intra-abdominal hypertension and 18 (3.6%) patients developed abdominal compartment syndrome. Highest prevalence of abdominal compartment syndrome occurred in pancreatitis (57%) followed by orthotopic liver transplantation (7%) and abdominal aorta surgery (5%). Length of intensive care stay increased by a factor 4 in patients with intra-abdominal hypertension and a factor 9 in abdominal compartment syndrome, compared to patients with normal intra-abdominal pressure. Rate of renal replacement therapy was higher in abdominal compartment syndrome (38.9%) and intra-abdominal hypertension (8.2%) compared to patients with normal intra-abdominal pressure (1.2%). Both intensive care mortality and 90-day mortality were significantly higher in intra-abdominal hypertension (4.8% and 15.2%) and abdominal compartment syndrome (16.7% and 38.9%) compared to normal intra-abdominal pressure (1.2% and 7.1%). Body mass index (odds ratio 1.08, 95% confidence interval 1.03–1.13), mechanical ventilation at admission (OR 3.52, 95% CI 2.08–5.96) and Apache IV score (OR 1.03, 95% CI 1.02–1.04) were independent risk factors for the development of intra-abdominal hypertension or abdominal compartment syndrome.ConclusionsThe prevalence of abdominal compartment syndrome was 3.6% and the prevalence of intra-abdominal hypertension was 33% in this cohort of high-risk patients. Morbidity and mortality increased when intra-abdominal hypertension or abdominal compartment syndrome was present. The patient most at risk of IAH or ACS in this high-risk cohort has a BMI > 30 kg/m2 and was admitted to the ICU after emergency abdominal surgery or with a diagnosis of pancreatitis.

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.

What is the Relationship among Patients' Position and Intra-abdominal Pressure and Mean Arterial Pressure?

Background: The prevalence of intra-abdominal hypertension in ICU patients is about 50% and can be affected by changing the position of the patients. This study aimed to investigate the relationship between changing patient positions in bed with intra-abdominal pressure and mean arterial pressure among mechanically ventilated patients in ICU.&#x0D; Methods: This study was a clinical trial conducted on 68 patients admitted in intensive care units of Imam Khomeini hospital of Urmia city, Iran. The patients were selected through convenience sampling based on the inclusion criteria. In this study, the effects of changes in five positions (0, 15, 30, 45, left and right lateral position with 30 degrees) on the mean arterial pressure was evaluated. Statistical tests such as chi square and repeated measures ANOVA were used as well. All analyzes were performed using SPSS 21.&#x0D; Results: In this study, there were 24 men (35.3%) and 44 women (64.7%). The mean age, weight and height of patients were 70.35±16.98 years, 75.76±9.77 kg and 168.82±8.14 cm, respectively. There was no significant difference regarding intra-abdominal pressure by gender (p&lt;0.05). There was a significant difference regarding intra-abdominal pressure between first, second, fourth and fifth measurements (p&lt;0.001). There was a significant difference regarding mean arterial pressure between first, second, third, fourth and fifth measurements (p&lt;0.001). Significant differences were observed between the fifth and fourth mean arterial pressure measurements as well (p&lt;0.001).&#x0D; Conclusion: According to the results of this study, the changing of patient's body position from supine to higher positions lead to the increase of intra-abdominal pressure.

Assessment Risk Factors of Abdominal Compartment Syndrome During Resuscitation Phase of Burned Patients

Background: Raised Intra-abdominal pressure in patients with severe burns can lead to organ dysfunction and can affect all organ systems due to massive IV fluid resuscitation. The aim of study was assess the risk factors of abdominal compartment syndrome during resuscitation phase of burned patients. Research design: exploratory research design was used to achieve the objectives of the study. Subjects: All available adult burned patients admitted to Burn unit who with (45) patients. Tools: two tool designs us to identify risk factors of abdominal compartment syndrome during resuscitation phase of burned patients, data collected through 6 months. Results: the result show that Vast Majority of patients had flame as a reason of burns with percentage 96.6%. Less than half of patients were at lower and upper limbs burned of body region with percentage40.0%. In addition, result show that the prevalence of Intra-abdominal hypertension in severe burn patients is with percentage 68.8% respectively. The findings of the study revealed that when increase BMI, TBSA and IV fluid increase IAP. Conclusion: Patients with >20% TBSA burned presented a very high prevalence of IAH. Recommendations: The Burns Unit needs to design protocols for screening, monitoring and management of Intra-abdominal hypertension

Announcement of the observational research on the prevalence of intra-abdominal hypertension and abdominal compartment syndrome among children in pediatric intensive care units in Ukraine

Announcement of the observational research on the prevalence of intra-abdominal hypertension and abdominal compartment syndrome among children in pediatric intensive care units in Ukraine

Prevalence and predictors of intra-abdominal hypertension and compartment syndrome in surgical patients in critical care units at Kenyatta National Hospital.

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.

Mild to moderate intra-abdominal hypertension: Does it matter?

This review summarizes the epidemiology, pathophysiological consequences and impact on outcome of mild to moderate (Grade I to II) intra-abdominal hypertension (IAH), points out possible pitfalls in available treatment recommendations and focuses on tasks for future research in the field. IAH occurs in about 40% of ICU patients. Whereas the prevalence of abdominal compartment syndrome seems to be decreasing, the prevalence of IAH does not. More than half of IAH patients present with IAH grade I and approximately a quarter with IAH grade II. However, most of the studies have addressed IAH as a yes-or-no variable, with little or no attention to different severity grades. Even mild IAH can have a negative impact on tissue perfusion and microcirculation and be associated with an increased length of stay and duration of mechanical ventilation. However, the impact of IAH and its different grades on mortality is controversial. The influence of intra-abdominal pressure (IAP) on outcome most likely depends on patient and disease characteristics and the concomitant macro- and microcirculation. Therefore, management might differ significantly. Today, clear triggers for interventions in different patient groups with mild to moderate IAH are not defined. Further studies are needed to clarify the clinical importance of mild to moderate IAH identifying clear triggers for interventions to lower the IAP.

Prevalence and diagnosis rate of intra-abdominal hypertension in critically ill adult patients: A single-center cross-sectional study

PurposeTo investigate the prevalence and diagnosis rate of intra-abdominal hypertension (IAH) in a mixed-population intensive care unit (ICU), and to investigate the knowledge of ICU staff regarding the guidelines published by the World Society of Abdominal Compartment Syndrome (WSACS) in 2013. MethodsA one-day cross-sectional study based on the WSACS 2013 guidelines was conducted in the general ICU of a tertiary teaching hospital in Chongqing, China. The included patients were divided into intravesical pressure (IVP) measured group and IVP unmeasured group. The epidemiologic data were recorded, and potential IAH risk factors (RFs) were collected based on the guidelines. IVP measurements were conducted by investigators every 4 h and the result was compared to that measured by the ICU staff to evaluate the diagnosis rate. Besides, a questionnaire was used to investigate the understanding of the guidelines among ICU staff. ResultsThirty-two patients were included, 14 in the IVP measured group and 18 in the IVP unmeasured group. The prevalence of IAH during the survey was 15.63% (5/32), 35.71% (5/14) in IVP measured group. Only one case of IAH had been diagnosed by the ICU physician and the diagnosis rate was as low as 20.00%. Logistic regression analysis showed that sequential organ failure assessment (SOFA) score was an independent RF for IAH (OR: 1.532, 95% CI: 1.029–2.282, p = 0.036. Fourteen doctors and 5 nurses were investigated and the response rate was 67.86%. The average scores of the doctors and nurses were 27.14 ± 20.16 and 16.00 ± 8.94 respectively. None of them had studied the WSACS 2013 guidelines thoroughly. ConclusionPatients with a higher SOFA score has a higher incidence of IAH. The IAH prevalence in 14 ICU patients with indwelling catheter was 35.71%. Strengthening the wide and rational use of WSACS guideline is important to improve the diagnosis of IAH.

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.

Prevalence of Intraabdominal Hypertension and Abdominal Compartment Syndrome in an Intensive Care Unit

Prevalence of Intraabdominal Hypertension and Abdominal Compartment Syndrome in an Intensive Care Unit

EComment. Intra-abdominal hypertension and abdominal compartment syndrome in cardiac surgery patients

Intra-abdominal hypertension (IAH) has been defined by the World Society of the Abdominal Compartment Syndrome (WSACS) as a sustained or repeated pathological elevation of intra-abdominalŰressure (IAP) ≥12 mmHg and abdominal compartment syndrome (ACS) as IAP >20 mmHg with new organ dysfunction or failure [1]. IAH/ACS are recognized with increasing frequency in critically-ill patients. ACS is encountered in surgical and medical intensive care units and must be considered as an important factor of multi-organ failure including splanchnic, renal, liver, cardiovascular, respiratory and central nervous system dysfunction. The syndrome is also associated with considerable morbidity and mortality. WSACS recommend that IAP be measured regularly in critically-ill patients who demonstrate risk factors for the development of IAH [1]. Even if these risk factors are found in cardiac surgery patients, the prevalence of IAH in cardiac surgery has not fully been elucidated. We read with great interest the paper by Dalfino et al. [2]. They aimed at identifying the risk factors for IAH in cardiac surgery patients. In their study, IAH is strongly associated with higher baseline IAP values, higher central venous pressure, positive fluid balance, extracorporeal circulation, use of vasoactive drugs and acute kidney injury. They conclude that patients presenting risk factors must be monitored properly during the perioperative period. We agree with their conclusions and would like to add a brief comment on therapeutic interventions. Currently, the diagnosis and management of IAH/ACS is evolving tremendously, and comprehensive strategies to reduce IAP play an important role in such patients. Approaches or techniques of potential utility include sedation and analgesia, neuromuscular blockade, body positioning, nasogastric/colonic decompression, promotility agents, diuretics and continuous renal replacement therapies, fluid resuscitation strategies, and percutaneous catheter drainage [1,3]. Non-operative strategies for the management of IAH/ACS may be summarized using five therapeutic goals: (1) evacuation of intraluminal contents; (2) evacuation of intra-abdominal space-occupying lesions; (3) improvement in abdominal wall compliance; (4) optimization of fluid administration; and (5) support of systemic and regional tissue perfusion [3]. Surgical abdominal decompression should be considered in any patient who demonstrates evidence of ACS. Decompressive laparotomy should not be feared or delayed because rapid decompression after the diagnosis of ACS dramatically improves cardiac function and results in improved organ perfusion and survival. Due to the severe morbidity associated with all forms of surgical decompression, the indications, timing and technique used should be carefully evaluated [3-5]. De Wolf et al. [4] reported two patients who required surgical abdominal decompression for ACS that developed early after emergency coronary artery bypass graft surgery. Both patients had a protracted clinical course, but they survived and were discharged from the hospital. Rabbi et al. [5] described a secondary ACS that occurred during an elective coronary revascularization which resulted in an inability to wean from cardiopulmonary bypass. After decompressive laparotomy was done, the patient was successfully weaned from bypass. ACS is a potentially fatal entity of which all clinicians, and cardiovascular surgeons in particular, need to be acutely aware. We think that successful outcome depends on early recognition, early conservative treatment to reduce IAH and decompressive laparotomy if ACS develops in these complicated patients. Conflict of interest: none declared

The effect of intra-abdominal hypertension on gastrointestinal function

Introduction. Intra-abdominal hypertension (IAH) is a frequent occurrence in critically ill patients. Raised intra-abdominal pressure negatively affects gastro-intestinal (GI) function and may reduce the success of enteral nutrition support, which in turn is associated with adverse clinical outcomes. Aim. To evaluate the impact of raised intra-abdominal pressure (IAP) on GI function and success of enteral nutrition support in an adult intensive care unit (ICU) population at risk of abdominal compartment syndrome (ACS). Methods. In a prospective observational study, critically ill patients in whom the IAP was monitored routinely for clinical indications were assessed for GI symptoms, methods of nutrition support and enteral feeding success on a daily basis. Results. In total, data from 17 patients for a total of 98 patient days were included in the study. The mean IAP was 14.0 mmHg (standard deviation (SD) 3.7) on admission to the ICU. There were 10 patients with grade I, 2 with grade II and 2 with grade III IAH. Seven patients (41%) developed ACS. GI symptoms were common in patients with IAH, and days of IAH correlated positively with number of GI symptoms ( r =0.85, p =0.000). Exclusive enteral feeding was possible on 32% of study days. There was a 12% incidence of enteral feeding intolerance and a 59% incidence of enteral feeding failure. Enteral feeding failure was not significantly associated with IAH ( r =0.43, p =0.08), but was associated with number of GI symptoms ( r =0.67, p =0.003). Days of IAH were positively associated with longer ICU stay ( r =0.65, p =0.005), as was prevalence of IAH combined with concurrent GI symptoms ( r =0.71, p =0.001). Days with IAH and multiple GI symptoms combined was associated with worse subsequent sequential organ failure assessment (SOFA) score ( r =0.64, p=0.005). The worst SOFA score in those who died was significantly higher than that of survivors (11.7 (SD 3.05) v. 6.86 (SD 3.2), p =0.03), and was also significantly higher in those who developed ACS than in those who did not (10.9 (SD 2.5) v. 5.5 (SD 1.1), p =0.0005). The mortality rate was 17%, and only patients who developed ACS died. Conclusion. Raised IAP was associated with poor GI function, enteral feed intolerance, prolonged hospital stay and death.

Intraabdominal Hypertension in Patients with Septic Shock

Intraabdominal hypertension (IAH) develops frequently in patients with septic shock. Even a moderate increase in intraabdominal pressure (IAP) in this setting could be associated with high lactate levels. The authors conducted a prospective, observational, nonrandomized control trial in the surgical intensive care unit of an academic tertiary center. Twenty-seven patients with septic shock (septic shock group), and 19 patients undergoing abdominal surgery with more than two risk factors for IAH (postoperative control group) were admitted consecutively to the intensive care unit. IAP was measured every 6 hours during the first 48 hours. IAH was diagnosed with two consecutive measurements greater than 20 mm Hg. The main outcome measures were prevalence of IAH in septic shock and control groups; and comparative lactate levels, norepinephrine requirements and organ dysfunctions in patients with and without IAH in both groups. Fifty-one per cent of patients with septic shock and 31 per cent of control patients developed IAH. Patients with septic shock with and without IAH were comparable in peak norepinephrine dose, sequential organ failure assessment score, and mortality. However, peak lactate levels were significantly higher in patients with septic shock and IAH compared with those without IAH (3.5 mmol/L versus 1.9 mmol/L, P < 0.04). There was a significant positive temporal correlation between IAP and lactate levels in patients with septic shock with IAH. Peak levels of both occurred early and decreased progressively over time. Control patients with and without IAH exhibited comparable peak lactate levels. Intraabdominal hypertension is very common in septic shock and appears to be related to high lactate levels, which diminish as IAP decreases. Future studies should address the usefulness of IAP monitoring in patients with septic shock.