Incidence and prognostic significance of intra-abdominal pressure in critically ill patients

الملخص EN

Background Elevated intra-abdominal pressure is frequently found among different populations of critically ill patients and may contribute to both morbidity and mortality.

Various risk factors such as abdominal surgery, massive fluid resuscitation, and ileus have been proposed to contribute to the development of intra-abdominal hypertension/abdominal compartmental syndrome.

This study was conducted to evaluate the incidence and prognostic significance of intra-abdominal hypertension in critically ill patients.

Materials and methods Forty patients who met the inclusion criteria were included in this prospective cohort study.

Patient characteristics were recorded on admission.

Intra-abdominal pressure was measured using Foley bladder catheter by modified Kron technique described by Cheatham and Safcsak, The intra-abdominal pressure (IAP) was measured in supine and hemodynamically stable position every 6 hours for the first 24 hours and then twice daily, thereafter, the mean intraabdominal pressures were defined as the mean of these daily measurements.

Intra-abdominal hypertension was defined as an intra-abdominal pressure of over 12 mmHg, severe elevation as an intra-abdominal pressure of over 15 mmHg, and abdominal compartmental syndrome as a pressure of over 20 mmHg with evidence of at least one organ failure.

Results In the study group, 47% were admitted for medical causes.

Age (P < 0.0001), Acute Physiology and Chronic Health Evaluation (APACHE) score (P < 0.0001), and Sequential Organ Failure Assessment (SOFA) score (P < 0.0001) were highly significant with regard to the outcome.

Nine patients (22.5%) did not survive; the mean age (61 ± 8 vs.

44 ± 12 years), APACHEII score (30 vs.

22), and SOFA score (6 vs.

4) were higher in the non- survivors group, significantly affecting the outcome.

The mean intra-abdominal pressure during the 25 days of intensive care unit (ICU) stay was higher in the non-survivors group (17 ± 2).

In addition, the occurrence of intra-abdominal hypertension was higher in the non-survivors group.

The mean intra-abdominal pressure during the 25 days of intensive care unit (ICU) stay was higher in the nonsurvival group (17 ± 2).

In addition, the occurrence of intra-abdominal hypertension was higher in the nonsurvival group.

On admission, the mean age (P = 0.006), APACHE II score (P = 0.001), SOFA score (P < 0.001), and mean intra-abdominal pressure greater than 12 (P = 0.001), as well as the occurrence of intra-abdominal hypertension during ICU stay (P = 0.008), were independent predictors of mortality.

The nonsurviving patients had a significantly higher SOFA score on admission and a significantly higher SOFA score during ICU stay.

Conclusion The incidence of intra-abdominal pressure greater than 12 mmHg was high in critically ill patients, and its presence on admission or the occurrence of intra-abdominal hypertension is a prognostic factor for mortality during the ICU stay.