Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
권호 표지

The Effects of Intra-Abdominal Hypertension on the Prognosis of Critically Ill Patients in the Intensive Care Unit (ICU)

복강 내압 항진증이 내과계 중환자의 예후에 미치는 영향

  • Kim, Se Joong (Department of Internal Medicine, College of Medicine, Korea University) ;
  • Seo, Jeong-Su (Intensive Care Unit, Ansan Hospital, Korea University Medical Center) ;
  • Son, Myeung-Hee (Intensive Care Unit, Ansan Hospital, Korea University Medical Center) ;
  • Kim, Soo-Youn (Intensive Care Unit, Guro Hospital, Korea University Medical Center) ;
  • Jung, Ki Hwan (Department of Internal Medicine, College of Medicine, Korea University) ;
  • Kang, Eun-Hae (Department of Internal Medicine, College of Medicine, Korea University) ;
  • Lee, Sung Yong (Department of Internal Medicine, College of Medicine, Korea University) ;
  • Lee, Sang Yeub (Department of Internal Medicine, College of Medicine, Korea University) ;
  • Kim, Je-Hyeong (Department of Internal Medicine, College of Medicine, Korea University) ;
  • Shin, Chol (Department of Internal Medicine, College of Medicine, Korea University) ;
  • Shim, Jae Jeong (Department of Internal Medicine, College of Medicine, Korea University) ;
  • In, Kwang Ho (Department of Internal Medicine, College of Medicine, Korea University) ;
  • Yoo, Se Hwa (Department of Internal Medicine, College of Medicine, Korea University) ;
  • Kang, Kyung Ho (Department of Internal Medicine, College of Medicine, Korea University)
  • 김세중 (고려대학교 의과대학 내과학교실) ;
  • 서정수 (고려대학교 의료원 안산병원 내과계 중환자실) ;
  • 손명희 (고려대학교 의료원 안산병원 내과계 중환자실) ;
  • 김수연 (고려대학교 의료원 구로병원 중환자실) ;
  • 정기환 (고려대학교 의과대학 내과학교실) ;
  • 강은해 (고려대학교 의과대학 내과학교실) ;
  • 이승룡 (고려대학교 의과대학 내과학교실) ;
  • 이상엽 (고려대학교 의과대학 내과학교실) ;
  • 김제형 (고려대학교 의과대학 내과학교실) ;
  • 신철 (고려대학교 의과대학 내과학교실) ;
  • 심재정 (고려대학교 의과대학 내과학교실) ;
  • 인광호 (고려대학교 의과대학 내과학교실) ;
  • 유세화 (고려대학교 의과대학 내과학교실) ;
  • 강경호 (고려대학교 의과대학 내과학교실)
  • Received : 2006.05.11
  • Accepted : 2006.07.10
  • Published : 2006.07.30
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Intra-abdominal hypertension (IAH) is defined as the presence of either an intra-abdominal pressure (IAP) ${\geq}12mmHg$ or an abdominal perfusion pressure (APP = mean arterial pressure - IAP) ${\leq}60mmHg$. Abdominal compartment syndrome (ACS) is defined as the presence of an IAP ${\geq}20mmHg$ together with organ failure. The purpose of this study was to investigate the prevalence of IAH and ACS on the day of admission and the effects of these maladies on the prognosis of critically ill patients in the ICU. Methods: At the day of admission to the ICU, the IAP was recorded by measuring the intravesicular pressure via a Foley catheter. The APACHE II and III scores were checked and SAPS II was also scored during the days the patients were in the ICU. The primary end point was the prevalence of IAH and ACS at the day of admission and the correlation between them with the 28-days mortality rate. The measurement of IAP continued until the 7th day or the day when the patient was transferred to the general ward before 7th day, unless the patient died or a Foley catheter was removed before 7th day. Patients were observed until death or the 28th day. Results: A total of 111 patients were enrolled. At the day of admission, the prevalence of IAH and ACS were 47.7% and 15.3%, respectively and the mean IAP was $15.1{\pm}8.5mmHg$. The rates of IAH for the survivor and the non-survivor groups were 56.5% and 71.4%, respectively, and these were not significantly different (p=0.593). Yet the rates of ACS between these two groups were significantly different (4/62, 6.5% vs. 13/49, 26.5%; Odds Ratio = 5.24, 95% CI = 1.58-17.30, p=0.004). Conclusion: In the present study, the prevalence of IAH was 47.7% and the prevalence of ACS was 15.3% on the day of admission. ACS was associated with a poor outcome for the critically ill patients in the ICU.

연구배경: IAP의 증가는 혈류량을 감소시켜 여러 장기에 영향을 준다. IAH는 IAP가 12 mmHg 이상 또는 APP가 60 mmHg 이하로, ACS는 IAP가 20 mmHg 이상이면서 동시에 하나 이상의 장기 손상이 있는 경우로 각각 정의한다. 저자들은 중환자에서 IAH 및 ACS의 유병률과 이들이 환자의 예후에 미치는 영향을 고찰하고자 하였다. 방 법: 고려대학교 의료원 중환자실에 입원하는 내과계 환자를 대상으로 하여, APACHE II 및 III 점수, SAPS II 점수를 기록하였다. IAP는 삼중관 요도관을 통하여, 입원 7일째까지 매일 3회 측정하였고, 환자가 사망하거나 일반 병실로 전실 또는 요도관을 제거할 때까지 계속하였다. 환자의 예후는 28일을 기준으로 판단하였다. 결 과: 총 111명 대상 환자들의 입원 1일 IAH 및 ACS의 유병률은 각각 47.7%, 15.3%였다. 사망군과 생존군 사이에 IAH의 유병률은 유의한 차이가 없었으나, ACS는 사망군에서 더 높았다 (p=0.004). 사망군에서 IAP는 더 높았고 (p=0.012), APP는 유의하게 낮았다 (p<0.001). 결 론: 중환자에서 입원 1일에 측정한 IAP의 증가, APP의 감소 및 ACS 발생은 환자의 사망과 연관이 있을 것으로 판단된다.

Keywords

References

  1. Sugerman HJ. Increased intra-abdominal pressure in obesity. Int J Obes Relat Metab Disord 1998;22:1138. https://doi.org/10.1038/sj.ijo.0800757
  2. Hering R, Wrigge H, Vorwerk R, Brensing KA, Schroder S, Zinserling J, et al. The effects of prone positioning on intraabdominal pressure and cardiovascular and renal function in patients with acute lung injury. Anesth Analg 2001;92:1226-31 https://doi.org/10.1097/00000539-200105000-00027
  3. Duggan JE, Drummond GB. Abdominal muscle activity and intraabdominal pressure after upper abdominal surgery. Anesth Analg 1989;69:598-603
  4. Navarro-Rodriguez T, Hashimoto CL, Carrilho FJ, Strauss E, Laudanna AA, Moraes-Filho JP. Reduction of abdominal pressure in patients with ascites reduces gastroesophageal reflux. Dis Esophagus 2003;16: 77-82 https://doi.org/10.1046/j.1442-2050.2003.00303.x
  5. Rosenthal RJ, Friedman RL, Kahn AM, Martz J, Thiagarajah S, Cohen D, et al. Reasons for intracranial hypertension and hemodynamic instability during acute elevations of intra-abdominal pressure: observations in a large animal model. J Gastrointest Surg 1998;2:415-25 https://doi.org/10.1016/S1091-255X(98)80031-0
  6. Ishizaki Y, Itoh T, Shimomura K, Noie T, Abe H, Izezuki Y. Cardiovascular effects of increasedintraabdominal pressure during pneumoperitoneum: preliminary report. Nippon Geka Gakkai Zasshi 1991; 92:614
  7. Rouby JJ, Puybasset L, Nieszkowska A, Lu Q. Acute respiratory distress syndrome: lessons from computed tomography of the whole lung. Crit Care Med 2003; 31:S285-95 https://doi.org/10.1097/01.CCM.0000057905.74813.BC
  8. Polat C, Aktepe OC, Akbulut G, Yilmaz S, Arikan Y, Dilek ON, et al. The effects of increased intraabdominal pressure on bacterial translocation. Yonsei Med J 2003;44:259-64 https://doi.org/10.3349/ymj.2003.44.2.259
  9. Markou N, Grigorakos L, Myrianthefs P, Boutzouka E, RizosM, Evagelopoulou P, et al. Venous pressure measurements in the superior and inferior vena cava: the influence of intra-abdominal pressure. Hepatogastroenterology 2004;51:51-5
  10. Reddy VG. Prevention of postoperative acute renal failure. J Postgrad Med 2002;48:64-70
  11. Sugrue M, Jones F, Deane SA, Bishop G, Bauman A, Hillman K. Intra-abdominal hypertension is an independent cause of postoperative renal impairment. Arch Surg 1999;134:1082-5 https://doi.org/10.1001/archsurg.134.10.1082
  12. Malbrain ML, Chiumello D, Pelosi P, Bihari D, Innes R, RanieriVM, et al. Incidence and prognosis of intraabdominal hypertension in a mixed population of critically ill patients: a multiple-center epidemiological study. Crit Care Med 2005;33:315-22 https://doi.org/10.1097/01.CCM.0000153408.09806.1B
  13. Cheatham ML, White MW, Sagraves SG, Johnson JL, Block EF. Abdominal perfusion pressure: a superior parameter in the assessment of intra-abdominal hypertension. J Trauma 2000;49:621-6 https://doi.org/10.1097/00005373-200010000-00008
  14. Cheatham ML, Safcsak K. Intraabdominal pressure: a revised method for measurement. J Am Coll Surg 1998;186:594-5 https://doi.org/10.1016/S1072-7515(98)00122-7
  15. Kron IL, Harman PK, Nolan SP. The measurement of intra-abdominal pressure as a criterion for abdominal re-exploration. Ann Surg 1984;199:28-30 https://doi.org/10.1097/00000658-198401000-00005
  16. Malbrain ML, Chiumello D, Pelosi P, Wilmer A, Brienza N, Malcangi V, et al. Prevalence of intraabdominal hypertension in critically ill patients: a multicentre epidemiological study. Intensive Care Med 2004;30:822-9 https://doi.org/10.1007/s00134-004-2169-9
  17. Sugrue M. Abdominal compartment syndrome. Curr Opin Crit Care 2005;11:333-8 https://doi.org/10.1097/01.ccx.0000170505.53657.48
  18. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med 1985;13:818-29 https://doi.org/10.1097/00003246-198510000-00009
  19. Knaus WA, Wagner DP, Draper EA, Zimmerman JE, Bergner M, Bastos PG, et al. The APACHE III prognostic system: risk prediction of hospital mortality for critically ill hospitalized adults. Chest 1991; 100:1619-36 https://doi.org/10.1378/chest.100.6.1619
  20. le Gall JR, Lemeshow S, Saulnier F. A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA 1993;270:2957-63 https://doi.org/10.1001/jama.270.24.2957
  21. Malbrain ML. Different techniques to measure intraabdominal pressure (IAP): time for a critical reappraisal. Intensive Care Med 2004;30:357-71 https://doi.org/10.1007/s00134-003-2107-2
  22. Malbrain ML. Is it wise not to think about intraabdominal hypertension in the ICU? Curr Opin Crit Care 2004;10:132-45 https://doi.org/10.1097/00075198-200404000-00010
  23. Malbrain ML, Deeren D, de Potter TJ. Intraabdominal hypertension in the critically ill: it is time to pay attention. Curr Opin Crit Care 2005;11:156-71 https://doi.org/10.1097/01.ccx.0000155355.86241.1b
  24. Doty JM, Oda J, Ivatury RR, Blocher CR, Christie GE, Yelon JA, et al. The effects of hemodynamic shock and increased intra-abdominal pressure on bacterial translocation. J Trauma 2002;52:13-7 https://doi.org/10.1097/00005373-200201000-00005
  25. Kotzampassi K, Metaxas G, Paramythiotis D, Pidonia I, Rekka H, Karamouzis M, et al. The influence of continuous seven-day elevated intra-abdominal pressure in the renal perfusion in cirrhotic rats. J Surg Res 2003;115:133-8 https://doi.org/10.1016/S0022-4804(03)00198-7