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

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)
Publication Information
Tuberculosis and Respiratory Diseases / v.61, no.1, 2006 , pp. 46-53 More about this Journal
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.
Keywords
Abdomen; Pressure; Perfusion; Hypertension; Compartment syndrome; Critical care;
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1 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
2 Reddy VG. Prevention of postoperative acute renal failure. J Postgrad Med 2002;48:64-70
3 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   DOI   ScienceOn
4 Cheatham ML, Safcsak K. Intraabdominal pressure: a revised method for measurement. J Am Coll Surg 1998;186:594-5   DOI   ScienceOn
5 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   DOI   ScienceOn
6 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   DOI
7 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   DOI   ScienceOn
8 Malbrain ML. Different techniques to measure intraabdominal pressure (IAP): time for a critical reappraisal. Intensive Care Med 2004;30:357-71   DOI   ScienceOn
9 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   DOI   ScienceOn
10 Duggan JE, Drummond GB. Abdominal muscle activity and intraabdominal pressure after upper abdominal surgery. Anesth Analg 1989;69:598-603
11 Sugerman HJ. Increased intra-abdominal pressure in obesity. Int J Obes Relat Metab Disord 1998;22:1138.   DOI
12 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   DOI   ScienceOn
13 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   DOI   ScienceOn
14 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   DOI
15 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   DOI   ScienceOn
16 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   DOI
17 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   DOI   ScienceOn
18 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   DOI   ScienceOn
19 Sugrue M. Abdominal compartment syndrome. Curr Opin Crit Care 2005;11:333-8   DOI   ScienceOn
20 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   DOI   ScienceOn
21 Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med 1985;13:818-29   DOI   ScienceOn
22 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
23 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   DOI   ScienceOn
24 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   DOI   ScienceOn
25 Malbrain ML. Is it wise not to think about intraabdominal hypertension in the ICU? Curr Opin Crit Care 2004;10:132-45   DOI   ScienceOn