Clinical Effects of Intra-Abdominal Pressure in Critically Ill Trauma Patients

Purpose: There is increasing interest in intra-abdominal pressure (IAP) and intra-abdominal hypertension (IAH) in critically ill patients. This study investigated the effects and outcomes of elevated IAP in a trauma intensive care unit (ICU) population. Methods: Eleven consecutive critically ill patients admitted to the trauma ICU at Pusan National University Hospital Regional Trauma Center were included in this study. IAP was measured every 8-12 hours (intermittently) for 72 hours. IAP was registered as mean and maximal values per day throughout the study period. IAH was defined as $IAP{\geq}12mmHg$. Abdominal compartment syndrome was defined as $IAP{\geq}20mmHg$ plus ${\geq}1$ new organ failure. The main outcome measure was in-hospital mortality. Results: According to maximal and mean IAP values, 10 (90.9%) of the patients developed IAH during the study period. The Sequential Organ Failure Assessment (SOFA) score was significantly higher in patients with $IAP{\geq}20mmHg$ than in those with IAP <20 mmHg (16 vs. 5, p=0.049). The hospital mortality rate was 27.3%. Patients with a maximum $IAP{\geq}20mmHg$ exhibited significantly higher hospital mortality rates (p=0.006). Non-survivors had higher maximum and mean IAP values. Conclusions: Our results suggest that an elevated IAP may be associated with a poor prognosis in critically ill trauma patients.