Tuberc Respir Dis.  2006 Jul;61(1):46-53.

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

• Kim SJ
• Seo JS
• Son MH
• Kim SY
• Jung KH
• Kang EH
• Lee SY
• Lee SY
• Kim JH
• Shin C
• Shim JJ
• In KH
• Yoo SH
• Kang KH

Abstract

BACKGROUND: Intra-abdominal hypertension (IAH) is defined as the presence of either an intra-abdominal pressure (IAP) > or = 12 mmHg or an abdominal perfusion pressure (APP = mean arterial pressure - IAP) < or = 60 mmHg. Abdominal compartment syndrome (ACS) is defined as the presence of an IAP > or = 20 mmHg 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+/-8.5 mmHg. 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.

Keyword

Abdomen; Pressure; Perfusion; Hypertension; Compartment syndrome; Critical care

MeSH Terms

Abdomen
APACHE
Arterial Pressure
Catheters
Compartment Syndromes
Critical Care
Critical Illness*
Humans
Hypertension
Intensive Care Units*
Critical Care*
Intra-Abdominal Hypertension*
Mortality
Odds Ratio
Patients' Rooms
Perfusion
Prevalence
Prognosis*
Survivors

Figure

• 

  Figure 1 The IAP values of the survivor and non-survivor groups. The IAP was higher in the non-survivor group than in the survivor group at 1st and 2nd day (p<0.05), but there were no differences from 3rd to 7th days. *: Survivor group vs. Non-survivor group, p<0.05 n: number of patients IAP: Intra-abdominal pressure

• 

  Figure 2 The APP values of the survivor and non-survivor groups. The APP was lower in the non-survivor group than in the survivor group from 1st to 4th day (p<0.001). The APP was more significantly related with mortality than the IAP, especially at 3rd to 4th day. *: Survivor group vs. Non-survivor group, p<0.001 n: number of patients APP: Abdominal perfusion pressure

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