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Intensive Care Medicine
Published in: Intensive Care Medicine 9/2008

01-09-2008 | Original

Primary and secondary intra-abdominal hypertension—different impact on ICU outcome

Authors: Annika Reintam, Pille Parm, Reet Kitus, Hartmut Kern, Joel Starkopf

Published in: Intensive Care Medicine | Issue 9/2008

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Abstract

Objective

To investigate the differences in incidence, time course and outcome of primary versus secondary intra-abdominal hypertension (IAH), and to evaluate IAH as an independent risk factor of mortality in a presumable risk population of critically ill patients.

Design

Prospective observational study.

Setting

General intensive care unit of a university hospital.

Patients

A total of 257 mechanically ventilated patients at presumable risk for the development of IAH were studied during their ICU stay and followed up for 90-day survival.

Interventions

Repeated measurements of intra-abdominal pressure (IAP).

Measurements and results

IAP was measured intermittently, via bladder. IAH (sustained or repeated IAP ≥ 12 mmHg) developed in 95 patients (37.0%). Primary IAH was observed in 60 and secondary IAH in 35 patients. Patients with secondary IAH demonstrated a significant increase of mean IAP during the first three days (mean ΔIAP was 2.2 ± 4.7 mmHg), whilst IAP decreased (mean ΔIAP −1.1 ± 3.7 mmHg) in the patients with primary IAH. The patients with IAH had a significantly higher ICU- (37.9 vs. 19.1%; P = 0.001), 28-day (48.4 vs. 27.8%, P = 0.001), and 90-day mortality (53.7 vs. 35.8%, P = 0.004) compared to the patients without the syndrome. Patients with secondary IAH had a significantly higher ICU mortality than patients with primary IAH (P = 0.032). Development of IAH was identified as an independent risk factor for death (OR 2.52; 95% CI 1.23–5.14).

Conclusions

Secondary IAH is less frequent, has a different time course and worse outcome than primary IAH. Development of IAH during ICU period is an independent risk factor for death.
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Metadata
Title
Primary and secondary intra-abdominal hypertension—different impact on ICU outcome
Authors
Annika Reintam
Pille Parm
Reet Kitus
Hartmut Kern
Joel Starkopf
Publication date
01-09-2008
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 9/2008
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-008-1134-4

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