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Open Access 01-12-2012 | Research

Incidence and prognosis of intra-abdominal hypertension in critically ill medical patients: a prospective epidemiological study

Authors: Patricia Santa-Teresa, Javier Muñoz, Ignacio Montero, María Zurita, María Tomey, Luis Álvarez-Sala, Pablo García

Published in: Annals of Intensive Care | Special Issue 1/2012

Abstract

Introduction

The aim of this study was to determine the incidence of intra-abdominal hypertension (IAH) in patients with two or more categorized risk factors (CRF) for IAH, and their morbidity and mortality during their intensive care unit (ICU) stay.

Methods

Prospective cohort study carried out at a medical ICU. A total of 151 medical patients were enrolled during a period of 3 months. After ICU whole staff training, we conducted daily screening of the four CRF for IAH based on the World Society of Abdominal Compartment Syndrome (WSACS) guidelines (namely, diminished abdominal wall compliance, increased intraluminal content, increased abdominal content, and capillary leak syndrome or fluid resuscitation). In those patients with risk factors of at least two different categories (≥2 CRF), intra-abdominal pressure (IAP) was measured every 8 h during ICU stay. Data included demographics, main diagnosis on admission, severity scores, cumulative fluid balance, daily mean IAP, resolution of IAH, days of ICU and hospital stay, and mortality.

Results

Eighty-seven patients (57.6%) had ≥2 CRF for IAH, 59 (67.8%) out of whom developed IAH. Patients with ≥2 CRF had a significantly higher mortality rate (41.4 vs. 14.3%, p < 0.001). Patients with IAH had higher body mass index, severity scores, organ dysfunctions/failures, number of CRF for IAH, days of ICU/hospital stay and hospital mortality rate (45.8 vs. 32.1%, p = 0.22). Non-resolution of IAH was associated with a higher mortality rate (64.7 vs. 35.3%, p = 0.001). None of the cohort patients developed abdominal compartment syndrome. The multivariate analysis showed that IAH development (odds ratio (OR) 4.09; 95% confidence interval (CI) 0.83-20.12) was a non-independent risk factor for mortality, and its non-resolution (OR 13.15; 95% CI 22.13-81.92) was an independent risk factor for mortality.

Conclusions

Critically ill medical patients admitted to ICU with ≥2 CRF have high morbidity, mortality rate, and incidence of IAH, so IAP should be measured and monitored as recommended by the WSACS. Our study highlights the importance of implementing screening and assessment protocols for an early diagnosis of IAH.

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Title: Incidence and prognosis of intra-abdominal hypertension in critically ill medical patients: a prospective epidemiological study
Authors: Patricia Santa-Teresa
Javier Muñoz
Ignacio Montero
María Zurita
María Tomey
Luis Álvarez-Sala
Pablo García
Publication date: 01-12-2012
Publisher: Springer Paris
Published in: Annals of Intensive Care / Issue Special Issue 1/2012
Electronic ISSN: 2110-5820
DOI: https://doi.org/10.1186/2110-5820-2-S1-S3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Incidence and prognosis of intra-abdominal hypertension in critically ill medical patients: a prospective epidemiological study

Abstract

Introduction

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

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