D Iyer1, P Rastogi, A Åneman, S D'Amours. 1. Intensive Care Unit, Liverpool Hospital, Sydney, NSW, Australia; Trauma Department, Liverpool Hospital, Sydney, NSW, Australia; South Western Sydney Clinical School, The University of New South Wales, Sydney, NSW, Australia.
Abstract
BACKGROUND: To develop a screening tool to identify patients at risk of developing intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) within 24 h of a patient's admission to intensive care unit (ICU). METHODS: Prospective, observational study of 403 consecutively enrolled patients with an indwelling catheter, admitted to a mixed medical-surgical ICU in a tertiary referral, university hospital. Intra-abdominal pressure was measured at least twice daily and IAH and ACS defined as per consensus definitions. RESULTS: Thirty-nine per cent of patients developed IAH and 2% developed ACS. Abdominal distension, hemoperitoneum/pneumoperitoneum/intra-peritoneal fluid collection, obesity, intravenous fluid received > 2.3 l, abbreviated Sequential Organ Failure Assessment score > 4 points and lactate > 1.4 mmol/l were identified as independent predictors of IAH upon admission to ICU. The presence of three or more of these risk factors at admission identified patients that would develop IAH with a sensitivity of 75% and a specificity of 76%, the development of grades II, III and IV IAH with a sensitivity of 91% and a specificity of 62%. Patients that developed IAH required a significantly longer duration of mechanical ventilation and ICU care. Patients that developed grades II-IV IAH had a significantly higher rate of ICU mortality. CONCLUSION: IAH is a common clinical entity in the intensive care setting that is associated with morbidity and mortality. A screening tool, based on data readily available within a patient's first 24 h in ICU, was developed and effectively identified patients that required intra-abdominal pressure monitoring.
BACKGROUND: To develop a screening tool to identify patients at risk of developing intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) within 24 h of a patient's admission to intensive care unit (ICU). METHODS: Prospective, observational study of 403 consecutively enrolled patients with an indwelling catheter, admitted to a mixed medical-surgical ICU in a tertiary referral, university hospital. Intra-abdominal pressure was measured at least twice daily and IAH and ACS defined as per consensus definitions. RESULTS: Thirty-nine per cent of patients developed IAH and 2% developed ACS. Abdominal distension, hemoperitoneum/pneumoperitoneum/intra-peritoneal fluid collection, obesity, intravenous fluid received > 2.3 l, abbreviated Sequential Organ Failure Assessment score > 4 points and lactate > 1.4 mmol/l were identified as independent predictors of IAH upon admission to ICU. The presence of three or more of these risk factors at admission identified patients that would develop IAH with a sensitivity of 75% and a specificity of 76%, the development of grades II, III and IV IAH with a sensitivity of 91% and a specificity of 62%. Patients that developed IAH required a significantly longer duration of mechanical ventilation and ICU care. Patients that developed grades II-IV IAH had a significantly higher rate of ICU mortality. CONCLUSION: IAH is a common clinical entity in the intensive care setting that is associated with morbidity and mortality. A screening tool, based on data readily available within a patient's first 24 h in ICU, was developed and effectively identified patients that required intra-abdominal pressure monitoring.
Authors: Annika Reintam Blaser; Adrian Regli; Bart De Keulenaer; Edward J Kimball; Liis Starkopf; Wendy A Davis; Patrick Greiffenstein; Joel Starkopf Journal: Crit Care Med Date: 2019-04 Impact factor: 7.598