Bahriye Kılıç1, Nihan Yapıcı2, Fikri Yapıcı3, Ali Sait Kavaklı4, Türkan Kudsioğlu2, Abdullah Kılıç1, Zuhal Aykaç5. 1. Department of Anesthesiology and Reanimation, Medicine Hospital, Istanbul, Turkey. 2. Department of Anesthesiology and Reanimation, University of Health Sciences Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey. 3. Department of Cardiovascular Surgery, Memorial Ataşehir Hospital, Istanbul, Turkey. 4. Department of Anesthesiology and Reanimation, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey. 5. Department of Anesthesiology and Reanimation, Marmara University School of Medicine, Pendik Training and Research Hospital, Istanbul, Turkey.
Abstract
BACKGROUND: The aim of this study was to investigate the intra-abdominal pressure changes and risk factors associated with increased intra-abdominal pressure in patients undergoing cardiac surgery. METHODS: Between July 2016 and January 2017, a total of 100 patients (74 males, 26 females; mean age 55.9±14.3 years; range, 19 to 75 years) who underwent cardiac surgery under cardiopulmonary bypass were included in the study. Patients" data including demographic and clinical characteristics and intra- and postoperative data were recorded. Intra-abdominal pressure was measured via a urinary catheter after anesthesia induction, on admission to the intensive care unit, and at postoperative 12 and 24 h. The patients were divided into two groups according to the intraabdominal pressure as Group 1 (≥12 mmHg; n=49) and Group 2 (<12 mmHg; n=51). RESULTS: In the univariate regression analysis, high intra-abdominal pressure was related to intra-abdominal pressure measured after anesthesia induction (Odds Ratio =0.70, p=0.001), age (odds ratio=0.95, p=0.004), hypertension (odds ratio=4.51, p=0.0001), duration of cardiopulmonary bypass (odds ratio=0.97, p=0.0001), intraoperative lactate levels (odds ratio=0.53, p=0.0001), use of red blood cells (odds ratio=0.24, p=0.0001), use of dopamine (odds ratio=0.21, p=0.002), dobutamine (odds ratio=0.28, p=0.005), use of noradrenaline (odds ratio=0.25, p=0.016), postoperative lactate levels (odds ratio=0.60, p=0.0001), duration of cross-clamp (odds ratio=0.97, p=0.0001), atrial fibrillation (odds ratio=5.89, p=0.004), and acute kidney injury (odds ratio=8.33, p=0.048). In the multivariate analysis, the intra-abdominal pressure at baseline (odds ratio=0.70, p=0.045), age (odds ratio=0.93, p=0.032), hypertension (odds ratio=6.87, p=0.023), duration of cardiopulmonary bypass (odds ratio=0.98, p=0.062), intraoperative lactate levels (odds ratio=0.57, p=0.035), and use of red blood cells (odds ratio=0.19, p=0.003) remained statistically significant. CONCLUSION: Our study results suggest that age, hypertension, duration of cardiopulmonary bypass, intraoperative lactate levels, and use of red blood cells are risk factors associated with elevated intra-abdominal pressure in patients undergoing cardiac surgery. Increased awareness of these risk factors and the addition of intra-abdominal pressure measurement to the standard follow-up scheme in patients with variable hemodynamics, low cardiac output, and high lactate levels in the intensive care unit may be useful in early diagnosis of complications and in decreasing morbidity.
BACKGROUND: The aim of this study was to investigate the intra-abdominal pressure changes and risk factors associated with increased intra-abdominal pressure in patients undergoing cardiac surgery. METHODS: Between July 2016 and January 2017, a total of 100 patients (74 males, 26 females; mean age 55.9±14.3 years; range, 19 to 75 years) who underwent cardiac surgery under cardiopulmonary bypass were included in the study. Patients" data including demographic and clinical characteristics and intra- and postoperative data were recorded. Intra-abdominal pressure was measured via a urinary catheter after anesthesia induction, on admission to the intensive care unit, and at postoperative 12 and 24 h. The patients were divided into two groups according to the intraabdominal pressure as Group 1 (≥12 mmHg; n=49) and Group 2 (<12 mmHg; n=51). RESULTS: In the univariate regression analysis, high intra-abdominal pressure was related to intra-abdominal pressure measured after anesthesia induction (Odds Ratio =0.70, p=0.001), age (odds ratio=0.95, p=0.004), hypertension (odds ratio=4.51, p=0.0001), duration of cardiopulmonary bypass (odds ratio=0.97, p=0.0001), intraoperative lactate levels (odds ratio=0.53, p=0.0001), use of red blood cells (odds ratio=0.24, p=0.0001), use of dopamine (odds ratio=0.21, p=0.002), dobutamine (odds ratio=0.28, p=0.005), use of noradrenaline (odds ratio=0.25, p=0.016), postoperative lactate levels (odds ratio=0.60, p=0.0001), duration of cross-clamp (odds ratio=0.97, p=0.0001), atrial fibrillation (odds ratio=5.89, p=0.004), and acute kidney injury (odds ratio=8.33, p=0.048). In the multivariate analysis, the intra-abdominal pressure at baseline (odds ratio=0.70, p=0.045), age (odds ratio=0.93, p=0.032), hypertension (odds ratio=6.87, p=0.023), duration of cardiopulmonary bypass (odds ratio=0.98, p=0.062), intraoperative lactate levels (odds ratio=0.57, p=0.035), and use of red blood cells (odds ratio=0.19, p=0.003) remained statistically significant. CONCLUSION: Our study results suggest that age, hypertension, duration of cardiopulmonary bypass, intraoperative lactate levels, and use of red blood cells are risk factors associated with elevated intra-abdominal pressure in patients undergoing cardiac surgery. Increased awareness of these risk factors and the addition of intra-abdominal pressure measurement to the standard follow-up scheme in patients with variable hemodynamics, low cardiac output, and high lactate levels in the intensive care unit may be useful in early diagnosis of complications and in decreasing morbidity.
Authors: Elizabeth L Daugherty; Darren Taichman; John Hansen-Flaschen; Barry D Fuchs Journal: J Intensive Care Med Date: 2007 Sep-Oct Impact factor: 3.510
Authors: Andrew W Kirkpatrick; Derek J Roberts; Jan De Waele; Roman Jaeschke; Manu L N G Malbrain; Bart De Keulenaer; Juan Duchesne; Martin Bjorck; Ari Leppaniemi; Janeth C Ejike; Michael Sugrue; Michael Cheatham; Rao Ivatury; Chad G Ball; Annika Reintam Blaser; Adrian Regli; Zsolt J Balogh; Scott D'Amours; Dieter Debergh; Mark Kaplan; Edward Kimball; Claudia Olvera Journal: Intensive Care Med Date: 2013-05-15 Impact factor: 17.440