Émilie Richer-Séguin1, Christian Ayoub1, Jean-Sébastien Lebon1, Jennifer Cogan1, Stéphanie Jarry1, Yoan Lamarche2, André Y Denault3, William Beaubien-Souligny4,5. 1. Department of Anesthesia, Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montreal, QC, Canada. 2. Department of Surgery, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada. 3. Department of Anesthesia, Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montreal, QC, Canada. andre.denault@umontreal.ca. 4. Division of Nephrology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada. 5. Centre de Recherche, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada.
Abstract
PURPOSE: While intra-abdominal hypertension (IAH) has been associated with adverse outcomes in multiple settings, the epidemiology and clinical implications of IAH in the context of cardiac surgery are less known. In this study, we aimed to describe the prevalence of IAH in patients undergoing cardiac surgery and determine its association with patient characteristics and postoperative outcomes. METHODS: We conducted a single-centre prospective cohort study in which intra-abdominal pressure was measured in the operating room after general anesthesia (T1), after the surgical procedure (T2), and two hours after intensive care unit (ICU) admission (T3) in a subset of patients. Intra-abdominal hypertension was defined as intra-abdominal pressure (IAP) ≥ 12 mm Hg. Postoperative outcomes included death, acute kidney injury (AKI), and length of stay in the ICU and hospital. RESULTS: A total of 513 IAP measurements were obtained from 191 participants in the operating room and 131 participants in the ICU. Intra-abdominal hypertension was present in 105/191 (55%) at T1, 115/191 (60%) at T2, and 31/131 (24%) at T3. Intra-abdominal pressure was independently associated with body mass index, central venous pressure, and mean pulmonary artery pressure but was not associated with cumulative fluid balance. Intraoperative IAH was not associated with adverse outcomes including AKI. CONCLUSIONS: Intra-abdominal hypertension is very common during cardiac surgery but its clinical implications are uncertain.
PURPOSE: While intra-abdominal hypertension (IAH) has been associated with adverse outcomes in multiple settings, the epidemiology and clinical implications of IAH in the context of cardiac surgery are less known. In this study, we aimed to describe the prevalence of IAH in patients undergoing cardiac surgery and determine its association with patient characteristics and postoperative outcomes. METHODS: We conducted a single-centre prospective cohort study in which intra-abdominal pressure was measured in the operating room after general anesthesia (T1), after the surgical procedure (T2), and two hours after intensive care unit (ICU) admission (T3) in a subset of patients. Intra-abdominal hypertension was defined as intra-abdominal pressure (IAP) ≥ 12 mm Hg. Postoperative outcomes included death, acute kidney injury (AKI), and length of stay in the ICU and hospital. RESULTS: A total of 513 IAP measurements were obtained from 191 participants in the operating room and 131 participants in the ICU. Intra-abdominal hypertension was present in 105/191 (55%) at T1, 115/191 (60%) at T2, and 31/131 (24%) at T3. Intra-abdominal pressure was independently associated with body mass index, central venous pressure, and mean pulmonary artery pressure but was not associated with cumulative fluid balance. Intraoperative IAH was not associated with adverse outcomes including AKI. CONCLUSIONS: Intra-abdominal hypertension is very common during cardiac surgery but its clinical implications are uncertain.
Authors: Marije Smit; Maureen J M Werner; Annemieke Oude Lansink-Hartgring; Willem Dieperink; Jan G Zijlstra; Matijs van Meurs Journal: Ann Intensive Care Date: 2016-10-10 Impact factor: 6.925