Intra-Abdominal Hypertension Is More Common Than Previously Thought: A Prospective Study in a Mixed Medical-Surgical ICU

Murphy, Patrick; Parry, Neil; Sela, Nathalie; Leslie, Ken; Vogt, Kelly; Ball, Ian

doi:10.1097/ccm.0000000000003122

Cited by 51 publications

(64 citation statements)

References 24 publications

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“…In a study of 83 patients published in 2008, the incidence of ACS was 12% in a heterogeneous intensive care population [14]. The incidence of ACS in the current study is comparable to a recent study in a mixed medical-surgical ICU where ACS occurred in 3% of patients, although this study included consecutive ICU patients who were not selected for their high-risk for IAH or ACS [3]. This might be explained by the fact that 67% of the patients in the current study were admitted after elective abdominal surgery.…”

Section: Discussionsupporting

confidence: 71%

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Intra-abdominal hypertension and abdominal compartment syndrome in patients admitted to the ICU

Smit

Koopman

Dieperink

et al. 2020

Ann. Intensive Care

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Background Intra-abdominal hypertension is frequently present in critically ill patients and is an independent predictor for mortality. Risk factors for intra-abdominal hypertension and abdominal compartment syndrome have been widely investigated. However, data are lacking on prevalence and outcome in high-risk patients. Our objectives in this study were to investigate prevalence and outcome of intra-abdominal hypertension and abdominal compartment syndrome in high-risk patients in a prospective, observational, single-center cohort study. Results Between March 2014 and March 2016, we included 503 patients, 307 males (61%) and 196 females (39%). Patients admitted to the intensive care unit with a diagnosis of pancreatitis, elective or emergency open abdominal aorta surgery, orthotopic liver transplantation, other elective or emergency major abdominal surgery and trauma were enrolled. One hundred and sixty four (33%) patients developed intra-abdominal hypertension and 18 (3.6%) patients developed abdominal compartment syndrome. Highest prevalence of abdominal compartment syndrome occurred in pancreatitis (57%) followed by orthotopic liver transplantation (7%) and abdominal aorta surgery (5%). Length of intensive care stay increased by a factor 4 in patients with intra-abdominal hypertension and a factor 9 in abdominal compartment syndrome, compared to patients with normal intra-abdominal pressure. Rate of renal replacement therapy was higher in abdominal compartment syndrome (38.9%) and intra-abdominal hypertension (8.2%) compared to patients with normal intra-abdominal pressure (1.2%). Both intensive care mortality and 90-day mortality were significantly higher in intra-abdominal hypertension (4.8% and 15.2%) and abdominal compartment syndrome (16.7% and 38.9%) compared to normal intra-abdominal pressure (1.2% and 7.1%). Body mass index (odds ratio 1.08, 95% confidence interval 1.03–1.13), mechanical ventilation at admission (OR 3.52, 95% CI 2.08–5.96) and Apache IV score (OR 1.03, 95% CI 1.02–1.04) were independent risk factors for the development of intra-abdominal hypertension or abdominal compartment syndrome. Conclusions The prevalence of abdominal compartment syndrome was 3.6% and the prevalence of intra-abdominal hypertension was 33% in this cohort of high-risk patients. Morbidity and mortality increased when intra-abdominal hypertension or abdominal compartment syndrome was present. The patient most at risk of IAH or ACS in this high-risk cohort has a BMI > 30 kg/m2 and was admitted to the ICU after emergency abdominal surgery or with a diagnosis of pancreatitis.

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Section: Discussionsupporting

confidence: 71%

“…Recently, data on prevalence of IAH and ACS were summarized by Padar et al [5]. Data of 285 consecutive patients from a mixed medical-surgical intensive care unit (ICU) showed that ACS occurred in 3% of patients [3]. In a mixed multi-center ICU population of 491 consecutive patients, ACS occurred in 6% of patients.…”

Section: Introductionmentioning

confidence: 99%

Intra-abdominal hypertension and abdominal compartment syndrome in patients admitted to the ICU

Smit

Koopman

Dieperink

et al. 2020

Ann. Intensive Care

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“…Pregnant women develop increased abdominal wall compliance, which helps them adapt to the chronically increased intra‐abdominal pressure (IAP) caused by a growing fetus, fluid, and tissue . However, sustained acute on chronic increases of IAP can lead to IAH and ACS, conditions that lead to organ dysfunction, compromise the fetoplacental unit, and contribute significantly to morbidity and mortality …”

Section: Introductionmentioning

confidence: 99%

“…5 However, sustained acute on chronic increases of IAP can lead to IAH and ACS, conditions that lead to organ dysfunction, compromise the fetoplacental unit, and contribute significantly to morbidity and mortality. 6 The Abdominal Compartment Society (WSACS, www.wsacs.org) is responsible for most medical literature published about this topic, including creating definitions and updated consensus guidelines for IAH and ACS. 7 Several recent studies applied standardized protocols and consensus measurement techniques to examine IAP in both healthy and critically ill pregnant women.…”

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confidence: 99%

Management of peripartum intra‐abdominal hypertension and abdominal compartment syndrome

Lozada

Goyal

Levin

et al. 2019

Acta Obstet Gynecol Scand

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Normal pregnancy leads to a state of chronically increased intra‐abdominal pressure. Obstetric and non‐obstetric conditions may increase intra‐abdominal pressure further, causing intra‐abdominal hypertension and abdominal compartment syndrome, which leads to maternal organ dysfunction and a compromised fetal state. Limited medical literature exists to guide treatment of pregnant women with these conditions. In this state‐of‐the‐art review, we propose a diagnostic and treatment algorithm for the management of peripartum intra‐abdominal hypertension and abdominal compartment syndrome, informed by newly available studies.

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“…Abdominal compartment syndrome (ACS)is defined as an increase of the intra-abdominal pressure, together with the dysfunction or failure of an organ7 .In critically ill patients, the pressure is usually between 5-7 mmHg. Elevations above 12 mmHg are considered as intra-abdominal hypertension (IAH), which is classified as follows (Table 1): The central role of measuring intraabdominal pressure in critically ill patients, as well as the careful surveillance and proactive procedures to prevent the development of ACS in patients diagnosed with IAH, is crucial.…”

mentioning

confidence: 99%

Protocolos Para Diagnóstico E Manejo Da Hipertensão Intra-Abdominal Em Centros De Tratamento Intensivo

Caldas

Ascenção

2020

Rev. Col. Bras. Cir.

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RESUMO Objetivo: A hipertensão intra-abdominal (HIA) é uma condição mórbida comum em pacientes críticos. A síndrome compartimental abdominal (SCA) é condição grave de tratamento cirúrgico que ocorre como evolução da HIA não diagnosticada e não tratada. O objetivo deste trabalho é disseminar evidências e propor protocolos de rastreio e condutas em casos de HIA e SCA para centros de terapia intensiva (CTI) Métodos: Foram realizadas buscas sobre o tema nas principais bases de dados e utilizadas as evidências e protocolos recomendadas pela World Society of the Abdominal Compartment Syndrome. Resultados: Apresentamos protocolos sobre investigação, aferição, manejo e controle da HIA, adequadas à realidade brasileira. Conclusão: Neste trabalho, apresentamos em detalhes os principais fatos e evidências sobre o manejo em casos de suspeita de HIA e como aferir a pressão intra-abdominal (PIA), de forma simples e reproduzível para qualquer CTI do nosso país.

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Intra-Abdominal Hypertension Is More Common Than Previously Thought: A Prospective Study in a Mixed Medical-Surgical ICU

Cited by 51 publications

References 24 publications

Intra-abdominal hypertension and abdominal compartment syndrome in patients admitted to the ICU

Intra-abdominal hypertension and abdominal compartment syndrome in patients admitted to the ICU

Management of peripartum intra‐abdominal hypertension and abdominal compartment syndrome

Protocolos Para Diagnóstico E Manejo Da Hipertensão Intra-Abdominal Em Centros De Tratamento Intensivo

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