Intra-abdominal hypertension; prevalence, incidence and outcomes in a low resource setting; a prospective observational study

Kuteesa, Job; Kituuka, Olivia; Namuguzi, Dan; Ndikuno, Cynthia; Kirunda, Samuel; Mukunya, David; Galukande, Moses

doi:10.1186/s13017-015-0051-4

Cited by 22 publications

(17 citation statements)

References 22 publications

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“…A prospective cohort study of 38 critically ill postlaparotomy patients in Zimbabwe, found prevalence of IAH of 92% and ACS at 8% [11]. Another prospective study, involving 192 paediatric and adult patients in general surgical wards in Uganda, reported IAH prevalence of 25 and 18.4% for paediatric and adult population, respectively [12]. …”

Section: Introductionmentioning

confidence: 99%

Prevalence and predictors of intra-abdominal hypertension and compartment syndrome in surgical patients in critical care units at Kenyatta National Hospital

et al. 2016

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BackgroundIntra-abdominal hypertension (IAH) affects almost every organ sytem.If it is not detected early and corrected, mortality would be high. The prevalence of IAH and abdominal compartment syndrome (ACS) at Kenyatta National Hospital (KNH) critical care units is not known. The aim of this sudy was to determine the prevalence and factors associated with development of IAH/ACS among critically ill surgical patients.MethodsThis was a cross sectional descriptive study involving surgical patients in critical care units at KNH, carried out from March 2015 to October 2015.One hundred and thirteen critically ill and ventilated patients 13 years or older were recruited into the study.Krohn’s intravesical method was used to measure intra- abdominal pressure (IAP). Measurements were done at first contact, then at 12 and 24 h. Additional parameters recorded included: laboratory tests such as serum bilirubin and total blood count as well as clinical parameters such as urine output, vital signs and peak airway pressure, among others.Frequency, means and standard deviation were used to describe the data. Categorical variables e.g. age, were analysed using Chi square test and continous variables using student ‘t’ test and Mann Whitney test as appropriateResultA total of 113 consecutive surgical patients admitted to the critical care units were recruited. Of our study population, 71.7% (by IAP max) and 67.3% (by IAP mean) had IAH. Abdominal compartment syndrome (ACS) developed in 4.4% of the population. The following factors were significant determinants of risk of IAH : amount of IV fluids over 24 h (3949.6 vs 2931.1, p = 0.003, adjusted OR 1.0 [1.0-1.002]), haemoglobin values at admission (9.9 vs 12.0, p = <0.012, adjusted OR 0.6 [0.4-0.9]), peak airway pressure (28.4 vs 17.3; p = 0.018, adjusted OR 1.6 [1.1-2.4]) and synchronised intermittent mandatory ventilation (SIMV) (60 vs 32; p = 0.041, adjusted OR 1.4 [0.78-2.04]).Of those who had IAH; age, amount of iv fluids over 24 h, fluid balance and ventilator mode were significant determinants of risk of progression to ACS .ConclusionThe prevalence of intraabdominal hypertension and abdominal compartment syndrome at KNH is high. Clinical parameters pertaining to fluids administration and ventilator mode are siginificant determinants.Electronic supplementary materialThe online version of this article (doi:10.1186/s12873-017-0120-y) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Prevalence and predictors of intra-abdominal hypertension and compartment syndrome in surgical patients in critical care units at Kenyatta National Hospital

et al. 2016

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“…In order to succeed in this great challenge it is important to understand the pathophysiology of abdominal hypertension 25 and spread the new knowledge among physicians and surgeons working in lowincome hospitals. 26 Even in case of scarce resources, the concept of damage control surgery and its application with tension-free closure of the abdominal wall after abbreviated laparotomies can increase survival rates in critical patients. 27 Moreover the awareness of the potential complications for clinicians and staff using laparostomy should be mandatory not to turn a good surgical tool into malpractice.…”

Section: Discussionmentioning

confidence: 99%

Laparostomy in a rural hospital: an African case report for a very important tool to be spread and increased

et al. 2017

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Laparostomy is a surgical technique enabling the surgeon to leave abdominal fascial edges opened after a laparotomy. This is a useful tool that can be very important in patients with intraabdominal hypertension. Open abdomen indications are: trauma, severe abdominal sepsis, intestinal infarction, vascular surgery and when the surgeon cannot close the abdomen due to high intra abdominal pressure in order to avoid abdominal compartment syndrome or in case of a second look in order to evaluate the conditions of the abdomen (and particularly of the gut). We used this technique in a low income country for a patient with intestinal obstruction where performing a primary anastomosis during the first operation was at high risk of leakage.A middle-aged woman was admitted in Pope John's Hospital -Aber, Uganda for abdominal pain and intestinal obstruction (IO) symptoms. A laparotomy found a tract of small gut necrotic and twisted under a single adhesion. The small gut above the volvulus was dilated for the obstruction created by the adhesion. We decided to excise the necrotic intestine and leave the abdomen open for a second look and delayed anastomosis and closure. The managing of the IO was conducted by inserting a big Foley catheter in the proximal intestine to drain its enteric content in a similar fashion to a guided external fistula.Open abdomen is a very important technique, relatively new, that can impact positively in treating some surgical patients even in rural hospitals and in the absence of Intensive Care Unit. A simple trick can solve successfully the IO due to the volvulus. Laparostomy should be spread more in African and low-income countries. Case ReportA 42(?)-year old woman came to Aber Hospital at around 7:00 p.m. and was admitted in October 2015 to the surgical ward complaining severe abdominal pain, she was not passing stools and flatus for the past 5 days and she had no history of previous surgeries. The patient was hemodynamically stable, although slightly tachicardic (BP 100/70, HR 100 bpm). Clinically she presented with severe abdominal distension and signs of peritonitis. Rectal exploration was carried out at hospital admission showing empty rectus. We tried to manage this case conservatively by passing a rectal tube thinking it could have been a sigmoid volvulus, very frequent in African communities but after a plain abdominal XR we realized the distension was coming from the small gut. Blood tests showed a mild leukocytosis, normal Hb and PLT. The patient started resuscitation fluids, IV antibiotics, and pain relief, we passed a NGT and urinary catheter. An explorative laparotomy was planned the following day: despite she was slightly peritonitic at presentation, it was impossible to set up the theatre and perform the operation sooner due to logistic deficiency. The NGT output before the operation was about 100 mls and urine output about 1500 mls. The operation was undertaken the following morning, as soon as it was possible to arrange the theatre (around 8:00 a.m.), and the patient's vi...

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“…Each IAP value was obtained by manometer (cmH2O) and recalculated in millimeter mercury using the conversion factor (1 cmH2O = 0.74 mmHg). The measuring system is closed and the urinary drainage bag clamp released at the end of the procedure (Kuteesa et al, 2015).…”

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confidence: 99%

Effect of Abdominal Massage on Gastrointestinal Complications and Intra-Abdominal Pressure of Critical-Enteral-Feed Patients: A Randomized Control Trial

2019

JHMN

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Background: critically ill patient need a nursing practice that can enhance him to get all benefits of enteral feeding and overlapping the GI complications and maintain the intra-abdominal pressure.Objective: This work aimed to explore the effect of abdominal massage on gastrointestinal complications and intra-abdominal pressure of critical-enteral-feed patients. Methods: A randomized controlled trial was applied on 74 eligibly enteral-fed patients at Trauma and General ICUs. Of these, the trail was completed on sixty patients who distributed randomly to equal intervention and control groups. The manipulation was two times for 15mins of abdominal massage for five days. The effect was measured on enteral feeding complications (GRV, abdominal circumference and distention, vomiting) and intra-abdominal pressure as compared with control group who didn't receive the massage.Results: the GRV difference between the massage group and control group subjects was statistically significant (P<0.001) in the 3 rd , 4 th , and 5 th days indicating higher GRV among control group. The abdominal circumference between the five days was not significantly in the two groups. The difference between the two groups in relation to the distension was statistically significant (p < 0.05) in day 3, 4 and5. None of intervention patients were vomited along the study period (5days) in compared to 5% of control patients without statistical significant. Conclusions: The abdominal massage was significantly effective in lowering GRV, preventing distension and avoiding vomiting. Besides, the abdominal massage maintained the IAP without any statistical significant support. Therefore, it is recommended that this practice can be applied as a caring procedure in the daily ICU care program.

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Intra-abdominal hypertension; prevalence, incidence and outcomes in a low resource setting; a prospective observational study

Cited by 22 publications

References 22 publications

Prevalence and predictors of intra-abdominal hypertension and compartment syndrome in surgical patients in critical care units at Kenyatta National Hospital

Prevalence and predictors of intra-abdominal hypertension and compartment syndrome in surgical patients in critical care units at Kenyatta National Hospital

Laparostomy in a rural hospital: an African case report for a very important tool to be spread and increased

Effect of Abdominal Massage on Gastrointestinal Complications and Intra-Abdominal Pressure of Critical-Enteral-Feed Patients: A Randomized Control Trial

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