The duration of intra-abdominal hypertension and increased serum lactate level are important prognostic markers in critically ill surgical patient's outcome: A prospective, observational study

Abstract

Aim: The present study analyzed the clinical significance of duration of intra-abdominal hypertension (IAH) associated with increased serum lactate in critically ill patients with severe sepsis. Materials and Methods: Our study was an observational, prospective study carried out in the Surgical Intensive Care Unit (ICU) at J.L.N Medical College, Ajmer, Rajasthan, India. In our study, we included a total of 100 patients and intra-abdominal pressure (IAP) was measured through intravesical route at the time of admission and after 6, 12, 24, 48, and 72 h via a urinary catheter filled with 25 ml of saline. Duration of ICU and hospital stay, need for ventilator support, initiation of enteral feeding, serum lactate level at time of admission and after 48 h, and 30-day mortality were noted as outcomes. Results: In our study, an overall incidence of IAH was 60%. Patients with cardiovascular surgery and renal and pulmonary dysfunction were 93.3%, 55%, and 60%, respectively, at the time of admission and 65%, 10%, and 10%, respectively, after 72 h of admission in the surgical ICU. Nonsurvivors had statistically significant higher IAP and serum lactate levels than survivors. Patients with longer duration of IAH had longer ICU and hospital stay, longer duration of vasopressors and ventilator support, and delayed enteral feeding. Conclusion: There is a strong relationship “risk accumulation” between duration of IAH associated with increased serum lactate and organ dysfunction. The duration of IAH was an independent predictor of 30-day mortality. Early recognition and prompt intervention for IAH and severe sepsis are essential to improve the patient outcomes.

Intra-Abdominal Hypertension and Increased Serum Procalcitonin Levels Are Important Prognostic Markers in Critically Ill Surgical Patient’s Outcome: A Prospective Observational Study

“…22% of our patients came with blunt trauma of the abdomen. Studies conducted showed a similar distribution of trauma patients [7,8]. In our study, patients with ascites (3%), burn (1%), and gut gangrene (2%) constituted a small percentage.…”

“…This mean duration in our non-survivor group is 3.77±1.92 days and in the survivor group are 1.94±1.55 days. Gupta et al [8] found in their study that the mean duration of IAH in the survivor group is 2.85 days and that in the non-survivor group is 8.38 days.…”

Abdominal compartment syndrome in burns patients: Introduction of an evidence-based management guideline and algorithm

“…Serum lactate levels are a commonly raised in burn patients, and causes are multifactorial. Raised lactate is used as a surrogate marker of ischemia and hypoperfusion and has been shown to increase in established IAH 29 . Therefore, intra-abdominal pathology should always be considered when searching for causes of raised lactate (>2 mmol/L), and the intra-abdominal pressure should be checked to exclude this as a cause.…”

Algorithm for Choosing the Methods of Disconnection of Anatomical Components of the Abdominal Wall in Combination With Alloplasty in Postoperative Ventral Hernias of Giant Size

“…Хірургічне лікування післяопераційних вентральних гриж (ПВГ) гігантських розмірів асоціюється з виникненням інтраабдомінальної гіпертензії (ІАГ) у післяопераційному періоді. Це ускладнення обумовлене переміщенням вмісту грижового мішка, зокрема ділянок кишківника та великого чепця в черевну порожнину та закриттям великого дефекту черевної стінки, що створює передумови для інтраабдомінальної гіпертензії [1,2]. Виникнення інтраабдомінальної гіперетензії ІІІ та IV ступенів, зокрема з внутрішньочеревним тиском (ВЧТ) більше 20 мм.…”