Incidence and prognosis of intraabdominal hypertension in a mixed population of critically ill patients: A multiple-center epidemiological study *.
Malbrain, Manu L. N. G. MD; Chiumello, Davide MD; Pelosi, Paolo MD, PhD; Bihari, David MD; Innes, Richard MD; Ranieri, V Marco MD, PhD; Del Turco, Monica MD; Wilmer, Alexander MD, PhD; Brienza, Nicola MD; Malcangi, Vincenzo MD; Cohen, Jonathan MD; Japiassu, Andre MD; De Keulenaer, Bart L. MD; Daelemans, Ronny MD; Jacquet, Luc MD, PhD; Laterre, Pierre-Francois MD, PhD; Frank, Gunther MD; de Souza, Paulo MD; Cesana, Bruno MD; Gattinoni, Luciano MD, PhD
Critical Care Medicine.
33(2):315-322, February 2005.
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Objective: Intraabdominal hypertension is associated with significant morbidity and mortality in surgical and trauma patients. The aim of this study was to assess, in a mixed population of critically ill patients, whether intraabdominal pressure at admission was an independent predictor for mortality and to evaluate the effects of intraabdominal hypertension on organ functions.
Design: Multiple-center, prospective epidemiologic study.
Setting: Fourteen intensive care units in six countries.
Patients: A total of 265 consecutive patients admitted for >24 hrs during the 4-wk study period.
Measurements and Main Results: Intraabdominal pressure was measured twice daily via the bladder. Data recorded on admission were the patient demographics with Simplified Acute Physiology Score II, Acute Physiology and Chronic Health Evaluation II score, and type of admission; during intensive care stay, Sepsis-Related Organ Failure Assessment score and intraabdominal pressure were measured daily together with fluid balance. Nonsurvivors had a significantly higher mean intraabdominal pressure on admission than survivors: 11.4 /- 4.8 vs. 9.5 /- 4.8 mm Hg. Independent predictors for mortality were age (odds ratio, 1.04; 95% confidence interval, 1.01-1.06; p = .003), Acute Physiology and Chronic Health Evaluation II score (odds ratio, 1.1; 95% confidence interval, 1.05-1.15; p < .0001), type of intensive care unit admission (odds ratio, 2.5 medical vs. surgical; 95% confidence interval, 1.24-5.16; p = .01), and the presence of liver dysfunction (odds ratio, 2.5; 95% confidence interval, 1.06-5.8; p = .04). The occurrence of intraabdominal hypertension during the intensive care unit stay was also an independent predictor of mortality (relative risk, 1.85; 95% confidence interval, 1.12-3.06; p = .01). Patients with intraabdominal hypertension at admission had significantly higher Sepsis-Related Organ Failure Assessment scores during the intensive care unit stay than patients without intraabdominal hypertension.
Conclusions: Intraabdominal hypertension on admission was associated with severe organ dysfunction during the intensive care unit stay. The mean intraabdominal pressure on admission was not an independent risk factor for mortality; however, the occurrence of intraabdominal hypertension during the intensive care unit stay was an independent outcome predictor.
(C) 2005 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins