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

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

doi:10.1097/CCM.0000000000003122

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

Crit Care Med. 2018 Jun;46(6):958-964. doi: 10.1097/CCM.0000000000003122.

Authors

Patrick B Murphy¹, Neil G Parry², Nathalie Sela¹, Ken Leslie¹, Kelly Vogt¹, Ian Ball³

Affiliations

¹ Division of General Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
² Divisions of General Surgery and Critical Care, Department of Surgery, Schulich School of Medicine and Dentistry, Trauma Program, London Health Sciences Centre & Divisions of General Surgery and Critical Care Medicine, Western University, London, ON, Canada.
³ Departments of Medicine and Epidemiology and Biostatistics, Western University, London, ON, Canada.

PMID: 29578878
DOI: 10.1097/CCM.0000000000003122

Abstract

Objectives: To determine the prevalence of intra-abdominal hypertension in mixed medical-surgical critically ill patients using modern definitions and measurement techniques. Secondarily to determine variables associated with intra-abdominal hypertension and ICU mortality.

Design: A prospective observational study.

Setting: Single institution trauma, medical and surgical ICU in Canada.

Patients: Consecutive adult patients admitted to the ICU (n = 285).

Intervention: Intra-abdominal pressure measurements twice a day during admission to the ICU.

Measurements and main results: In 285 patients who met inclusion criteria, 30% were diagnosed with intra-abdominal hypertension at admission and a further 15% developed intra-abdominal hypertension during admission. The prevalence of abdominal compartment syndrome was 3%. Obesity, sepsis, mechanical ventilation, and 24-hour fluid balance (> 3 L) were all independent predictors for intra-abdominal hypertension. Intra-abdominal hypertension occurred in 28% of nonventilated patients. Admission type (medical vs surgical vs trauma) was not a significant predictor of intra-abdominal hypertension. Overall ICU mortality was 20% and was significantly higher for patients with intra-abdominal hypertension (30%) compared with patients without intra-abdominal hypertension (11%). Intra-abdominal hypertension of any grade was an independent predictor of mortality (odds ratio, 3.33; 95% CI, 1.46-7.57).

Conclusions: Intra-abdominal hypertension is common in both surgical and nonsurgical patients in the intensive care setting and was found to be independently associated with mortality. Despite prior reports to the contrary, intra-abdominal hypertension develops in nonventilated patients and in patients who do not have intra-abdominal hypertension at admission. Intra-abdominal pressure monitoring is inexpensive, provides valuable clinical information, and there may be a role for its routine measurement in the ICU. Future work should evaluate the impact of early interventions for patients with intra-abdominal hypertension.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Critical Care / statistics & numerical data
Female
Humans
Intensive Care Units / statistics & numerical data*
Intra-Abdominal Hypertension / epidemiology*
Intra-Abdominal Hypertension / etiology
Intra-Abdominal Hypertension / mortality
Male
Middle Aged
Prevalence
Prospective Studies
Risk Factors
Surgical Procedures, Operative / adverse effects