RESEARCH – March 2008

Intra-abdominal hypertension in critically ill patients: incidence and impact on outcome


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AIM. To study the incidence and outcome of intra-abdominal hypertension (IAH) in intensive care patients in comparison of the two periods: 2004–2006 and 2006–2007.
METHODS. Consecutive patients treated at least for 24 hours in the general ICU of Tartu University Hospital during three years were screened for the risk factors of IAH. Mechanically ventilated patients with at least one additional risk factor for IAH in 2004–2006 (264 patients) and all mechanically ventilated patients in 2006–2007 (257) were included in the study. Intra-abdominal pressure (IAP) was measured via the bladder, using the closed loop system repeated measurement technique. Measurements were performed at least twice daily, in patients with elevated IAP, at least four times a day.
RESULTS. During ICU stay, IAH developed in 37% of the study patients (approx. 1/8 of all patients treated during ICU stay) in the fi rst, and in 27.3% of the study patients (approx. 1/5 of all treated patients) in the second study period. Mean SOFA score and mean IAP in the first 3 days of the IAH patients were lower in the second period, suggesting that less critically ill patients with less severe IAH were included in the second period. The ICU mortality of the patients with IAH was signifi cantly higher compared to that of the patients without this syndrome in both periods. Development of IAH was identified as the independent risk factor of death in the first study period, while mean IAP during the first three days appeared to be the independent risk factor of death in the second study period.
CONCLUSION. IAH is frequent in critically ill patients. Development of IAH is associated with increased ICU mortality. Measuring IAP only in patients with presumable risk factors may lead to underestimation of the incidence of IAH in the whole ICU population.