This article is part of the supplement: Diagnosis and management of intra-abdominal hypertension and abdominal compartment syndrome

Open Access Research

Incidence and prognosis of intra-abdominal hypertension in critically ill medical patients: a prospective epidemiological study

Patricia Santa-Teresa1*, Javier Muñoz1, Ignacio Montero1, María Zurita1, María Tomey1, Luis Álvarez-Sala2 and Pablo García1

Author Affiliations

1 Intensive Care Unit, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo 46, Madrid, 28007, Spain

2 Department of Internal Medicine, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo 46, Madrid, 28007, Spain

For all author emails, please log on.

Annals of Intensive Care 2012, 2(Suppl 1):S3  doi:10.1186/2110-5820-2-S1-S3

Published: 5 July 2012

Abstract

Introduction

The aim of this study was to determine the incidence of intra-abdominal hypertension (IAH) in patients with two or more categorized risk factors (CRF) for IAH, and their morbidity and mortality during their intensive care unit (ICU) stay.

Methods

Prospective cohort study carried out at a medical ICU. A total of 151 medical patients were enrolled during a period of 3 months. After ICU whole staff training, we conducted daily screening of the four CRF for IAH based on the World Society of Abdominal Compartment Syndrome (WSACS) guidelines (namely, diminished abdominal wall compliance, increased intraluminal content, increased abdominal content, and capillary leak syndrome or fluid resuscitation). In those patients with risk factors of at least two different categories (≥2 CRF), intra-abdominal pressure (IAP) was measured every 8 h during ICU stay. Data included demographics, main diagnosis on admission, severity scores, cumulative fluid balance, daily mean IAP, resolution of IAH, days of ICU and hospital stay, and mortality.

Results

Eighty-seven patients (57.6%) had ≥2 CRF for IAH, 59 (67.8%) out of whom developed IAH. Patients with ≥2 CRF had a significantly higher mortality rate (41.4 vs. 14.3%, p < 0.001). Patients with IAH had higher body mass index, severity scores, organ dysfunctions/failures, number of CRF for IAH, days of ICU/hospital stay and hospital mortality rate (45.8 vs. 32.1%, p = 0.22). Non-resolution of IAH was associated with a higher mortality rate (64.7 vs. 35.3%, p = 0.001). None of the cohort patients developed abdominal compartment syndrome. The multivariate analysis showed that IAH development (odds ratio (OR) 4.09; 95% confidence interval (CI) 0.83-20.12) was a non-independent risk factor for mortality, and its non-resolution (OR 13.15; 95% CI 22.13-81.92) was an independent risk factor for mortality.

Conclusions

Critically ill medical patients admitted to ICU with ≥2 CRF have high morbidity, mortality rate, and incidence of IAH, so IAP should be measured and monitored as recommended by the WSACS. Our study highlights the importance of implementing screening and assessment protocols for an early diagnosis of IAH.

Keywords:
intra-abdominal hypertension; abdominal compartment syndrome; intra-abdominal pressure; multiple organ failure; critically ill patients; intensive care.