Intra-abdominal hypertension and abdominal compartment syndrome.

Werner, M. J.M. (2014) Intra-abdominal hypertension and abdominal compartment syndrome. thesis, Medicine.

Text WeenerM.pdf Restricted to Registered users only Download (1MB)

Abstract

Introduction: Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are associated with morbidity and mortality in critically ill patients. The incidence of IAH and ACS is high, but very variable, depending on the employed definitions for IAH and ACS. In high intra-abdominal pressures (IAP), reductions in microcirculatory blood flow occur, which results in organ dysfunction. If this process is not recognised and treated in time, ACS develops, with multisystem organ failure and eventually death. Aims: The primary aim of this pilot study was to determine the incidence of IAH and ACS in a surgical intensive care unit (ICU) population. A secondary aim was to investigate the consequences of IAP on vital parameters. Furthermore we would like to perform a systematic review of the incidence of IAH and ACS in the literature. Methods: We performed a prospective pilot cohort study from March 2014 to May 2014, involving adult patients admitted to the ICU after elective abdominal surgery. Intra-abdominal pressure and clinical parameters were measured six times per day. The incidence of IAH (defined as a sustained or repeated IAP elevation of ≥12 mmHg) and ACS (defined as a sustained IAP ≥20 mmHg associated with new organ dysfunction or failure) was recorded for mean, median and maximal IAP values. Patient characteristics and vital parameters were assessed and patients were subdivided into an IAH-group, which included patients with a sustained IAP ≥12 mmHg in at least two successive measurements, and a normal IAP-group. The systematic literature search for incidences of IAH and ACS was performed in PubMed, Embase and Google Scholar. Results: Forty-five patients were enrolled in the study. Thirty-seven had a normal IAP while 8 had IAH. They had a mean age of 65.9 (±9.5) years with a mean APACHE-score of 13.2 (±3.9) and SAPS of 29.1 (±10.2). An IAH incidence of 11.1% for the mean IAP and 62.2% for the maximal IAP values was seen. Twenty-nine percent of the patients had IAH on admission. No patient developed ACS. Patient characteristics were similar in both groups. Patients in the IAH-group had, compared to the normal IAP-group, a significant longer duration of support of inotropes (0.9 vs. 0.7 days, P=0.048) and higher levels of lactate (1.48 vs. 2.00 mmol/l, P=0.014). No associations were found between IAP and vital parameters like heart rate, mean arterial pressure, use of inotropes, need for mechanical ventilation and ventilation pressures, urine production, arterial pH, arterial lactate or serum creatinine. The systemic literature search showed an averaged incidence of 35.5% for IAH and 3.7% for ACS. Conclusions: This study showed an IAH incidence of 11.1% for the mean IAP to 62.2% for the maximal IAP values and no patients developed ACS. The literature showed a mean IAH incidence of 35.5% and a mean ACS incidence of 3.7%. Patients with IAH had a longer duration of support of inotropes and higher lactate levels during ICU stay, and in this small pilot study population, no associations were found between IAP and vital parameters. To get a better perspective of IAH and ACS, more studies with larger study populations are needed. Therefore this study will be continued and could be a base for further research. For now, in clinical practice, in patients with elevated IAPs, it is important to look at the maximal IAP values including the IAP trend, combined with the clinical state of the patient, like the presence of organ failure, to define the best treatment.

Item Type:	Thesis (Thesis)
Supervisor name:	Meurs, Dr. M. van
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 11:02
Last Modified:	25 Jun 2020 11:02
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/2238

Actions (login required)

View Item