Intra abdominal hypertension : More common than thought

Patrick B. Murphy, Neil G. Parry et el published a prospective study of prevalance of intra-abdominal hypertension in mixed medical-surgical critically ill patients .

WHERE

It was a prospective observational study in a single institute,  Including trauma, medical and surgical patients, in the Canada.

WHAT THEY DID

All adult (> 18 yr old) patients admitted to the ICU with a bladder catheter in situ were considered for inclusion.
Exclusion criteria included death prior to IAP measurement, lack of informed consent, pregnancy, discharge prior to IAP measurement, no IAP measurement within 24 hours of admission, organ donors, and cases where the care team declined to enroll the patient. Bladder pressure was measured using the modified Kron technique(residual urine from the bladder was completely drained, and the bladder catheter clamped. Twenty-five milliliters of sterile saline was injected into the bladder via a port on the Foley catheter. IAP was measured via a pressure transducer at end expiration and was expressed in mm Hg.)

RESULTS

Out of 285 patient studied in the study, 30% Were diagnosed with intra-abdominal hypertension at admission and further 15% developed intra-abdominal hypertension during admission. Obesity’s, sepsis, mechanical ventilation and 24 hour fluid balance Of more than 3 L were all independent predictors of intra-abdominal hypertension.

Surprisingly 28% of the nonventilated patients also developed intra-abdominal hypertension.  There was no difference in incidence in medical versus surgical versus trauma patients.  ICU mortality was significantly higher in patients who developed intra-abdominal hypertension(30% vs 11%).

BACKGROUND

The concept of Intra Abdominal Pressure  was first described in 1863 by Marey and further explored by early investigators who described the relationship between intra-abdominal and thoracic pressures in both normal and pathophysiologic states.

Initial evidence emerged from animal studies examining the relationship of IAP on respiration, organ function, and urine output. Intra-abdominal hypertension was largely overlooked until 1980s when Kron and colleagues First used that abdominal compartment syndrome. There were more studies published which studied the prevalence of intra-abdominal hypertension.  Lack of consensus definitions and the confusion arising from constraints related to interstudy comparisons fostered the creation of the WSACS(World Society of abdominal compartment syndrome), a non-for-profit society founded by a multinational group of physicians, in 2004, with the purpose of promoting research and education.

DEFINITION

MANAGEMENT

Following is the algorithm for management of intra abdominal hypertension by world society of abdominal compartment syndrome.

 

INTRA ABDOMINAL PRESSURE MEASUREMENT

This video shows the measurement described above.