The Effects of Intra-Abdominal Hypertension on the Prognosis of Critically Ill Patients in the Intensive Care Unit (ICU).

Kim, Se Joong; Seo, Jeong Su; Son, Myeung Hee; Kim, Soo Youn; Jung, Ki Hwan; Kang, Eun Hae; Lee, Sung Yong; Lee, Sang Yeub; Kim, Je Hyeong; Shin, Chol; Shim, Jae Jeong; In, Kwang Ho; Yoo, Se Hwa; Kang, Kyung Ho

doi:2006.61.1.46

Tuberc Respir Dis > Volume 61(1); 2006 > Article

Original Article

Tuberculosis and Respiratory Diseases 2006;61(1):46-53.
DOI: https://doi.org/10.4046/trd.2006.61.1.46 Published online July 1, 2006.

The Effects of Intra-Abdominal Hypertension on the Prognosis of Critically Ill Patients in the Intensive Care Unit (ICU).

Se Joong Kim, Jeong Su Seo, Myeung Hee Son, Soo Youn Kim, Ki Hwan Jung, Eun Hae Kang, Sung Yong Lee, Sang Yeub Lee, Je Hyeong Kim, Chol Shin, Jae Jeong Shim, Kwang Ho In, Se Hwa Yoo, Kyung Ho Kang

¹Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea. kkhchest@korea.ac.kr
²Intensive Care Unit, Ansan Hospital, Korea University Medical Center, Korea.
³Intensive Care Unit, Guro Hospital, Korea University Medical Center, Korea.

Abstract

BACKGROUND
Intra-abdominal hypertension (IAH) is defined as the presence of either an intra-abdominal pressure (IAP) > or = 12 mmHg or an abdominal perfusion pressure (APP = mean arterial pressure - IAP) < or = 60 mmHg. Abdominal compartment syndrome (ACS) is defined as the presence of an IAP > or = 20 mmHg together with organ failure. The purpose of this study was to investigate the prevalence of IAH and ACS on the day of admission and the effects of these maladies on the prognosis of critically ill patients in the ICU. METHODS: At the day of admission to the ICU, the IAP was recorded by measuring the intravesicular pressure via a Foley catheter. The APACHE II and III scores were checked and SAPS II was also scored during the days the patients were in the ICU. The primary end point was the prevalence of IAH and ACS at the day of admission and the correlation between them with the 28-days mortality rate. The measurement of IAP continued until the 7th day or the day when the patient was transferred to the general ward before 7th day, unless the patient died or a Foley catheter was removed before 7th day. Patients were observed until death or the 28th day. RESULTS: A total of 111 patients were enrolled. At the day of admission, the prevalence of IAH and ACS were 47.7% and 15.3%, respectively and the mean IAP was 15.1+/-8.5 mmHg. The rates of IAH for the survivor and the non-survivor groups were 56.5% and 71.4%, respectively, and these were not significantly different (p=0.593). Yet the rates of ACS between these two groups were significantly different (4/62, 6.5% vs. 13/49, 26.5%; Odds Ratio = 5.24, 95% CI = 1.58-17.30, p=0.004). CONCLUSION: In the present study, the prevalence of IAH was 47.7% and the prevalence of ACS was 15.3% on the day of admission. ACS was associated with a poor outcome for the critically ill patients in the ICU.

Key Words: Abdomen, Pressure, Perfusion, Hypertension, Compartment syndrome, Critical care