DOI: http://dx.doi.org/10.18203/2349-2902.isj20213605

A prospective study of outcome in patients with intra-abdominal hypertension

Kapil Rampal, Devendra K. Prajapati, Meghna Sharma, Parampreet Singh, Jasmaan Singh, Harinder Singh

Abstract


Background: Intra-abdominal hypertension (IAH) and Abdominal compartment syndrome (ACS) is increasingly recognized in critically ill patients, and the deleterious effects of increased intra-abdominal pressure (IAP) are well documented. It is known to affect almost all the system in the body, but mainly the renal, cardiovascular and pulmonary systems. The purpose of this study is to prospectively observe the outcome of IHP in patients admitted in ICU, acute surgical and emergency wards over three years and give our recommendations based on the outcome in such patients.

Methods: We measured intravesical pressure using simple manometry to measure IAP.

Results: We observed cardiac dysfunction in 16.30%, renal dysfunction in 10.86%, respiratory dysfunction in 21.74% and mortality of 15.2%. Significant mortality was associated with IAH grade II (55.6%) and grade III (100%).

Conclusions: Due to the contribution towards mortality and common occurrence we suggest that intra-abdominal pressure be measured in ICU conditions.


Keywords


IAH, IAP, ACS, Intravesical pressure, Manometry

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References


Pavlovic DB, Kogler VM. Intraabdominal hypertension and abdominal compartment syndrome in the intensive care unit. Signa vitae. 2006;1(1):13-5.

Burchard KW, Ciombor DM, MCLeod MK, Slothman GJ, Gann DS. Positive end expiratory pressure with increased intra-abdominal pressure. Surg Gynecol Obstet. 1985;161(4):313-8.

Hong JJ, Cohn SM, Perez JM, Dolich MO, Brown M, McKenny MG. Prospective study of the incidence and outcome of intra-abdomnal hypertension and the abdominal compartment syndrome. Br J Surg. 2002;89:591-6.

Burch JM, Moore EE, Moore FA, Franciose R. The abdominal-compartment syndrome. Surg Clin North Am. 1996;76:833-42.

Banks PA. Practice guidelines in acute pancreatitis. Am J Gastroenterol. 1997;92:377-86.

Caldwell CB, Ricotta JJ. Changes in visceral blood flow with elevated intra-abdominal pressure. J Surg Res. 1987;43:14-20.

Lozen Y. Intra-abdominal hypertension and abdominal compartment syndrome in trauma: pathophysiology and interventions. AACN Clin Issues. 1999;10(1):104-12.

Lacey SR, Bruce J, Brooks SP, Griswald J, Ferguson W et al. The relative merits of various methods of indirect measurement of intra-abdominal pressure as a guide to closure of abdominal wall defects. J Pediatr Surg. 1987;22(12):1207-11.

Iberti TJ, Kelly KM, Gentili DR, Hirsch S, Benjamin E.A simple technique to accurately determine intrabdominal pressure. Crit care Med. 1987;15:1140-42.

Collee GG, Lomax DM, Ferguson C, Hanson GC. Bedside measurement of intra-abdominal pressure via an indwelling nasogastric tube: clinical validation of the technique. Intensive care Med. 1993;19:478-80.

Sugrue M, Buist MD, Lee A, Sanchez DJ, Hillman KM. Intra-abdominal pressure measurement using a modified nasogastric tube: Description and validation of new technique. Intensive Care Med. 1994;20:588-90.

Cerabona T, Savino J, Agarwal N. Urinary bladder measurements of intra-abdominal pressure (IAP) in ascitic cirrhotics predictive of hemodynamic and renal function. Crit Care Med. 1988;16:431.

Yol S, Kartal A, Tavli S, Tatkan Y. Is urinary bladder pressure a sensitive indicator of intra-abdominal pressure? Endoscopy. 1998;30(9):778-80.

Iberti TJ, Kelly KM, Gentili DR, Hirsch S, Benjamin E. A simple technique to accurately determine intra-abdominal pressure. Crit Care Med. 1987;15:1140-2.

Meldrum DR, Moore FA, Moore EE. Cardiopulmonary hazards of perihepatic packing for major liver injuries. Am J Surg. 1995;170:537-40.

Rasmussen TE, Hallett Jr JW, Noel AA, Jenkins G, Bower TC et al. Early abdominal closure with mesh reduces multiple organ failure after ruptured abdominal aortic aneurysm repair: guidelines from a 10-year case-control study. J Vasc Surg. 2002;35(2):246-53.

Simon RJ, Friedlander MH, Ivatury RR, Diraimo R Machiedo GW. Haemorrhage lowers the threshold for intra-abdominal hypertension-induced pulmonary dysfunction. J Trauma. 1997;42(3):398-405.

Kron IL, Harman PK, Nolan SP. The measurement of intra-abdominal pressure as a criterion for abdominal re-exploration. Ann Surg. 1984;199:28-30.

Sugrue M, Buist MD, Hourihan F, Deane S, Bauman A, Hillman K. Prospective study of intra-abdominal hypertension and renal function after laprotomy. Br J Surg. 1995;82:235-28.