The duration of intra-abdominal hypertension strongly predicts outcomes for the critically ill surgical patients: a prospective observational study

Kyu-Hyouck Kyoung, Suk-Kyung Hong, Kyu-Hyouck Kyoung, Suk-Kyung Hong

Abstract

Introduction: Intra-abdominal hypertension (IAH) is associated with morbidity and mortality in critically ill patients. The present study analyzed the clinical significance of IAH in surgical patients with severe sepsis.

Methods: This was a prospective study carried out in the surgical intensive care unit (SICU). Intra-abdominal pressure (IAP) was measured three times a day via a urinary catheter filled with 25 mL of saline. IAH was defined as an IAP ≥ 12 mmHg, and the peak IAP was recorded as the IAP for the day. Data were analyzed in terms of IAH development and the IAH duration.

Results: Of the 46 patients enrolled in the study, 42 developed IAH while in the SICU. The development of IAH aggravated the clinical outcomes; such as longer SICU stay, requirement of ventilator support, and delayed initiation of enteral feeding (EF). The IAH duration showed a significant correlation with pulmonary, renal, and cardiovascular function, and enteral feeding. The IAH duration was an independent predictor of 60-day mortality (odds ratio: 1.196; p = 0.014).

Conclusions: The duration of IAH is a more important prognostic factor than the development of IAH; thus every effort should be made to reduce the IAH duration in critically ill patients.

Trial registration: NCT01784458.

Keywords: Enteral feeding, abdominal perfusion pressure; Intra-abdominal hypertension; Intra-abdominal pressure; Severe sepsis.

Figures

Fig. 1
Fig. 1
Distribution of patients by duration of intra-abdominal hypertension
Fig. 2
Fig. 2
Clinical course according to duration of intra-abdominal hypertension. Correlation between duration of intra-abdominal hypertension and a length of intensive care unit stay, b duration of ventilatory support, c duration of renal replacement therapy, d initiation of enteral feeding. Two patients with chronic renal failure on hemodialysis were excluded on Fig. 2c. Two patients who did not try enteral feeding were excluded on Fig. 2d

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