Intra-abdominal hypertension in cardiac surgery patients: a multicenter observational sub-study of the Accuryn registry

Abstract

Intra-abdominal hypertension (IAH) is frequently present in the critically ill and is associated with increased morbidity and mortality. Conventionally, intermittent 'spot-check' manual measurements of bladder pressure in those perceived as high risk are used as surrogates for intra-abdominal pressure (IAP). True patterns of IAH remain unknown. We explored the incidence of IAH in cardiac surgery patients and describe the intra-and postoperative course of IAP using a novel, high frequency, automated bladder pressure measurement system. Sub-analysis of a prospective, multicenter, observational study (NCT04669548) conducted in three large academic medical centers. Continuous urinary output (CUO) and IAP measurements were observed using the Accuryn Monitoring System (Potrero Medical, Hayward, CA). Data collected included demographics, hemodynamic support, and high-frequency IAP and CUO. One Hundred Thirty-Seven cardiac surgery patients were analyzed intraoperatively and followed 48 h postoperatively in the intensive care unit. Median age was 66.4 [58.3, 72.0] years, and 61% were men. Median Foley catheter dwell time was 56.0 [46.8, 77.5] hours, and median baseline IAP was 6.3 [4.0, 8.1] mmHg. 93% (128/137) of patients were in IAH grade I, 82% (113/137) in grade II, 39% (53/137) in grade III, and 5% (7/137) in grade IV for at least 12 cumulative hours. For maximum consecutive duration of IAH, 84% (115/137) of patients spent at least 12 h in grade I, 62% (85/137) in grade II, 18% (25/137) in grade III, and 2% (3/137) in grade IV IAH. During the first 48 h after cardiac surgery, IAH is common and persistent. Improved and automated monitoring of IAP will increase the detection of IAH-which normally would remain undetected using traditional intermittent monitoring methods.

Keywords: Abdominal compartment syndrome; Cardiac surgery; Intra-abdominal hypertension; IAH; Intra-abdominal pressure; IAP; Perioperative; Real-time monitoring.

Conflict of interest statement

SM and AP declare no support from any organization for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work. AKK is a paid consultant for and chairs the steering committee for the Predict AKI group for Potrero Medical and also consults for Edwards Lifesciences, Philips North America, GE Healthcare, Hill-Rom, and Caretaker Medical. His institution has grant funding from Caretaker Medical for ongoing investigations on portable hemodynamic monitoring. AKK is on the executive advisory board for Medtronic and Retia Medical. AKK receives support from the Wake Forest CTSI via NIH/NCATS KL2 for a trial of continuous portable hemodynamic and saturation monitoring on hospital wards. AK is a member of the steering committee for the Predict AKI group for Potrero Medical. VM serves as Chief Medical Officer, KS as Vice President of Data Science, and LE is a data scientist for Potrero Medical, Hayward, CA, USA and are salaried employees. We acknowledge that Vanessa Moll, Kelly Stanton, and Leina Essakalli are employees of Potrero Medical. However, data analysis, as well as manuscript preparation, were led by authors who actively enrolled study patients. Furthermore, while the study was funded by Potrero Medical, this descriptive manuscript is not testing any hypothesis and there is no intervention involved that could potentially be influenced by bias. Dr. Khanna is a paid consultant for the steering committee of the registry; however, he did not directly consent or enroll any patients. Rather this was done at his site by members of his research staff.

© 2022. The Author(s).

Figures

Fig. 1

Intra-abdominal pressure and urinary output intra-operatively and for the first 48 postoperative hours. The red line represents surgery end. IAP intra-abdominal pressure; UO urinary output; IQR interquartile range; mmHg millimeter Hydrargyrum (Mercury); ml/kg/h milliliter/kilogram/hour

Fig. 2

Histogram of median intra-abdominal pressure from surgery end to 24 h postoperatively. The median IAP within the first 24 postoperative hours was 15.9 [13.6, 18.7] mmHg. IAP intra-abdominal pressure; mmHg millimeter Hydrargyrum (Mercury)

Fig. 3

Histogram of median intra-abdominal pressure duration within the time period from 24 to 48 postoperative hours. The median IAP within this time frame was 16.6 [14.5, 19.1] mmHg. IAP intra-abdominal pressure; mmHg millimeter Hydrargyrum (Mercury)

Fig. 4

Course of median IAP 6 h before and after extubation. Red line represents time of extubation. Median IAP within the 6 h’ time frame before extubation is 10.2 [7.7, 13.6] and 17.2 [14.1, 20.7] after extubation

Fig. 5

Differences in IAP by CVICU site. Median [IQR] for CCF 15.4 [12.5, 16.5], Emory 17.8 [16.0, 19.4], Wake Forest 16.7 [14.3, 19.5]. CCF, Cleveland Clinic Florida, Emory University Hospital Midtown and Wake Forest Hospital. CVICU, cardiovascular intensive care unit

Fig. 6

Differences in IAP by body mass index (BMI) within the first 24 postoperative hours. Median [IQR] for different BMIs are reflected as follows: Underweight: 12.5 [12.5, 12.5], healthy weight: 15.7 [11.9, 18.7], overweight: 16.3 [14.3, 18.9], obesity class 1: 18.1 [15.0, 19.9], obesity class 2: 16.8 [16.0, 18.8], obesity class 3: 16.2 [15.2, 20.1]. Underweight = BMI of