Dr Chan Yuen Sze; Department of Intensive Care, Princess Margaret Hospital
Abstract
Objective: The aim of this study is to collect the incidence of intra-abdominal hypertension (IAH) in mechanically ventilated patients in local intensive care unit (ICU), and to study the impact of IAH on ICU outcomes.
Design and setting: Prospective observational study conducted at a medical-surgical ICU in a regional hospital.
Patients: One hundred and nineteen mechanically ventilated critically ill Chinese patients admitted from January to April 2010 were enrolled into the study.
Methods and Main Results: Intra-abdominal pressure (IAP) was measured eight hourly for the first seven ventilator-days. IAH was defined as sustained elevation of IAP ≥ 12mmHg. Abdominal perfusion pressure (APP) and renal filtration gradient (FG) were calculated. ICU mortality was the primary outcome. Secondary outcomes included hospital mortality, 28-day ventilator-free days, 30-day ICU-free days, dialysis status, SOFA score, renal and respiratory SOFA sub-scores. The results showed that the cumulative incidence of IAH in the first seven ventilator-days was high. Positive fluid balance was found to be the only significant risk factor of developing IAH. ICU length-of-stay was shown to be longer in patient with IAH. However, IAP was unsatisfactory as a predictor of ICU outcomes even using a higher cut-off value of 25mmHg. APP ≤ 60mmHg and FG ≤ 50mmHg were shown to have better prognostic values in predicting ICU outcomes.
Conclusion: IAH was common in mechanically ventilated patients in this local ICU population, and was associated with longer ICU length-of-stay. APP and FG were superior as predictors of ICU outcomes when compared to IAP.
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