| Abstract: Aims of the study: The intraabdominal pressure (IAP) is an important indicator of the patient’s physiologic status because even slight increase of IAP (i.e., intraabdominal hypertension IAH) can have deleterious effects on several organ function. In two previous studies, in surgical and trauma patients, the IAH was found to be an independent predictor of mortality (1,2).
We evaluated in all the new patients admitted to general ICUs, during a four weeks period, the cumulative incidence of IAH and if IAH during the first days of ICU stay could be an independent risk factor for hospital mortality.
Methods: At admission: APACHE II, clinical etiologic factors and type of admission were evaluated. SOFA score and IAP was measured by the bladder technique (3), twice every day, for seven days or less if ICU discharged or dead occurred.
Results: 265 patients were enrolled from ICUs, mean age 61.5±18.1 y, BMI 25.7±5.2 kg/m^2, APACHE II 17.4±5.3, and IAP at admission of 9.9± 4.9 mmHg,
The cumulative incidence of IAH (defined as a mean IAP of 12 mmHg or more at admission) was 32.1% and 73 patients (27.5%) died in ICU.
Non survivors had a significantly higher mean IAP on admission than survivors 11.4±4.8 vs 9.5±4.8 mmHg. The independent predictors for mortality were age (OR=1.04, 95% CI 1.01-1.06, p=0.003), maximal IAP within the first three days (OR=1.12 for each unity increase, 95% CI 1.05-1.19, p=0.001), APACHE II score (OR=1.1 for each unity increase, 95% CI 1.05-1.15, p<0.0001), type of ICU admission (OR=2.5 medical vs surgical, 95% CI 1.24-5.16, p=0.01), fluid balance (OR=1.12 for each unity increase, 95% CI 1.01-1.24, p=0.03), and the presence of liver dysfunction (OR=2.5 95% CI 1.06-5.8, p=0.04). Patients with IAH at admission had significantly higher total, respiratory, liver, coagulation and renal SOFA scores than patients without IAH during the ICU stay.
Discussions: These data suggest that in a mixed population of critically ill patients the IAH is associated with organ dysfunction and the worst IAP within the first three days was an independent risk factor for mortality.
|
