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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care
Minerva Anestesiologica 2007 September;73(9):447-50
Intra-abdominal hypertension is not reliable as an early predictor of mortality in the intensive care unit
Lonardo M., Piazza O., De Marco G., De Robertis E., Servillo G., Tufano R.
Department of Surgical Sciences, Anesthesiology and Critical Care, University Federico II, Naples, Italy
Aim. The aim of this study was to assess the prevalence of intra-abdominal hypertension and its prognostic value in critical patients.
Methods. In an observational study, 56 patients of a multidisciplinary intensive care unit (ICU) of a university hospital, with either surgical (44.6%) or medical (55.4%) diagnoses, were studied. Intra-abdominal pressure was quantified daily by bladder pressure method from the first to the eighth day of hospitalization.
Results. The mean intra-abdominal pressure at admission was 9.97±5.26 mmHg; 41% of patients suffered moderate intra-abdominal hypertension (defined as intra-abdominal pressure greater than 11 mmHg) at admission. On day 1 mean intra-abdominal pressure was not significantly different between the patients who died and those who survived (9.69±5.06 mmHg vs 10.12±5.57 mmHg respectively), but by measuring IAP until day 8 it was possible to distinguish a subgroup of patients who showed a persistently elevated intra-abdominal pressure, developed further complications, later died (12.5±4.37 mmHg vs 7.17±2.02 mmHg, P=0.022).
Conclusion. Intra-abdominal pressure does not have prognostic value at ICU admission, but may predict bad outcomes later during the ICU stay. Intra-abdominal hypertension is a frequent and rarely recognized event in the ICU which can be monitored by the bladder pressure method throughout the period of hospitalization.