Intra-Abdominal Hypertension Is More Common Than Previously Thought: A Prospective Study in a Mixed Medical-Surgical ICU

Objectives: To determine the prevalence of intra-abdominal hypertension in mixed medical-surgical critically ill patients using modern definitions and measurement techniques. Secondarily to determine variables associated with intra-abdominal hypertension and ICU mortality. Design: A prospective observational study. Setting: Single institution trauma, medical and surgical ICU in Canada. Patients: Consecutive adult patients admitted to the ICU (n = 285). Intervention: Intra-abdominal pressure measurements twice a day during admission to the ICU. Measurements and Main Results: In 285 patients who met inclusion criteria, 30% were diagnosed with intra-abdominal hypertension at admission and a further 15% developed intra-abdominal hypertension during admission. The prevalence of abdominal compartment syndrome was 3%. Obesity, sepsis, mechanical ventilation, and 24-hour fluid balance (> 3 L) were all independent predictors for intra-abdominal hypertension. Intra-abdominal hypertension occurred in 28% of nonventilated patients. Admission type (medical vs surgical vs trauma) was not a significant predictor of intra-abdominal hypertension. Overall ICU mortality was 20% and was significantly higher for patients with intra-abdominal hypertension (30%) compared with patients without intra-abdominal hypertension (11%). Intra-abdominal hypertension of any grade was an independent predictor of mortality (odds ratio, 3.33; 95% CI, 1.46–7.57). Conclusions: Intra-abdominal hypertension is common in both surgical and nonsurgical patients in the intensive care setting and was found to be independently associated with mortality. Despite prior reports to the contrary, intra-abdominal hypertension develops in nonventilated patients and in patients who do not have intra-abdominal hypertension at admission. Intra-abdominal pressure monitoring is inexpensive, provides valuable clinical information, and there may be a role for its routine measurement in the ICU. Future work should evaluate the impact of early interventions for patients with intra-abdominal hypertension. This work was performed at the London Health Sciences Centre and Western University. Trial Registration: ClinicalTrials.gov NCT02514135. Drs. Murphy, Parry, Leslie, Vogt, and Ball participated in study design and served as content experts in the field. Data collection was performed by Drs. Murphy and Sela, and analysis was performed by Dr. Murphy. Dr. Vogt also reviewed and repeated the data analysis. All authors contributed to and reviewed the final article. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (https://ift.tt/29S62lw). Supported, in part, by resident research grant from the Department of Surgery, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada. Presented, in part, at the 2016 American Association for the Surgery of Trauma Conference, Hawaii, HI, September 14, 2016. Dr. Murphy received funding from Western University. The remaining authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: patrick.murphy@londonhospitals.ca Copyright © by 2018 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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