Incidence, Risk Factors, and Outcomes of Intra-Abdominal Hypertension in Critically Ill Patients-A Prospective Multicenter Study (IROI Study)

被引：126

作者：

Blaser, Annika Reintam ^{[1
,2
]}

Regli, Adrian ^{[3
,4
,5
]}

De Keulenaer, Bart ^{[3
,6
]}

Kimball, Edward J. ^{[7
]}

Starkopf, Liis ^{[8
]}

Davis, Wendy A. ^{[4
]}

Greiffenstein, Patrick ^{[9
]}

Starkopf, Joel ^{[1
,10
]}

Palermo, Annamaria ^{[11
]}

Tamme, Kadri

Maddison, Liivi ^{[10
]}

Jakobson, Triin ^{[10
]}

Kirov, Mikhail ^{[12
]}

Smetkin, Alexey ^{[12
]}

Ilyina, Yana ^{[12
]}

Litvin, Andrey ^{[13
,14
]}

Kazlova, Anastasiya ^{[13
]}

Filatov, Aliaksandr ^{[13
]}

Pracca, Francisco ^{[15
]}

Sosa, Gustavo ^{[15
]}

Dos Santos, Maicol ^{[15
]}

Grigoras, Ioana ^{[16
]}

Ristescu, Irina ^{[16
]}

Blejusca, Adina ^{[16
]}

Bodnar, Zsolt ^{[17
]}

Tidrenczel, Edit ^{[17
]}

Oliveira, Gina ^{[18
]}

Albuquerque, Ana ^{[18
]}

Fernandes, Manuela ^{[18
]}

Kirsimagi, Ulle ^{[19
]}

Ordonez, Carlos A. ^{[20
,21
]}

Manzano-Nunez, Ramiro ^{[20
,21
]}

Pereira, Bruno M. ^{[22
]}

Moore, Margaret M. ^{[23
]}

Dabrowski, Wojciech ^{[24
]}

机构：

[1] Univ Tartu, Dept Anaesthesiol & Intens Care, Tartu, Estonia

[2] Lucerne Cantonal Hosp, Dept Intens Care Med, Luzern, Switzerland

[3] Fiona Stanley Hosp, Dept Intens Care, Perth, WA, Australia

[4] Univ Western Australia, Med Sch, Div Emergency Med, Perth, WA, Australia

[5] Notre Dame Univ, Med Sch, Fremantle, WA, Australia

[6] Univ Western Australia, Sch Surg, Perth, WA, Australia

[7] Univ Utah, Sch Med, Dept Surg, Salt Lake City, UT USA

[8] Univ Copenhagen, Dept Publ Hlth, Sect Biostat, Copenhagen, Denmark

[9] Louisiana State Univ, Hlth Sci Ctr, Dept Surg, New Orleans, LA USA

[10] Tartu Univ Hosp, Dept Anaesthesiol & Intens Care, Tartu, Estonia

[11] Fiona Stanley Hosp, Intens Care Unit, Perth, WA, Australia

[12] Northern State Med Univ, Dept Anesthesiol & Intens Care Med, Arkhangelsk, Russia

[13] Gomel Reg Clin Hosp, Dept Intens Care Med, Gomel, BELARUS

[14] Immanuel Kant Balt Fed Univ, Dept Surg Disciplines, Kaliningrad, Russia

[15] UDELAR, Clin Univ Hosp, Dept Intens Care Unit, Montevideo, Uruguay

[16] Grigore T Popa Univ Med & Pharm, Reg Inst Oncol Iasi, Iasi, Romania

[17] Univ Hosp Torrevieja, Torrevieja, Spain

[18] Hosp Ctr Tondela Viseu, Polyvalent Intens Care Unit, Tondela, Portugal

[19] Univ Tartu, Dept Surg, Tartu, Estonia

[20] Fdn Valle Lili, Dept Surg, Div Trauma & Acute Care Surg, Cali, Colombia

[21] Univ Valle, Cali, Colombia

[22] Univ Estadual Campinas, Trauma Acute Care Surg & Surg Crit Care, Campinas, SP, Brazil

[23] Louisiana State Univ, Hlth Sci Ctr, New Orleans, LA USA

[24] Med Univ Lublin, Dept Anaesthesiol & Intens Therapy, Lublin, Poland

来源：

CRITICAL CARE MEDICINE | 2019年 / 47卷 / 04期

关键词：

intra-abdominal hypertension; intra-abdominal pressure; prevalence; risk factors; ABDOMINAL COMPARTMENT SYNDROME; INTERNATIONAL-CONFERENCE; PRESSURE; EXPERTS;

D O I：

10.1097/CCM.0000000000003623

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Objectives: To identify the prevalence, risk factors, and outcomes of intra-abdominal hypertension in a mixed multicenter ICU population. Design: Prospective observational study. Setting: Fifteen ICUs worldwide. Patients: Consecutive adult ICU patients with a bladder catheter. Interventions: None. Measurements and Main Results: Four hundred ninety-one patients were included. Intra-abdominal pressure was measured a minimum of every 8 hours. Subjects with a mean intra-abdominal pressure equal to or greater than 12 mm Hg were defined as having intra-abdominal hypertension. Intra-abdominal hypertension was present in 34.0% of the patients on the day of ICU admission (159/467) and in 48.9% of the patients (240/491) during the observation period. The severity of intra-abdominal hypertension was as follows: grade I, 47.5%; grade II, 36.6%; grade III, 11.7%; and grade IV, 4.2%. The severity of intra-abdominal hypertension during the first 2 weeks of the ICU stay was identified as an independent predictor of 28-and 90-day mortality, whereas the presence of intra-abdominal hypertension on the day of ICU admission did not predict mortality. Body mass index, Acute Physiology and Chronic Health Evaluation II score greater than or equal to 18, presence of abdominal distension, absence of bowel sounds, and positive end-expiratory pressure greater than or equal to 7 cm H2O were independently associated with the development of intra-abdominal hypertension at any time during the observation period. In subjects without intra-abdominal hypertension on day 1, body mass index combined with daily positive fluid balance and positive end-expiratory pressure greater than or equal to 7 cm H2O (as documented on the day before intra-abdominal hypertension occurred) were-associated with the development of intraabdominal hypertension during the first week in the ICU. Conclusions: In our mixed ICU patient cohort, intra-abdominal hypertension occurred in almost half of all subjects and was twice as prevalent in mechanically ventilated patients as in spontaneously breathing patients. Presence and severity of intra-abdominal hypertension during the observation period significantly and independently increased 28-and 90-day mortality. Five admission day variables were independently associated with the presence or development of intra-abdominal hypertension. Positive fluid balance was associated with the development of intra-abdominal hypertension after day 1.

引用

页码：535 / 542

页数：8

共 24 条

[1] Postinjury abdominal compartment syndrome: from recognition to prevention [J].