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Kim, Seo, Son, Kim, Jung, Kang, Lee, Lee, Kim, Shin, Shim, In, Yoo, and Kang: The Effects of Intra-Abdominal Hypertension on the Prognosis of Critically Ill Patients in the Intensive Care Unit (ICU)
Original Article
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2006; 61(1): 46-53.

Published online: 31 July 2006

DOI: https://doi.org/10.4046/trd.2006.61.1.46

The Effects of Intra-Abdominal Hypertension on the Prognosis of Critically Ill Patients in the Intensive Care Unit (ICU)

Se Joong Kim, M.D., Jeong-Su Seo, R.N.1, Myeung-Hee Son, R.N.1, Soo-Youn Kim, R.N.2, Ki Hwan Jung, M.D., Eun-Hae Kang, M.D., Sung Yong Lee, M.D., Sang Yeub Lee, M.D., Je-Hyeong Kim, M.D., Chol Shin, M.D., Jae Jeong Shim, M.D., Kwang Ho In, M.D., Se Hwa Yoo, M.D., Kyung Ho Kang, M.D.

Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea.

1Intensive Care Unit, Ansan Hospital, Korea University Medical Center, Korea.

2Intensive Care Unit, Guro Hospital, Korea University Medical Center, Korea.

Address of correspondence: Kyung Ho Kang, M.D. Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital 80, Guro-dong, Guro-gu, Seoul, 152-703, Korea. Phone: +82-2-818-6638, Fax: +82-2-865-9670, kkhchest@korea.ac.kr

Received 11 May 2006       Accepted 10 July 2006

Copyright © 2006 The Korean Academy of Tuberculosis and Respiratory Diseases

Abstract

Background

Intra-abdominal hypertension (IAH) is defined as the presence of either an intra-abdominal pressure (IAP) ≥ 12 mmHg or an abdominal perfusion pressure (APP = mean arterial pressure - IAP) ≤ 60 mmHg. Abdominal compartment syndrome (ACS) is defined as the presence of an IAP ≥ 20 mmHg together with organ failure. The purpose of this study was to investigate the prevalence of IAH and ACS on the day of admission and the effects of these maladies on the prognosis of critically ill patients in the ICU.

Methods

At the day of admission to the ICU, the IAP was recorded by measuring the intravesicular pressure via a Foley catheter. The APACHE II and III scores were checked and SAPS II was also scored during the days the patients were in the ICU. The primary end point was the prevalence of IAH and ACS at the day of admission and the correlation between them with the 28-days mortality rate. The measurement of IAP continued until the 7th day or the day when the patient was transferred to the general ward before 7th day, unless the patient died or a Foley catheter was removed before 7th day. Patients were observed until death or the 28th day.

Results

A total of 111 patients were enrolled. At the day of admission, the prevalence of IAH and ACS were 47.7% and 15.3%, respectively and the mean IAP was 15.1 ± 8.5 mmHg. The rates of IAH for the survivor and the non-survivor groups were 56.5% and 71.4%, respectively, and these were not significantly different (p=0.593). Yet the rates of ACS between these two groups were significantly different (4/62, 6.5% vs. 13/49, 26.5%; Odds Ratio = 5.24, 95% CI = 1.58-17.30, p=0.004).

Conclusion

In the present study, the prevalence of IAH was 47.7% and the prevalence of ACS was 15.3% on the day of admission. ACS was associated with a poor outcome for the critically ill patients in the ICU.

Keywords: Abdomen, Pressure, Perfusion, Hypertension, Compartment syndrome, Critical care

Figures and Tables

Figure 1
The IAP values of the survivor and non-survivor groups.
The IAP was higher in the non-survivor group than in the survivor group at 1st and 2nd day (p<0.05), but there were no differences from 3rd to 7th days.
*: Survivor group vs. Non-survivor group, p<0.05
n: number of patients
IAP: Intra-abdominal pressure
trd-61-46-g001
Figure 2
The APP values of the survivor and non-survivor groups.
The APP was lower in the non-survivor group than in the survivor group from 1st to 4th day (p<0.001). The APP was more significantly related with mortality than the IAP, especially at 3rd to 4th day.
*: Survivor group vs. Non-survivor group, p<0.001
n: number of patients
APP: Abdominal perfusion pressure
trd-61-46-g002
Table 1
The baseline characteristics of the patients
trd-61-46-i001

*: including pneumonia sepsis

†: extrapulmonary sepsis

COPD: Chronic Obstructive Pulmonary Disease

AMI: Acute Myocardial Infarction

ARF: Acute Renal Failure

PTB: Pulmonary Tuberculosis

CVA: Cerebrovascular Accident

DI: Drug Intoxication

GI bleeding: Gastrointestinal bleeding

Table 2
The prevalence of IAH and ACS
trd-61-46-i002

IAP: Intra-abdominal pressure

APP: Abdominal perfusion pressure

IAH: Intra-abdominal hypertension

ACS: Abdominal compartment syndrome

Table 3
The data of 111 patients at the day of admission to ICU
trd-61-46-i003

IAP: Intra-abdominal pressure, APP: Abdominal perfusion pressure

IAH: Intra-abdominal hypertension, ACS: Abdominal compartment syndrome

APACHE: acute physiology and chronic health evaluation, SAPS: Simplified acute physiology score

Table 4
The analysis of mortality risk by multiple variables
trd-61-46-i004

IAP: Intra-abdominal pressure, APP: Abdominal perfusion pressure

IAH: Intra-abdominal hypertension, ACS: Abdominal compartment syndrome

MV: Mechanical Ventilator, 95% CI: 95% Confidence Interval

Table 5
The differences of IAP and APP between the survivor and non-survivor groups treated with mechanical ventilation or vasopressor
trd-61-46-i005

MV: Mechanical Ventilator

IAP: Intra-abdominal pressure

APP: Abdominal perfusion pressure

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