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Critical Care Medicine:
doi: 10.1097/CCM.0b013e3182a6459b
Clinical Investigations

Expanded Measurements of Intra-Abdominal Pressure Do Not Increase the Detection Rate of Intra-Abdominal Hypertension: A Single-Center Observational Study*

Blaser, Annika Reintam MD, PhD1; Sarapuu, Silver MD2; Tamme, Kadri MD1,2; Starkopf, Joel MD, PhD1,2

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Abstract

Objective:

Intra-abdominal hypertension may contribute to a poor outcome. Whether limiting intra-abdominal pressure measurements to preselected at-risk patients allows for sufficient detection of intra-abdominal hypertension is unclear. We aimed to clarify whether expanded intra-abdominal pressure monitoring results in an increased detection rate of intra-abdominal hypertension.

Design:

Retrospective observational study.

Setting:

General ICU of University Hospital.

Patients:

Consecutive adult ICU patients from 2004 to 2011.

Interventions:

Intra-abdominal pressure measurements in predefined at-risk patients.

Measurements and Main Results:

Prospectively collected data of 2,696 admissions were divided into three subgroups according to the intra-abdominal pressure measurement policy in different years: 1) 2004–2005, mechanically ventilated patients with at least one additional risk factor for intra-abdominal hypertension (multiple trauma, abdominal surgery, pancreatitis, post-cardiopulmonary resuscitation, fluid resuscitation > 5 L/24 hr, vasoactive or inotropic support, and renal replacement therapy); 2) 2006–2009, all mechanically ventilated patients expected to stay for more than or equal to 24 hours; and 3) 2010–2011, mechanically ventilated patients with a body mass index greater than 30 kg/m2, positive end-expiratory pressure more than 10 cm H2O, Pao2/Fio2 less than 300, use of vasopressors/inotropes, pancreatitis, hepatic failure/cirrhosis with ascites, gastrointestinal bleeding, or postlaparotomy. In all, 2,696 patients were studied, and 1,241 patients (46.0%) underwent intra-abdominal pressure monitoring. The intra-abdominal pressure was measured in 31.7%, 55.6%, and 41.1% of patients during the first, second, and third time periods (p < 0.001), and intra-abdominal hypertension (intra-abdominal pressure ≥ 12 mm Hg) occurred in 19.9%, 20.3%, and 20.1% of patients, respectively (p = 0.972). The mean intra-abdominal pressure at admission day was an independent predictor of mortality in patients with intra-abdominal pressure measurements started within the first 24 hours (odds ratio, 1.046 [95% CI, 1.019–1.072]). The mortality of patients with intra-abdominal hypertension was 29.8% versus 18.6% in those without intra-abdominal hypertension (p < 0.001).

Conclusions:

Expanding the measurement of intra-abdominal pressure to more than 50% of intensive care admissions does not increase the detection rate of intra-abdominal hypertension. In patients with intra-abdominal pressure monitoring, the mean intra-abdominal pressure on the admission day is an independent predictor of mortality.

Copyright © 2014 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins

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