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

Reintam Blaser, Annika, MD, PhD1,2; Regli,, Adrian, MD3,4,5; De Keulenaer,, Bart, MD3,6; Kimball,, Edward J., MD7; Starkopf, Liis, MSc8; Davis,, Wendy A., MPH, PhD4; Greiffenstein,, Patrick, MD, FACS9; Starkopf,, Joel, MD, PhD1,10 the Incidence, Risk Factors, and Outcomes of Intra-Abdominal (IROI) Study Investigators

doi: 10.1097/CCM.0000000000003623
Clinical Investigation: PDF Only

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 intra-abdominal 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.

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

1Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu, Estonia.

2Department of Intensive Care Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland.

3Department of Intensive Care, Fiona Stanley Hospital, Perth, WA, Australia.

4Division of Emergency Medicine, Medical School, The University of Western Australia, Perth, WA, Australia.

5Medical School, The Notre Dame University, Fremantle, WA, Australia.

6School of Surgery, The University of Western Australia, Perth, WA, Australia.

7Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT.

8Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.

9Louisiana State University Health Sciences Center, Department of Surgery, New Orleans, LA.

10Department of Anaesthesiology and Intensive Care, Tartu University Hospital, Tartu, Estonia.

The Incidence, Risk Factors, and Outcomes of Intra-Abdominal (IROI) Study Investigators are listed in the Acknowledgments.

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 (http://journals.lww.com/ccmjournal).

ConvaTec Limited (Deerside, United Kingdom) provided either the Abdo-Pressure (Foley manometer method) or AbViser systems (modified Kron’s method) for intra-abdominal pressure measurements free of charge for all participating sites if products were licensed in the respective countries.

Dr. Reintam Blaser received funding (honoraria for advisory board meetings or speaker fees) from Nestlé, Fresenius, and Nutricia, and shedisclosed she is a member of Executive Committee of the Abdominal Compartment Society. Drs. Regli, De Keulenaer, and Kimball disclosed that ConvaTec Limited (Deerside, United Kingdom) provided either Abdo-Pressure (modified Kron’s method) or AbViser systems (Foley Manometer method) for intra-abdominal pressure measurements free of charge for all the participating sites if products were licensed in the countries.

ConvaTec Limited had no influence on study design, analysis of data, or manuscript preparation. Dr. Joel Starkopf has received speaker fees from B. Braun and Fresenius. Dr. Greiffenstein received funding from Zimmer Biomet, DuPuy Synthes, and KLS Martin, and he disclosed that Atox Bio Ltd. (http://www.atoxbio.com) is sponsoring a Phase III Drug trial for which he is Principal Investigator at his site/hospital, but he does not receive any funds directly. The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: annika.reintam.blaser@ut.ee

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