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Abdominal Perfusion Pressure: A Superior Parameter in the Assessment of Intra-abdominal Hypertension

Cheatham, Michael L. MD; White, Mark W. MD; Sagraves, Scott G. MD; Johnson, Jeffrey L. MD, and; Block, Ernest F. J. MD

The Journal of Trauma: Injury, Infection, and Critical Care: October 2000 - Volume 49 - Issue 4 - p 621-627
Annual Meeting Articles

Objective To assess the clinical utility of abdominal perfusion pressure (mean arterial pressure minus intra-abdominal pressure) as both a resuscitative endpoint and predictor of survival in patients with intra-abdominal hypertension.

Methods 144 surgical patients treated for intra-abdominal hypertension between May 1997 and June 1999 were retrospectively reviewed. Multivariate logistic regression and receiver operating characteristic curve analysis of common physiologic variables and resuscitation endpoints were performed to determine the decision thresholds for each variable that predict patient survival.

Results Abdominal perfusion pressure was statistically superior to both mean arterial pressure and intravesicular pressure in predicting patient survival from intra-abdominal hypertension and abdominal compartment syndrome. Multiple regression analysis demonstrated that abdominal perfusion pressure was also superior to other common resuscitation endpoints, including arterial pH, base deficit, arterial lactate, and hourly urinary output.

Conclusion Abdominal perfusion pressure appears to be a clinically useful resuscitation endpoint and predictor of patient survival during treatment for intra-abdominal hypertension and abdominal compartment syndrome.

From the Department of Surgical Education, Orlando Regional Medical Center, Orlando, Florida.

Submitted for publication February 23, 2000.

Accepted for publication June 21, 2000.

Presented at the 13th Annual Scientific Meeting of the Eastern Association for the Surgery of Trauma, January 12–15, 2000, Fort Myers, Florida.

Address for reprints: Michael L. Cheatham, MD, Department of Surgical Education, Orlando Regional Medical Center, 86 West Underwood Street, Mailpoint #100, Orlando, Florida 32806; email: mikec@orhs.org.

© 2000 Lippincott Williams & Wilkins, Inc.