nach oben

Canadian Journal of Anesthesia/Journal canadien d'anesthésie

Erschienen in:

30.11.2021 | Reports of Original Investigations

Intra-abdominal pressure during and after cardiac surgery: a single-centre prospective cohort study

verfasst von: Émilie Richer-Séguin, MD, Christian Ayoub, MD, Jean-Sébastien Lebon, MD, Jennifer Cogan, MD, Stéphanie Jarry, MSc, Yoan Lamarche, MD, MSc, André Y. Denault, MD, PhD, William Beaubien-Souligny, MD, PhD

Erschienen in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Ausgabe 2/2022

Einloggen, um Zugang zu erhalten

Abstract

Purpose

While intra-abdominal hypertension (IAH) has been associated with adverse outcomes in multiple settings, the epidemiology and clinical implications of IAH in the context of cardiac surgery are less known. In this study, we aimed to describe the prevalence of IAH in patients undergoing cardiac surgery and determine its association with patient characteristics and postoperative outcomes.

Methods

We conducted a single-centre prospective cohort study in which intra-abdominal pressure was measured in the operating room after general anesthesia (T1), after the surgical procedure (T2), and two hours after intensive care unit (ICU) admission (T3) in a subset of patients. Intra-abdominal hypertension was defined as intra-abdominal pressure (IAP) ≥ 12 mm Hg. Postoperative outcomes included death, acute kidney injury (AKI), and length of stay in the ICU and hospital.

Results

A total of 513 IAP measurements were obtained from 191 participants in the operating room and 131 participants in the ICU. Intra-abdominal hypertension was present in 105/191 (55%) at T1, 115/191 (60%) at T2, and 31/131 (24%) at T3. Intra-abdominal pressure was independently associated with body mass index, central venous pressure, and mean pulmonary artery pressure but was not associated with cumulative fluid balance. Intraoperative IAH was not associated with adverse outcomes including AKI.

Conclusions

Intra-abdominal hypertension is very common during cardiac surgery but its clinical implications are uncertain.

Nur mit Berechtigung zugänglich

Malbrain ML, Cheatham ML, Kirkpatrick A, et al. Results from the International Conference of Experts on Intra-abdominal Hypertension and Abdominal Compartment Syndrome. I. Definitions. Intensive Care Med 2006; 32: 1722-32.CrossRef

Cheatham ML, Malbrain ML, Kirkpatrick A, et al. Results from the International Conference of Experts on Intra-abdominal Hypertension and Abdominal Compartment Syndrome. II. Recommendations. Intensive Care Med 2007; 33: 951-62.CrossRef

Kyoung KH, Hong SK. The duration of intra-abdominal hypertension strongly predicts outcomes for the critically ill surgical patients: a prospective observational study. World J Emerg Surg 2015; DOI: https://doi.org/10.1186/s13017-015-0016-7.CrossRefPubMedPubMedCentral

Papavramidis TS, Marinis AD, Pliakos I, Kesisoglou I, Papavramidou N. Abdominal compartment syndrome - intra-abdominal hypertension: defining, diagnosing, and managing. J Emerg Trauma Shock 2011; 4: 279-91.CrossRef

De Laet IE, Malbrain ML, De Waele JJ. A clinician's guide to management of intra-abdominal hypertension and abdominal compartment syndrome in critically ill patients. Crit Care 2020; DOI: https://doi.org/10.1186/s13054-020-2782-1.CrossRefPubMedPubMedCentral

Balogh Z, McKinley BA, Cocanour CS, et al. Supranormal trauma resuscitation causes more cases of abdominal compartment syndrome. Arch Surg 2003; 138: 637-42; discussion 642-3.

Warren OJ, Smith AJ, Alexiou C, et al. The inflammatory response to cardiopulmonary bypass: part 1--mechanisms of pathogenesis. J Cardiothorac Vasc Anesth 2009; 23: 223-31.CrossRef

Dabrowski W, Rzecki Z. Intra-abdominal and abdominal perfusion pressure in patients undergoing coronary artery bypass graft surgery. Acta Clin Belg 2009; 64: 216-24.CrossRef

Nazer R, Albarrati A, Ullah A, Alamro S, Kashour T. Intra-abdominal hypertension in obese patients undergoing coronary surgery: a prospective observational study. Surgery 2019; 166: 1128-34.CrossRef

10.

Dalfino L, Sicolo A, Paparella D, Mongelli M, Rubino G, Brienza N. Intra-abdominal hypertension in cardiac surgery. Interact Cardiovasc Thorac Surg 2013; 17: 644-51.CrossRef

11.

Iyer D, D'Amours S, Aneman A. Intra-abdominal hypertension in postoperative cardiac surgery patients. Crit Care Resusc 2014; 16: 214-9.PubMed

12.

Mazzeffi MA, Stafford P, Wallace K, et al. Intra-abdominal hypertension and postoperative kidney dysfunction in cardiac surgery patients. J Cardiothorac Vasc Anesth 2016; 30: 1571-7.CrossRef

13.

Borioni R, Turani F, Fratticci L, Pederzoli A, Binaco I, Garofalo M. Acute mesenteric ischemia after cardiac surgery. Role of the abdominal compartment syndrome treatment. Ann Ital Chir 2015; 86: 386-9.

14.

Nashef SA, Roques F, Sharples LD, et al. EuroSCORE II. Eur J Cardiothorac Surg 2012; 41: 734-44; discussion 744-5.

15.

Levey AS, Coresh J, Greene T, et al. Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Ann Intern Med 2006; 145: 247-54.CrossRef

16.

Kirkpatrick AW, Roberts DJ, De Waele J, et al. Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome. Intensive Care Med 2013; 39: 1190-206.CrossRef

17.

Kellum JA, Lameire N, Aspelin P, et al. Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney Inter Suppl 2012; 2: 1-138.

18.

Jones PM, Bryson GL, Backman SB, Mehta S, Grocott HP. Statistical reporting and table construction guidelines for publication in the Canadian Journal of Anesthesia. Can J Anesth 2018; 65: 152-61.CrossRef

19.

Czajkowski M, Dabrowski W. Changes in intra-abdominal pressure during CABG with normovolemic hemodilution. Med Sci Monit 2006; 12: CR487-92.

20.

Dabrowski W. Changes in intra-abdominal pressure and central venous and brain venous blood pressure in patients during extracorporeal circulation. Med Sci Monit 2007; 13: CR548-54.

21.

Dabrowski W, Wacinski P, Visconti J. Abdominal perfusion pressure and coronary arterial perfusion pressure in patients undergoing coronary artery bypass graft surgery. Exp Clin Cardiol 2009; 14: e84-8.PubMedPubMedCentral

22.

Smit M, Werner MJ, Lansink-Hartgring AO, Dieperink W, Zijlstra JG, van Meurs M. How central obesity influences intra-abdominal pressure: a prospective, observational study in cardiothoracic surgical patients. Ann Intensive Care 2016; DOI: https://doi.org/10.1186/s13613-016-0195-8.CrossRefPubMedPubMedCentral

23.

Kilic B, Yapici N, Yapici F, et al. Factors associated with increased intra-abdominal pressure in patients undergoing cardiac surgery. Turk Gogus Kalp Damar Cerrahisi Derg 2020; 28: 134-42.CrossRef

24.

Chassé M, Mathieu P, Voisine P, et al. The underestimated belly factor: waist circumference is linked to significant morbidity following isolated coronary artery bypass grafting. Can J Cardiol 2016; 32: 327-35.CrossRef

25.

Dalfino L, Tullo L, Donadio I, Malcangi V, Brienza N. Intra-abdominal hypertension and acute renal failure in critically ill patients. Intensive Care Med 2008; 34: 707-13.CrossRef

26.

Mullens W, Abrahams Z, Skouri HN, et al. Elevated intra-abdominal pressure in acute decompensated heart failure: a potential contributor to worsening renal function? J Am Coll Cardiol 2008; 51: 300-6.CrossRef

27.

Thakar CV, Arrigain S, Worley S, Yared JP, Paganini EP. A clinical score to predict acute renal failure after cardiac surgery. J Am Soc Nephrol 2005; 16: 162-8.CrossRef

28.

Mehta RH, Grab JD, O'Brien SM, et al. Bedside tool for predicting the risk of postoperative dialysis in patients undergoing cardiac surgery. Circulation 2006; 114: 2208-16.CrossRef

29.

Wijeysundera DN, Karkouti K, Dupuis JY, et al. Derivation and validation of a simplified predictive index for renal replacement therapy after cardiac surgery. JAMA 2007; 297: 1801-9.CrossRef

30.

Malbrain ML, Deeren D, De Potter TJ. Intra-abdominal hypertension in the critically ill: it is time to pay attention. Curr Opin Crit Care 2005; 11: 156-71.CrossRef

31.

Mohmand H, Goldfarb S. Renal dysfunction associated with intra-abdominal hypertension and the abdominal compartment syndrome. J Am Soc Nephrol 2011; 22: 615-21.CrossRef

Titel: Intra-abdominal pressure during and after cardiac surgery: a single-centre prospective cohort study
verfasst von: Émilie Richer-Séguin, MD
Christian Ayoub, MD
Jean-Sébastien Lebon, MD
Jennifer Cogan, MD
Stéphanie Jarry, MSc
Yoan Lamarche, MD, MSc
André Y. Denault, MD, PhD
William Beaubien-Souligny, MD, PhD
Publikationsdatum: 30.11.2021
Verlag: Springer International Publishing
Erschienen in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Ausgabe 2/2022
Print ISSN: 0832-610X
Elektronische ISSN: 1496-8975
DOI: https://doi.org/10.1007/s12630-021-02141-9

Neu im Fachgebiet AINS

Eingreifen von Umstehenden rettet vor Erstickungstod!

15.05.2024 Fremdkörperaspiration Nachrichten

Wer sich an einem Essensrest verschluckt und um Luft ringt, benötigt vor allem rasche Hilfe. Dass Umstehende nur in jedem zweiten Erstickungsnotfall bereit waren, diese zu leisten, ist das ernüchternde Ergebnis einer Beobachtungsstudie aus Japan. Doch es gibt auch eine gute Nachricht.

Update AINS

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

hier abonnieren

Springer Medizin

Intra-abdominal pressure during and after cardiac surgery: a single-centre prospective cohort study