1 IAP and the kidneys, an inseparable couple
2 What does the study tell us?
3 Intra-abdominal pressure and the kidneys: the relationship works both ways!
4 Intra-abdominal pressure increase during cardiac surgery
Author, year of publication [reference] | Type of surgery | Number of studied patients | Risk factors of IAH | IAP baseline (mmHg) | IAP after surgery (mmHg) | Adverse effect of elevated IAP and comments |
---|---|---|---|---|---|---|
Czajkowski [17] | CABG | 21 | Normovolemic hemodilution | 9 (7.5–0) | BW < 75 kg: 12 (9.3–14) BW > 75 kg: 17 (17–18.5) | Correlation between IAP and CVP. IAP higher in obesity. Median IAP returns to baseline (BL) of 9 mmHg after 18 h |
Dabrowski [18] | CABG | 25 | Normovolemic hemodilution, cumulative fluid balance | 8.1 ± 1.8 9(8–9) | 12.2 ± 3.1 12 (10–16) | IAP relates to disorders in venous outflow from the brain, increase in CVP. Median IAP returns to BL of 9 mmHg (8–10) after 18 h |
Dabrowski [20] | CABG and aortic Valve surgery | 50 BMI < 25(18) BMI25-30 (23) BMI > 30 (9) | Fluid balance, intra-operative blood dilution | BMI < 25: 4.72 ± 1.19 BMI < 30: 6.69 ± 1.78 BMI > 30: 9.11 ± 0.99 | 11 ± 4.01 11.3 ± 3.4 12.9 ± 2.02 | Decrease in abdominal perfusion pressure. Correlation IAP and BMI. Return to IAP 9 ± 2 mmHg, median of 8(6–11) after 18 h in all BMI groups |
Dabrowski [36] | CABG | 45 | Not studied | 6.64 ± 1.87 | 11.17 ± 3.81 | Decrease in coronary perfusion pressure (CoPP). Correlation between IAP and CoPP and PCWP. Correlation CoPP and APP. IAP decreased to 9.08 ± 3.93 mmhg after 18 h |
Dalfino et al. [22] | CABG and Off-pump cardiac by-pass surgery | 69 | Fluid balance | 8 (IAH in 32%) 6.5 (no IAH) | 14 9 | IAP correlated with CVP, risk of AKI, prolonged mechanical ventilation, FB, higher doses of vasopressors. Higher IAP when on pump. Median IAP of 13 mmHg after 24 h (IAH) vs 7 (no IAH) |
Iyer D. et al. [25] | CABG and Off-pump cardiac by-pass surgery | 108 | Fluid balance, duration of aorta cross-clamping | IAH in 46% (n = 50) | NA | Prolonged mechanical ventilation, higher doses of vasopressors, lower pH and PaO2/FiO2 ratio |
Smit M. et al. [28] | CABG, CABG + Valve surgery, Thoracic aortic aneurysm | 186 | BMI | 9.1 ± 4.4 | IAH in 26.9% (n = 50) ACS in 2.2% (n = 4) | Correlation IAP with W:H ratio, waist circumference and BMI |
Mazeffi et al. [24] | CABG, CABG + Valve surgery, | 50 | Not studied | Increased risk of AKI | ||
Nazer et al. [27] | CABG | 50 (25 with BMI > 30) | BMI | BMI > 30: 10.3 ± 3.3 BMI < 30: 8.4 ± 2.4 | 15.4 ± 1.6 10.6 ± 1.6 | Increased risk of AKI, liver dysfunction, prolonged postoperative mechanical
ventilation |
Kılıç et al. [21] | CABG, CABG + Valve surgery, | 100 | Age, hypertension, fluid balance, intra-operative blood dilution, duration of cardiopulmonary by-pass | 10.1 ± 2.4 (IAH in 49%) 8.1 ± 2.3 | 12.2 ± 0.7 (IAH) 9.5 ± 1.6 (no IAH) | Increased incidence of atrial fibrillation, higher doses of vasopressors, higher lactate level, lower central venous saturation, AKI. Correlation with CVP. IAP after 24 h 14.7 ± 3.2 mmHg in IAH group |
Ramser et al. [29] | CABG, CABG + Valve surgery, | 4128 | Risk factor for ACS: Perioperative ejection fraction, high Euroscore 2, duration of cardiopulmonary bypass | ACS in 1% (n = 42) | NA | In the 18 surviving patients, fascial closure was achieved in 72% after a median of 9 days. Outcome predictor in ACS: emergency, BMI, ASA, age |
Richer-Séguin et al. [30] | CABG, CABG + Valve surgery, | 191 | BMI | 13 [9–15] (n = 191) 9 [7–10] (no IAH) 15 [13–17] (IAH in 55%, n = 105) | 13 [10–15] | IAP independently associated with BMI, CVP and mean pulmonary artery pressure IAP measured 2 h after the admission to the postoperative cardiac intensive care unit was 8 [6–11]. |
Khanna et al. (present study) [9] | Cardiac surgery | 137 | NA | 6.3 [4.0–8.1] | Within 6 h 10.2 [7.7–13.6] (ETT) and 17.2 [14.1–20.7] (postextubation) | IAP first 24 h: 15.9 [13.6–18.7] IAP next 24–48 h 16.6 [14.5–19.1]. 93% (128/137) of patients spent at least 12 h in IAH grade I, 88% (113/128) of those patients in grade I also had grade II, 47% (53/113) of patients with grade II also had grade III, and 13% (7/53) of patients with grade III also had grade IV IAH |