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Primary and secondary intra-abdominal hypertension—different impact on ICU outcome

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Abstract

Objective

To investigate the differences in incidence, time course and outcome of primary versus secondary intra-abdominal hypertension (IAH), and to evaluate IAH as an independent risk factor of mortality in a presumable risk population of critically ill patients.

Design

Prospective observational study.

Setting

General intensive care unit of a university hospital.

Patients

A total of 257 mechanically ventilated patients at presumable risk for the development of IAH were studied during their ICU stay and followed up for 90-day survival.

Interventions

Repeated measurements of intra-abdominal pressure (IAP).

Measurements and results

IAP was measured intermittently, via bladder. IAH (sustained or repeated IAP ≥ 12 mmHg) developed in 95 patients (37.0%). Primary IAH was observed in 60 and secondary IAH in 35 patients. Patients with secondary IAH demonstrated a significant increase of mean IAP during the first three days (mean ΔIAP was 2.2 ± 4.7 mmHg), whilst IAP decreased (mean ΔIAP −1.1 ± 3.7 mmHg) in the patients with primary IAH. The patients with IAH had a significantly higher ICU- (37.9 vs. 19.1%; P = 0.001), 28-day (48.4 vs. 27.8%, P = 0.001), and 90-day mortality (53.7 vs. 35.8%, P = 0.004) compared to the patients without the syndrome. Patients with secondary IAH had a significantly higher ICU mortality than patients with primary IAH (P = 0.032). Development of IAH was identified as an independent risk factor for death (OR 2.52; 95% CI 1.23–5.14).

Conclusions

Secondary IAH is less frequent, has a different time course and worse outcome than primary IAH. Development of IAH during ICU period is an independent risk factor for death.

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References

  1. Malbrain ML, Chiumello D, Pelosi P, Wilmer A, Brienza N, Malcangi V, Bihari D, Innes R, Cohen J, Singer P, Japiassu A, Kurtop E, De Keulenaer BL, Daelemans R, Del Turco M, Cosimini P, Ranieri M, Jaquet L, Laterre PF, Gattinoni L (2004) Prevalence of intra-abdominal hypertension in critically ill patients: a multicentre epidemiological study. Intensive Care Med 30:822–829. doi:10.1007/s00134-004-2169-9

    Article  PubMed  Google Scholar 

  2. Malbrain ML, Chiumello D, Pelosi P, Bihari D, Innes R, Ranieri VM, Del Turco M, Wilmer A, Brienza N, Malcangi V, Cohen J, Japiassu A, De Keulenaer BL, Daelemans R, Jacquet L, Laterre PF, Frank G, de Souza P, Cesana B, Gattinoni L (2005) Incidence and prognosis of intraabdominal hypertension in a mixed population of critically ill patients: a multiple-center epidemiological study. Crit Care Med 33:315–322

    Article  PubMed  Google Scholar 

  3. Reintam A, Parm P, Kern H, Starkopf J (2005) Impact of intraabdominal pressure on ICU mortality. Intensive Care Med 31(suppl 1):S8. doi:10.1007/s00134–005-2777-z

    Google Scholar 

  4. Reintam A, Parm P, Kern H, Starkopf J (2005) Gastrointestinal failure and intraabdominal hypertension in medical and surgical patients. Intensive Care Med 31(suppl 1):S125. doi:10.1007/s00134-005-2780-4

    Google Scholar 

  5. Malbrain ML, Cheatham ML, Kirkpatrick A, Sugrue M, Parr M, De Waele J, Balogh Z, Leppaniemi A, Olvera C, Ivatury R, D’Amours S, Wendon J, Hillman K, Johansson K, Kolkman K, Wilmer A (2006) Results from the international conference of experts on intra-abdominal hypertension and abdominal compartment syndrome. I. Definitions. Intensive Care Med 32:1722–1732. doi:10.1007/s00134-006-0349-5

    Article  PubMed  Google Scholar 

  6. Moore-Olufemi SD, Xue H, Allen SJ, Moore FA, Stewart RH, Laine GA, Cox CS Jr (2005) Effects of primary and secondary intra-abdominal hypertension on mesenteric lymph flow: implications for the abdominal compartment syndrome. Shock 23:571–575

    PubMed  Google Scholar 

  7. Reintam A, Parm P, Kitus R, Kern H, Starkopf J (2007) Primary and secondary intra-abdominal hypertension: different incidence, time-course and impact on ICU outcome. Acta Clin Belg 62(suppl 1):248

    Google Scholar 

  8. Malbrain ML (2004) Different techniques to measure intra-abdominal pressure (IAP): time for a critical re-appraisal. Intensive Care Med 30:357–371. doi:10.1007/s00134-003-2107-2

    Article  PubMed  Google Scholar 

  9. Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) APACHE II: a severity of disease classification system. Crit Care Med 13:818–829

    Article  PubMed  CAS  Google Scholar 

  10. Vincent JL, Moreno R, Takala J, Willatts S, De Mendonca A, Bruining H, Reinhart CK, Suter PM, Thijs LG (1996) The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. Intensive Care Med 22:707–710. doi:10.1007/BF01709751

    Article  PubMed  CAS  Google Scholar 

  11. De laet I, Malbrain ML (2007) ICU management of the patient with intra-abdominal hypertension: what to do, when and to whom? Acta Clin Belg 62(Suppl 1):190–199

    Google Scholar 

  12. Busani S, Soccorsi MC, Poma C, Girardis M (2006) Intra-abdominal hypertension in nonelective surgery: a preliminary report. Transplant Proc 38:836–837

    Article  PubMed  CAS  Google Scholar 

  13. Djavani K, Wanhainen A, Bjorck M (2006) Intra-abdominal hypertension and abdominal compartment syndrome following surgery for ruptured abdominal aortic aneurysm. Eur J Vasc Endovasc Surg 31:581–584

    Article  PubMed  CAS  Google Scholar 

  14. Rosas JM, Soto SN, Aracil JS, Cladera PR, Borlan RH, Sanchez AV, Ros FB, Posa LG (2007) Intra-abdominal pressure as a marker of severity in acute pancreatitis. Surgery 141:173–178

    Article  PubMed  Google Scholar 

  15. Andrews P, Azoulay E, Antonelli M, Brochard L, Brun-Buisson C, de Backer D, Dobb G, Fagon J-Y, Gerlach H, Groeneveld J, Mancebo J, Metnitz P, Nava S, Pugin J, Pinsky M, Radermacher P, Richard C, Tasker R (2006) Year in review in intensive care medicine. 2005. I. Acute respiratory failure and acute lung injury, ventilation, hemodynamics, education, renal failure. Intensive Care Med 32:207–216. doi:10.1007/s00134-005-0027-z

    Article  PubMed  Google Scholar 

  16. Frezza EE, Shebani KO, Robertson J, Wachtel MS (2007) Morbid obesity causes chronic increase of intraabdominal pressure. Dig Dis Sci 52:1038–1041. doi:10.1007/s10620-006-9203-4

    Article  PubMed  Google Scholar 

  17. Balogh Z, McKinley BA, Cocanour CS, Kozar RA, Valdivia A, Sailors RM, Moore FA (2003) Supranormal trauma resuscitation causes more cases of abdominal compartment syndrome. Arch Surg 138:637–643

    Article  PubMed  Google Scholar 

  18. Balogh Z, Moore FA, Moore EE, Biffl WL (2007) Secondary abdominal compartment syndrome: a potential threat for all trauma clinicians. Injury 38:272–279

    Article  PubMed  Google Scholar 

  19. Duperret S, Lhuillier F, Piriou V, Vivier E, Metton O, Branche P, Annat G, Bendjelid K, Viale JP (2007) Increased intra-abdominal pressure affects respiratory variations in arterial pressure in normovolaemic and hypovolaemic mechanically ventilated healthy pigs. Intensive Care Med 33:167–171. doi:10.1007/s00134-006-0412-2

    Article  Google Scholar 

  20. Pelosi P, Calzia E, Asfar P (2007) It’s time to measure intra-abdominal pressure to optimize hemodynamics! Intensive Care Med 33:6–8. doi:10.1007/s00134-006-0413-1

    Article  PubMed  Google Scholar 

  21. Cheatham ML, Malbrain ML, Kirkpatrick A, Sugrue M, Parr M, De Waele J, Balogh Z, Leppäniemi A, Olvera C, Ivantury R, D´Amors S, Wendon J, Hillman K, Wilmer A (2007) Results from the international conference of experts on intra-abdominal hypertension and abdominal compartment syndrome. II. Recommendations. Intensive Care Med 33:951–962. doi:10.1007/s00134-007-0592-4

    Article  PubMed  Google Scholar 

  22. De Waele JJ, De laet I, Malbrain ML (2007) Rational intraabdominal pressure monitoring: how to do it? Acta Clin Belg 62(suppl 1):16–25

    Google Scholar 

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Acknowledgments

This study was supported by Estonian Science Foundation (Grant 6950).

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Authors and Affiliations

  1. Clinic of Anaesthesiology and Intensive Care, University of Tartu, Puusepa 8, 51014, Tartu, Estonia

    Annika Reintam, Reet Kitus, Hartmut Kern & Joel Starkopf

  2. Department of Anaesthesiology and Intensive Care, East Tallinn Central Hospital, Ravi 18, 10138, Tallinn, Estonia

    Annika Reintam

  3. Clinic of Anaesthesiology and Intensive Care, Tartu University Hospital, Puusepa 1A, 51014, Tartu, Estonia

    Pille Parm, Reet Kitus & Joel Starkopf

  4. Klinik für Anästhesiologie und Intensivmedizin, DRK Kliniken Berlin Köpenick, Salvador-Allende-Straße 2–8, 12559, Berlin, Germany

    Hartmut Kern

Authors
  1. Annika Reintam
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  2. Pille Parm
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  3. Reet Kitus
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  4. Hartmut Kern
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  5. Joel Starkopf
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Corresponding author

Correspondence to Annika Reintam.

Additional information

This article is discussed in the editorial available at doi:10.1007/s00134-008-1135-3

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Reintam, A., Parm, P., Kitus, R. et al. Primary and secondary intra-abdominal hypertension—different impact on ICU outcome. Intensive Care Med 34, 1624–1631 (2008). https://doi.org/10.1007/s00134-008-1134-4

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  • DOI: https://doi.org/10.1007/s00134-008-1134-4

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