by Reintam Blaser,
Annika; Regli, Adrian; De Keulenaer, Bart; Kimball, Edward J.; Starkopf, Liis;
Davis, Wendy A.; Greiffenstein, Patrick; Starkopf, Joel; the Incidence, Risk
Factors, and Outcomes of Intra-Abdominal (IROI) Study Investigators
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.
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