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This article is part of the supplement: 33rd International Symposium on Intensive Care and Emergency Medicine

Poster presentation

Intraabdominal hypertension and abdominal compartment syndrome in patients admitted to a medical and surgical ICU at a third referral university hospital

N Chindavech1*, S Yenarkart2 and S Kongsayreepong2

  • * Corresponding author: N Chindavech

Author Affiliations

1 Siriraj Hospital, Mahidol University, Bangkok, Thailand

2 Division of Critical Care Medicine, Bangkok, Thailand

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Critical Care 2013, 17(Suppl 2):P231  doi:10.1186/cc12169


The electronic version of this article is the complete one and can be found online at: http://ccforum.com/content/17/S2/P231


Published:19 March 2013

© 2013 Chindavech et al.; licensee BioMed Central Ltd.

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Introduction

Intraabdominal hypertension (IAH), especially abdominal compartment syndrome (ACS), can affect organ function leading to multiple organ failure. Appropriate and prompt management could improve survival. Less recognition of this problem in critically ill patients has been reported. The aim of this study was to study the prevalence, predictive factors and clinical outcome of IAH and ACS in a mixed population of critically ill patients by intermittent measuring bladder pressure during the ICU stay.

Methods

This prospective observational study was done in 130 adult patients (age >18 years) admitted to a medical and general surgical ICU at a third referral university hospital during June to November 2011. Variables about the patient's profile laboratory data and clinical outcome as ICU and hospital length of stay, and ICU, in-hospital and 28-day mortality were recorded.

Results

There were 33 (25.4%) medical and 93 (74.6%) surgical ICU patients in this study. Surgical patients had higher prevalence of IAH than medical patients (57.8% vs. 33.3%, P = 0.015). Medical patients were admitted with severe sepsis/septic shock, AKI, pneumonia and ARDS. Surgical patients were more acutely ill with high ASA (III to IV), severity score, underwent emergency abdominal surgery and received more transfusion but were no different in type of fluid replacement. Significant risk factors of IAH were coagulopathy (OR = 2.09, 95% CI = 1.62 to 2.69), intraabdominal infection (OR = 1.87, 95% CI = 1.40 to 2.48), retroperitonium hematoma (OR = 1.82, 95% CI = 1.36 to 2.44), marked ascites (OR = 1.76, 95% CI = 1.32 to 2.36), acidosis (pH <7.2) (OR = 1.82, 95% CI = 1.37 to 2.43), severe sepsis/septic shock (OR = 1.63, 95% CI = 1.14 to 2.33), and massive transfusion (OR = 1.51, 95% CI = 1.10 to 2.08). Patients with IAH had more reopened surgeries and had higher ICU, hospital and 28-day mortality. Sixteen (12.3%) patients had ACS, 15 patients underwent emergency surgery, two patients had temporary abdominal closured and one-half of the patients had severe abdominal sepsis and massive transfusion. Fourteen patients died despite temporary abdominal closure. Delayed release abdominal tamponade were most causes of death.

Conclusion

The prevalence and morbidity/mortality of IAH and ACS were high in this institute. Early appropriate and prompt management, especially fluid and releasing a tamponade effect, were important.