The monitoring of intra-abdominal pressure in critically ill patients / 中华危重病急救医学

ABSTRACT

Objective To monitor intra-abdominal pressure (IAP) in critically ill patients.Methods A prospective cohort study was conducted.IAP was measured through the bladder technique.Patients were screened for intra-abdominal hypertension (IAH,IAP ≥ 12 mmHg,1 mmHg=0.133 kPa) upon ICU admission.The patients with IAH/abdominal compartment syndrome (ACS) were given appropriate treatment and management for IAH and/or ACS.Mean arterial pressure (MAP),IAP,abdominal perfusion pressure (APP),filtration gradient (FG) and serum creatinine (Cr) were determined in patients with or without IAH,as well as in survivors and non-survivors.Results The entire protocol of IAP measurement was completed in 88 patients.Number of IAH and ACS patients was 25 (28.4％) and 2 (2.3％),respectively.The number of survivors was 80 (90.9％),with 8 (9.1％) non-survivors.Compared with non-IAH patients,IAP and SCr were increased in IAH patients [IAP (mmHg)14.16 ± 2.43 vs.8.13 ± 2.28,t=10.984,P=0.000; SCr (μmol/L)126.72 ± 83.02 vs.73.41 ± 37.59,t=3.087,P=0.005],with a lower FG (mmHg59.32 ± 17.08 vs.70.24 ± 15.03,t=-2.956,P=0.004).There were no significant differences in MAP and APP between IAH group and non-IAH group [MAP (mmHg)79.18 ± 12.33 vs.88.71 ± 17.34,t=-1.368,P=0.190; APP (mmHg)73.40 ± 16.11 vs.78.37 ± 14.32,t=-1.415,P=0.161].Compared with survivors,non-survivors showed significantly lower APP and FG [APP (mmHg)60.88 ± 14.58 vs.78.56 ± 14.06,t=3.382,P=0.001 ; FG (mmHg)50.38 ± 16.18 vs.68.81 ± 15.44,t=3.208,P=0.002],and higher SCr (μmol/L129.12 ±83.62 vs.84.36 ± 55.15,t=-2.082,P=0.040).There was no significant difference in IAP and MAP between survivors and non-survivors [MAP (mmHg)71.00 ± 25.46 vs.84.38 ± 13.53,t =1.224,P=0.238 ; IAP (mmHg)10.62 ±5.34 vs.9.76 ± 3.40,t=-0.647,P=0.519].Conclusions Earlier IAP measurements in critically ill patients are essential for the detection of IAH/ACS and renal injury.With appropriate management of IAH/ACS,significant decrease in morbidity and mortality of patients has been achieved.