ABSTRACT
BACKGROUND: Intra-abdominal hypertension (IAH) in intensive care patients is associated with an adverse outcome, but the risk factors for development of IAH have not been extensively studied. We aimed to identify independent risk factors for IAH in mechanically ventilated (MV) patients. METHODS: In this prospective observational study, 563 MV patients staying in the general intensive care unit (ICU) of a university hospital for more than 24 h were observed during their ICU stay. Repeated intermittent measurements of intra-abdominal pressure (IAP) via the urinary bladder were performed. RESULTS: IAH (sustained or repeated IAP≥12 mmHg) developed in 182 patients (32.3%). From all the study patients, 44.4% had a primary pathology in the abdomino-pelvic region. Two thirds of all IAH cases developed in this group. Obesity [body mass index (BMI)>30], high positive end-expiratory pressure (PEEP>10), respiratory failure (PaO(2)/FiO(2) <300), use of vasopressors/inotropes, pancreatitis, hepatic failure/cirrhosis with ascites, gastrointestinal bleeding and laparotomy on admission day were identified as independent risk factors for IAH. None of the patients without any of these risk factors (26 patients) developed IAH. CONCLUSION: The precise prediction of development IAH in mixed ICU population remains difficult. In the absence of BMI>30, PEEP>10 cmH(2)O, PaO(2)/FiO(2) <300, use of vasopressors/inotropes, pancreatitis, hepatic failure/cirrhosis with ascites, gastrointestinal bleeding and laparotomy on admission day, the risk for development of IAH in MV ICU patients is minimal.
Subject(s)
Abdominal Cavity , Intra-Abdominal Hypertension/epidemiology , Intra-Abdominal Hypertension/etiology , Respiration, Artificial , APACHE , Age Factors , Aged , Area Under Curve , Blood Pressure/physiology , Checklist , Critical Care , Female , Hospital Mortality , Humans , Intra-Abdominal Hypertension/therapy , Logistic Models , Male , Middle Aged , Monitoring, Physiologic , Prospective Studies , ROC Curve , Risk Factors , Sex Factors , Treatment OutcomeABSTRACT
BACKGROUND: Gastrointestinal (GI) problems are not uniformly assessed in intensive care unit (ICU) patients and respective data in available literature are insufficient. We aimed to describe the prevalence, risk factors and importance of different GI symptoms. METHODS: We prospectively studied all patients hospitalized to the General ICU of Tartu University Hospital in 2004-2007. RESULTS: Of 1374 patients, 62 were excluded due to missing data. Seven hundred and seventy-five (59.1%) patients had at least one GI symptom at least during 1 day of their stay, while 475 (36.2%) suffered from more than one symptom. Absent or abnormal bowel sounds were documented in 542 patients (41.3%), vomiting/regurgitation in 501 (38.2%), high gastric aspirate volume in 298 (22.7%), diarrhoea in 184 (14.0%), bowel distension in 139 (10.6%) and GI bleeding in 97 (7.4%) patients during their ICU stay. Absent or abnormal bowel sounds and GI bleeding were associated with significantly higher mortality. The number of simultaneous GI symptoms was an independent risk factor for ICU mortality. The ICU length of stay and mortality of patients who had two or more GI symptoms simultaneously were significantly higher than in patients with a maximum of one GI symptom. CONCLUSION: GI symptoms occur frequently in ICU patients. Absence of bowel sounds and GI bleeding are associated with impaired outcome. Prevalence of GI symptoms at the first day in ICU predicts the mortality of the patients.
