Intra-abdominal hypertension; prevalence, incidence and outcomes in a low resource setting; a prospective observational study

World Journal of Emergency Surgery

Moses Galukande²  David Mukunya³  Samuel Kirunda²  Cynthia Ndikuno⁴  Dan Namuguzi²  Olivia Kituuka²  Job Kuteesa¹ 

[1] Department of Surgery, School of Medicine, College of Health Sciences, Makerere University, Kampala, P.O Box 7072, Uganda;Department of Surgery, College of Health Sciences, Makerere University, Mulago Hill road, Kampala, Uganda, East Africa;Department of Paediatrics, College of Health Sciences, Makerere University, Kampala, Uganda;Department of Nursing, College of Health Sciences, Makerere University, Kampala, Uganda

关键词: Mortality;    Emergency laparotomy;    Intra-abdominal hypertension;    Intra-abdominal pressure;   

Others  :  1235449
DOI  :  10.1186/s13017-015-0051-4

 received in 2015-07-26, accepted in 2015-11-19,  发布年份 2015

【 摘 要 】

Background

Intra-abdominal hypertension (IAH) is defined as a sustained elevation in intra-abdominal pressure (IAP) greater than or equal to 12 mmHg. IAH has been shown to cause organ derangements and dysfunction in the body. Objective screening of IAH is neither done early enough nor at all thus leading to significant morbidity and mortality among surgical patients. The epidemiology and outcome of IAH among surgical patients has not been documented in Uganda. The aim of this study was to determine the prevalence, incidence and outcome of intra-abdominal hypertension among patients undergoing emergency laparotomy.

Methodology

Prospective observational study, conducted from January to April 2015 among patients undergoing emergency laparotomy. Inclusion criteria was; age >7 yrs, scheduled for emergency laparotomy, able to lie supine. Exclusion Criteria: pregnant, failed urethral catheterization, known cardiac, renal and respiratory disorders. Consecutive sampling was used. IAP, blood pressure, heart rate, respiratory rate, Sp02, Serum creatinine, Serum urea, and Urine output were measured preoperatively and postoperatively at 0, 6, 24 and 48 h. IAH was defined as IAP > 12 mmHg on three consecutive readings 3 min apart.

Results

In total 192 patients were enrolled. Mean age ± SD was 14.25 (±3.16) yrs in the paediatrics and 34.4(±13.72) yrs in the adults with male preponderance 65 and 80.7 % respectively. The prevalence of IAH was 25 % paediatrics and 17.4 % adults and the cumulative incidence after surgery was 20 % paediatrics and 21 % adults. In paediatrics, IAH was associated with mortality at 0 h postoperatively, RRR = 1:24, 95 % CI (1.371–560.178), p-value 0.048. In adults, the statistically significant outcomes associated with IAH were respiratory system dysfunction RRR1:2.783, p-value 0.023, 95 % CI (1.148–6.744) preoperatively and mortality RRR 1:2.933, p-value 0.034, 95 % CI (1.017–8.464) at 6 h, RRR 1:3.769, p-value 0.033, 95 % CI (1.113–12.760) at 24 h postoperatively.

Conclusion

The prevalence and incidence of IAH in the paediatrics and adults group in our study population were high. IAH was associated with mortality in both adult and paediatrics groups and respiratory system dysfunction in adult group. This calls for objective monitoring of intraabdominal pressure in patients undergoing emergency laparotomy with the aim of reducing associated mortality.

【 授权许可】

   
2015 Kuteesa et al.

【 参考文献 】

• [1]Kirkpatrick AW, Roberts DJ, De Waele J, Jaeschke R, Malbrain ML, De Keulenaer B, et al.: Intra-abdominal hypertension and the abdominal compartment syndrome: Updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome. Intensive Care Med 2013, 39(7):1190-1206.
• [2]Kirkpatrick AW, Pelosi P, De Waele JJ, Malbrain ML, Ball CG, Meade MO, et al.: Clinical review: Intra-abdominal hypertension: Does it influence the physiology of prone ventilation? Crit care 2010, 14(4):232.
• [3]Correa-Martin L, Castellanos G, Garcia M, Sanchez-Margallo FM: Renal consequences of intraabdominal hypertension in a porcine model. Search for the choice indirect technique for intraabdominal pressure measurement. Actas Urol Esp 2013, 37(5):273-279.
• [4]Scollay JM, de Beaux I, Parks RW: Prospective study of intra-abdominal pressure following major elective abdominal surgery. World J Surg 2009, 33(11):2372-2377.
• [5]Sugrue M, Buhkari Y: Intra-abdominal pressure and abdominal compartment syndrome in acute general surgery. World J Surg 2009, 33(6):1123-1127.
• [6]da Silva Almeida JR, Machado FS, Schettino GP, Park M, Azevedo LC: Cardiopulmonary effects of matching positive end-expiratory pressure to abdominal pressure in concomitant abdominal hypertension and acute lung injury. J Trauma 2010, 69(2):375-383.
• [7]Moore AF, Hargest R, Martin M, Delicata RJ: Intra-abdominal hypertension and the abdominal compartment syndrome. Br J Surg 2004, 91(9):1102-1110.
• [8]Kashtan J, Green JF, Parsons EQ, Holcroft JW: Hemodynamic effect of increased abdominal pressure. J Surg Res 1981, 30(3):249-255.
• [9]Carr JA: Abdominal compartment syndrome: A decade of progress. J Am Coll Surg 2013, 216(1):135-146.
• [10]Kimball EJ, Rollins MD, Mone MC, Hansen HJ, Baraghoshi GK, Johnston C, et al.: Survey of intensive care physicians on the recognition and management of intra-abdominal hypertension and abdominal compartment syndrome. Crit Care Med 2006, 34(9):2340-2348.
• [11]Ravishankar N, Hunter J: Measurement of intra-abdominal pressure in intensive care units in the United Kingdom: A national postal questionnaire study. Br J Anaesth 2005, 94(6):763-766.
• [12]Malbrain ML, Chiumello D, Pelosi P, Wilmer A, Brienza N, Malcangi V, et al.: Prevalence of intra-abdominal hypertension in critically ill patients: A multicentre epidemiological study. Intensive Care Med 2004, 30(5):822-829.
• [13]Khan S, Verma AK, Ahmad SM, Ahmad R: Analyzing intra-abdominal pressures and outcomes in patients undergoing emergency laparotomy. J Emerg Trauma Shock 2010, 3(4):318-325.
• [14]Divarci E, Karapinar B, Yalaz M, Ergun O, Celik A: Incidence and prognosis of intraabdominal hypertension and abdominal compartment syndrome in children. Journal of Pediatric Surgery 2014. doi:. 10.1016/j.jpedsurg.2014.03.014 webcite
• [15]Meldrum DR, Moore FA, Moore EE, Franciose RJ, Sauaia A, Burch JM: Prospective characterization and selective management of the abdominal compartment syndrome. Am J Surg 1997, 174(6):667-672.
• [16]Hong JJ, Cohn SM, Perez JM, Dolich MO, Brown M, McKenney MG: Prospective study of the incidence and outcome of intra-abdominal hypertension and the abdominal compartment syndrome. Br J Surg 2002, 89(5):591-596.
• [17]United-Nations-Population-Division: World population prospects: The 2012 revision. Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat, New York; 2013.
• [18]Murtaza G, Pal KM, Jajja MR, Nawaz Z, Koondhar R, Nasim S: Intra abdominal hypertension; incidence, prevalence and outcomes in a mixed intensive care unit: Prospective cohort study. Int J Surg 2015, 9:67-71.
• [19]Malbrain ML, Chiumello D, Cesana BM, Reintam Blaser A, Starkopf J, Sugrue M, et al.: A systematic review and individual patient data meta-analysis on intra-abdominal hypertension in critically ill patients: The wake-up project. World initiative on Abdominal Hypertension Epidemiology, a Unifying Project (WAKE-Up!). Minerva Anestesiol 2014, 80(3):293-306.
• [20]Cheatham ML, Malbrain ML, Kirkpatrick A, Sugrue M, Parr M, De Waele J, et al.: Results from the International Conference of Experts on Intra-abdominal Hypertension and Abdominal Compartment Syndrome. II. Recommendations. Intensive Care Med 2007, 33:951-962.
• [21]Thabet FC, Bougmiza IM, Chehab MS, Bafaqih HA, AlMohaimeed SA, Malbrain ML: Incidence, Risk Factors, and Prognosis of Intra-Abdominal Hypertension in Critically Ill Children: A Prospective Epidemiological Study. Journal of intensive care medicine 2015.