ORIGINAL ARTICLE
Clinical warning signs for intra-abdominal hypertension in septic shock patients
1
Division of Trauma Surgery, Department of Surgery, School of Medical Sciences, University of Campinas (Unicamp), Campinas, SP, Brazil
2
School of Medical Sciences, University of Campinas (Unicamp), Campinas, SP, Brazil
Publication date: 2019-08-30
Anaesthesiol Intensive Ther 2019;51(3):200-204
KEYWORDS
ABSTRACT
Background:
The latest World Society of the Abdominal Compartment (WSACS) guideline published in 2013 states that risk factors are the most reliable predictors for the diagnosis of intra-abdominal hypertension (IAH) and the bottom line to guide propaedeutic and clinical practice. The objective of this study is to search for clinical, laboratory, and ventilator-associated factors in order to warn medical staff for prompt IAH diagnosis in septic shock patients beyond risk factors simply.
Methods:
This is a prospective, observational study, involving all admitted intensive care unit septic shock patients of a single teaching hospital between April and October 2016. All enrolled patients met Sepsis III and Surviving Sepsis Campaign diagnostic criteria. Patients with primary abdominal conditions were excluded, in order to avoid possible bias. Intra-abdominal pressure (IAP) was measured every 6 hours in accordance with WSACS guidelines.
Results:
25 sequential patients were included and followed for 10 days after admission. Median age was 51.13 ± 16.52 years old, 64% male. Pulmonary infection was the most frequent etiology of sepsis, representing 76% of the cases. Elevated IAP correlated with higher central venous pressure (CVP) (P = 0.0421); positive end-expiratory pressure (PEEP) (P = 0.0056); elevated airway pressure (P = 0.0015); accumulated fluid balance (P = 0.0273), and elevated SOFA (P = 0.0393) in all septic patients. Reduction of acidosis (P = 0.0096) and increase of serum bicarbonate (P = 0.0247) correlated with lower IAP values.
Conclusions:
Elevated CVP, PEEP, SOFA, airway pressure and accumulated fluid balance are correlated with elevated IAP in septic shock patients. Acidosis correction appears to decrease the risk for IAH. Multicentric randomized studies are needed to confirm this hypothesis in a large population.
The latest World Society of the Abdominal Compartment (WSACS) guideline published in 2013 states that risk factors are the most reliable predictors for the diagnosis of intra-abdominal hypertension (IAH) and the bottom line to guide propaedeutic and clinical practice. The objective of this study is to search for clinical, laboratory, and ventilator-associated factors in order to warn medical staff for prompt IAH diagnosis in septic shock patients beyond risk factors simply.
Methods:
This is a prospective, observational study, involving all admitted intensive care unit septic shock patients of a single teaching hospital between April and October 2016. All enrolled patients met Sepsis III and Surviving Sepsis Campaign diagnostic criteria. Patients with primary abdominal conditions were excluded, in order to avoid possible bias. Intra-abdominal pressure (IAP) was measured every 6 hours in accordance with WSACS guidelines.
Results:
25 sequential patients were included and followed for 10 days after admission. Median age was 51.13 ± 16.52 years old, 64% male. Pulmonary infection was the most frequent etiology of sepsis, representing 76% of the cases. Elevated IAP correlated with higher central venous pressure (CVP) (P = 0.0421); positive end-expiratory pressure (PEEP) (P = 0.0056); elevated airway pressure (P = 0.0015); accumulated fluid balance (P = 0.0273), and elevated SOFA (P = 0.0393) in all septic patients. Reduction of acidosis (P = 0.0096) and increase of serum bicarbonate (P = 0.0247) correlated with lower IAP values.
Conclusions:
Elevated CVP, PEEP, SOFA, airway pressure and accumulated fluid balance are correlated with elevated IAP in septic shock patients. Acidosis correction appears to decrease the risk for IAH. Multicentric randomized studies are needed to confirm this hypothesis in a large population.
REFERENCES (43)
1.
Kirkpatrick WA, Robert DJ, Waele JD, et al.; Pediatric Guidelines Sub-Committee for the World Society of the Abdominal Compartment Syndrome. 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: 1190-1206. doi: 10.1007/s00134-013-2906-z.
2.
Ivatury RR, Sugerman HJ. Abdominal compartment syndrome: a century later, isn’t it time to pay attention? Crit Care Med 2000; 28: 2137-2138. doi: 10.1097/00003246-200006000-00083.
3.
Coombs HC. The mechanism of the regulation of intra-abdominal pressure. Am J Physiol 1920; 61: 159-163.
4.
Kron IL, Harman PK, Nolan SP. The measurement of intra-abdominal pressure as a criteria for abdominal reexploration. Ann Surg 1984; 199: 28-30.
5.
Saggi BH, Sugerman HJ, Ivatury RR, Bloomfield GL. Abdominal compartment syndrome. J Trauma 1998; 45: 597-609. doi: 10.1097/00005373-199809000-00033.
6.
Cheatham ML, Safcsak K. Is the evolving management of intra-abdominal hypertension and abdominal compartment syndrome improving survival? Crit Care Med 2010; 38: 402-407. doi: 10.1097/ccm.0b013e3181b9e9b1.
7.
Kimball EJ, Kim W, Cheatham ML, Malbrain NG. Clinical awareness of intra-abdominal hypertension and abdominal compartment syndrome in 2007. Acta Clinica Belgica 2007; 62 Suppl 1: 65-73.
8.
Cheatham ML. Abdominal compartment syndrome. Curr Opin Crit Care 2009; 15: 154-162. doi: 10.1097/MCC.0b013e3283297934.
9.
Malbrain ML. Abdominal pressure in the critically ill: measurement and clinical relevance. Intensive Care Med 1999; 25: 1453-1458.
10.
Mutoh T, Lamm WJ, Embree LJ. Abdominal distension alters regional pleural pressures and chest wall mechanics in pigs in vivo. J Appl Physiol (1985) 1991; 70: 2611-2618. doi: 10.1152/jappl.1991. 70.6.2611.
11.
Moffa SM, Quinn JV, Slotman GJ. Hemodynamic effects of carbon dioxide pneumoperitoneum during mechanical ventilation and positive end-expiratory pressure. J Trauma 1993; 36: 613-618. doi: 10.1097/00005373-199310000-00018.
12.
Diebel L, Saxe J, Dulchavsky S. Effect of intra-abdominal pressure on abdominal wall blood flow. Am Surg 1992; 58: 573-576.
13.
Emerson H. Intra-abdominal pressures. Arch Intern Med (Chic) 1911; 7: 754-784. doi: 10.1001/archinte.1911.00060060036002.
16.
Salkin D. Intra-abdominal pressure and its regulation. Am Rev Tuberc Pulm Dis 1934; 30: 436-457.
18.
Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA 2016; 315: 801-810. doi: 10.1001/jama.2016.0287.
19.
Rhodes A, Evans LE, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Intensive Care Med 2017; 43: 304-377. doi: 10.1007/s00134-017-4683-6.
20.
Wise R, Roberts DJ, Vandervelden S, et al. Awareness and knowledge of intra-abdominal hypertension and abdominal compartment syndrome: results of an international survey. Anaesthesiol Intensive Ther 2015; 47: 14-29. doi: 10.5603/AIT.2014.0051.
21.
Starkopf J, Tamme K, Blaser AR. Should we measure intra-abdominal pressure in every intensive care patient? Ann Intensive Care 2012; 2 (Suppl 1): S9. doi: 10.1186/2110-5820-2-S1-S9.
22.
Malbrain ML, Chiumello D, Pelosi P, et al. Prevalence of intra-abdominal hypertension in critically ill patients: a multicentre epidemiological study. Intensive Care Med 2004; 30: 822-829. doi: 10.1007/s00134-004-2169-9.
23.
Reintam Blaser A, Parm P, Kitus R, Starkopf J. Risk factors for intra-abdominal hypertension in mechanically ventilated patients. Acta Anaesthesiol Scand 2011; 55: 607-614. doi: 10.1111/j.1399-6576.2011.02415.x.
24.
Malbrain ML, Chiumello D, Pelosi P, et al. Incidence and prognosis of intraabdominal hypertension in a mixed population of critically ill patients: a multiple-Center epidemiological study. Crit Care Med 2005; 33: 315-322. doi: 10.1097/01.ccm.0000153408.09806.1b.
25.
Daugherty EL, Hongyan L, Taichman D, Hansen-Flaschen J, Fuchs BD. Abdominal compartment syndrome is common in medical intensive care unit patients receiving large-volume resuscitation. J Intensive Care Med 2007; 22: 294-299. doi: 10.1177/0885066607305247.
26.
Regueira T, Bruhn A, Hasbun P, et al. Intra-abdominal hypertension: incidence and association with organ dysfunction during early septic shock. J Crit Care 2008; 23: 461-467. doi: 10.1016/j.jcrc.2007.12.013.
27.
Dalfino L, Tullo L, Donadio I, Malcangi V, Brienza N. Intra-abdominal hypertension and acute renal failure in critically ill patients. Intensive Care Med 2008; 34: 707-713. doi: 10.1007/s00134-007-0969-4.
28.
Vidal MG, Ruiz Weisser J, Gonzalez F, et al. Incidence and clinical effects of intra-abdominal hypertension in critically ill patients.
30.
Serpytis M, Ivaskevicius J. The influence of fluid balance on intra-abdominal pressure after major abdominal surgery. Medicina (Kaunas) 2008; 44: 421-427.
31.
Al-Bahrani AZ, Abid GH, Holt A, et al. Clinical relevance of intra-abdominal hypertension in patients with severe acute pancreatitis. Pancreas 2008; 36: 39-43. doi: 10.1097/mpa.0b013e318149f5bf.
32.
Dabrowski W, Rzecki Z. Intra-abdominal and abdominal perfusion pressure in patients undergoing coronary artery bypass graft surgery. Acta Clin Belg 2009; 64: 216-224. doi: 10.1179/acb.2009.038.
33.
Anvari E, Nantsupawat N, Gard R, Raj R, Nugent K. Bladder pressure measurements in patients admitted to a medical intensive care unit. Am J Med Sci 2015; 350: 181-185. doi: 10.1097/MAJ.00000000 00000543.
34.
Dalfino L, Sicolo A, Paparella D, Mongelli M, Rubino G, Brienza N. Intra-abdominal hypertension in cardiac surgery. Interact Cardiovasc Thorac Surg 2013; 17: 644-651. doi: 10.1093/icvts/ivt272.
35.
Murphy PB, Parry NG, Sela N, Leslie K, Vogt K, Ball I. Intraabdominal hypertension is more common than previously thought: a prospective study in a mixed medical-surgical ICU. Crit Care Med 2018; 46: 958-964. doi: 10.1097/CCM.0000000000003122.
36.
Reintam A, Parm P, Kitus R, Kern H, Starkopf J. Primary and secondary intra-abdominal hypertension – different impact on ICU outcome. Intensive Care Med 2008; 34: 1624-1631. doi: 10.1007/s00134-008-1134-4.
37.
Malbrain ML, De laet IE. Intra-abdominal hypertension: evolving concepts. Clin Chest Med 2009; 30: 45-70.
38.
Malbrain ML, De Laet IE, De Waele JJ, Kirkpatrick AW. Intraabdominal hypertension: definitions, monitoring, interpretation and management. Best Pract Res Clin Anaesthesiol 2013; 27: 249-270. doi: 10.1016/j.bpa.2013.06.009.
39.
Reintam Blaser A, Starkopf J, Björck M, Malbrain ML. Risk factors to develop intra-abdominal hypertension among mechanically ventilated patients: results from a prospective multicentre study. Intensive Care Med 2010; 36: R249. doi: 10.15386/cjmed-455.
40.
Carr JA. Abdominal compartment syndrome: a decade of progress. J Am Coll Surg 2013; 216: 135-146. doi: 10.1016/j.jamcollsurg. 2012.09.004.
41.
Sugrue M, Buhkari Y. Intra-abdominal pressure and abdominal compartment syndrome in acute general surgery. World J Surg 2009; 33: 1123-1127. doi: 10.1007/s00268-009-0040-4.
42.
Iyer D, Rastogi P, Åneman A, D’Amours S. Early screening to identify patients at risk of developing intra-abdominal hypertension and abdominal compartment syndrome. Acta Anaesthesiol Scand 2014; 58: 1267-1275. doi: 10.1111/aas.12409.
43.
Vandervelden S, Malbrain M. Initial resuscitation from severe sepsis: one size do not fit all. Anaesthesiol Intensive Ther 2015; 47: 44-55. doi: 10.5603/AIT.a2015.0075.
| eISSN: | 1731-2531 |
| ISSN: | 1642-5758 |
We process personal data collected when visiting the website. The function of obtaining information about users and their behavior is carried out by voluntarily entered information in forms and saving cookies in end devices. Data, including cookies, are used to provide services, improve the user experience and to analyze the traffic in accordance with the Privacy policy. Data are also collected and processed by Google Analytics tool (more).
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
