Incidence and clinical effects of intra-abdominal hypertension in critically ill patients
Incidence and clinical effects of intra-abdominal hypertension in critically ill patients
复制标题
DOI：
10.1097/ccm.0b013e31817c7a4d
复制
发表时间：
2008-06-01
影响因子：
8.8
通讯作者：
Estenssoro, Elisa
中科院分区：
文献类型：
--
作者：
Vidal, Maria Gabriela;Weisser, Javier Ruiz;Estenssoro, Elisa
目的：本研究的目的是确定异质性重症监护病房人群中腹内高血压的流行病学和结局。设计：这是一项前瞻性队列研究。环境：本研究在一所大学医院的内科外科重症监护病房进行。患者：研究患者包括所有连续住院9个月，住院24小时，需要膀胱导尿的患者。测量方法和主要结果：对入院时的流行病学资料和危险因素进行了研究；然后记录每日最大和平均腹内压（IAP（max）和IAP(mean)）、腹腔灌注压、液体平衡、滤过梯度和顺序器官衰竭评估评分。每6小时通过膀胱导尿管记录一次iap，直到死亡、出院或7天。腹腔内高血压定义为IAP > 12 mm Hg，腹腔隔室综合征定义为IAP >= mm Hg + >= 1新器官衰竭。主要结局指标为住院死亡率。在83例患者中，考虑IAP（最大），31%的患者在入院时患有腹内高压，另有33%的患者在入院后出现腹内高压（23%和31%的患者患有IAP（平均））。主要危险因素为机械通气、急性呼吸窘迫综合征和液体复苏（相对危险度分别为5.26、3.19和2.50）。腹腔内高血压患者病情更重，死亡率更高（53%对27%，p = 0.02），并始终表现出更高的总和肾序贯器官衰竭评估评分、每日和累积体液平衡以及更低的滤过梯度。非幸存者有较高的IAP（max）、IAP（meaw）、液体平衡和较低的腹腔灌注压。腹腔隔室综合征的发生率为12%；20%的幸存下来。在调整急性生理和慢性健康评估11和共病（优势比1.15；95%可信区间，1.06-1.25;p = 0.001；优势比2.68；95%可信区间，1.27-5.67;p = 0.013）后，Logistic回归发现IAP（max）是死亡率的独立预测因子（优势比1.17；95%可信区间，1.05-1.30;p = 0.003）。具有IAP（平均值）和腹腔灌注压的模型也表现良好。受试者工作特征曲线下面积分别为81和83。结论：腹内高压，诊断为IAP（最大）或IAP（平均），是常见的，并显示出与死亡率的独立关联。腹内高压与更严重的器官衰竭，特别是肾脏和呼吸衰竭，以及延长重症监护病房的住院时间显著相关。
Objective: The objective of this study was to determine the epidemiology and outcomes of intra-abdominal hypertension in a heterogeneous intensive care unit population.Design: This was a prospective cohort study.Setting: This study was conducted at a medical-surgical intensive care unit in a university hospital.Patients: Study patients included all those consecutively admitted during 9 months, staying > 24 hrs, and requiring bladder catheterization.Measurements and Main Results: On admission, epidemiologic data and risk factors for intra-abdominal hypertension were studied; then, daily maximal and mean intra-abdominal pressures (IAP(max) and IAP(mean)), abdominal perfusion pressure, fluid balances, filtration gradient, and sequential organ failure assessment score, were registered. IAPs were recorded through a bladder catheter every 6 hrs until death, discharge, or along 7 days. Intra-abdominal hypertension was defined as IAP > 12 mm Hg. Abdominal compartment syndrome was defined as IAP >= mm Hg plus >= 1 new organ failure. Main outcome measure was hospital mortality. of 83 patients, considering IAP(max), 31% had intra-abdominal hypertension on admission and another 33% developed it after (23% and 31% with IAP(mean)). Main risk factors were mechanical ventilation, acute respiratory distress syndrome, and fluid resuscitation (relative risk, 5.26, 3.19, and 2.50, respectively). Patients with intra-abdominal hypertension were sicker, had higher mortality (53% vs. 27%, p =.02), and consistently showed higher total and renal sequential organ failure assessment score, daily and cumulative fluid balances, and lower filtration gradient. Non-survivors had higher IAP(max), IAP(meaw) and fluid balances and lower abdominal perfusion pressure. Abdominal compartment syndrome developed in 12%; 20% survived. Logistic regression identified IAP(max) as an independent predictor of mortality (odds ratio, 1.17; 95% confidence interval, 1.05-1.30; p =.003) after adjusting with Acute Physiology and Chronic Health Evaluation 11 and comorbidities (odds ratio, 1.15; 95% confidence interval, 1.06-1.25; p =.001; and odds ratio, 2.68; 95% confidence interval, 1.27-5.67; p =.013, respectively). Models with IAP(mean) and abdominal perfusion pressure also performed well. Areas under receiver operating characteristic curves were 81 and 83.Conclusions: Intra-abdominal hypertension, diagnosed either with IAP(max) or IAP(mean), was frequent and showed an independent association with mortality. Intra-abdominal hypertension was significantly associated with more severe organ failures, particularly renal and respiratory, and a prolonged intensive care unit stay.