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Prevalence of intra-abdominal hypertension in critically ill patients: a multicentre epidemiological study

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Abstract

Objective

Although intra-abdominal hypertension (IAH) can cause dysfunction of several organs and raise mortality, little information is available on the incidence and risk factors for IAH in critically ill patients. This study assessed the prevalence of IAH and its risk factors in a mixed population of intensive care patients.

Design

A multicentre, prospective 1-day point-prevalence epidemiological study conducted in 13 ICUs of six countries.

Interventions

None.

Patients

Ninety-seven patients admitted for more than 24 h to one of the ICUs during the 1-day study period.

Methods

Intra-abdominal pressure (IAP) was measured four times (every 6 h) by the bladder pressure method. Data included the demographics, medical or surgical type of admission, SOFA score, etiological factors such as abdominal surgery, haemoperitoneum, abdominal infection, massive fluid resuscitation, and ileus and predisposing conditions such as hypothermia, acidosis, polytransfusion, coagulopathy, sepsis, liver dysfunction, pneumonia and bacteraemia.

Results

We enrolled 97 patients, mean age 64±15 years, 57 (59%) medical and 40 (41%) surgical admission, SOFA score of 6.5±4.0. Mean IAP was 9.8±4.7 mmHg. The prevalence of IAH (defined as IAP 12 mmHg or more) was 50.5 and 8.2% had abdominal compartment syndrome (defined as IAP 20 mmHg or more). The only risk factor significantly associated with IAH was the body mass index, while massive fluid resuscitation, renal and coagulation impairment were at limit of significance.

Conclusion

Although we found a quite high prevalence of IAH, no risk factors were reliably associated with IAH; consequently, to get valid information about IAH, IAP needs to be measured.

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Acknowledgements

The writers are indebted to the study coordinators, clinical research associates, medicine residents, and pulmonary/criticalcare fellows who participated in the data collection for thisstudy. The writers thank all the nurses from the participating ICUs for IAP measurements. The authors are indebted to Miss B. Depré for her advice and technical assistance with the preparation of the article. This work was carried out by the Critically Ill and Abdominal Hypertension (CIAH) Study Group. The participating centres and number of patients enrolled per country are as follows: Belgium (31): M. Malbrain (Europe Hospitals, Ste-Elisabeth Hospital, Brussels), Y. Debaveye (Europe Hospitals, Ste-Elisabeth Hospital, Brussels), D. Delmarcelle (Europe Hospitals, Ste-Elisabeth Hospital, Brussels), A. Wilmer (University Hospital UZ Gasthuisberg, Leuven), L. Jacquet (University Hospital St-Luc, Brussels), P.-F. Laterre (University Hospital St-Luc, Brussels), B. De Keulenaere (ACZA campus Stuivenberg, Antwerpen), R. Daelemans (ACZA campus Stuivenberg, Antwerpen), D. Denie (ACZA campus Stuivenberg, Antwerpen); Italy (33): M. Del Turco (University of Pisa, S. Chiara Hospital, Pisa), P. Cosimini (University of Pisa, S. Chiara Hospital, Pisa), M. Ranieri (University of Pisa, S. Chiara Hospital, Pisa), F. Giunta (University of Pisa, S. Chiara Hospital, Pisa), P. Pelosi (Ospedale di Circolo, Varese), D. Chiumello (Ospedale Maggiore Policlinico, Milano), L. Gattinoni (Ospedale Maggiore Policlinico, Milano), N. Brienza (Policlinico University of Bari, Bari), V. Malcagni (Policlinico University of Bari, Bari); Israel (8): J. Cohen (Rabin Medical Centre, Petah Tikva), O.B. Shimon (Rabin Medical Centre, Petah Tikva), P. Singer (Rabin Medical Centre, Petah Tikva); Austria (4): G. Frank (Hospital Wiener-Neustadt, Wiener-Neustadt), H. Trimmel (Hospital Wiener-Neustadt, Wiener-Neustadt); Brasil (12): A. Japiassù (Hospital Universitario Clementino, Federal University, Rio de Janeiro), F. Bozza (Federal University of Rio de Janeiro, Rio de Janeiro), P.C.P. Souza (Hospital de Clínicas Niterói, Rio de Janeiro); Australia (9): D. Bihari (Prince of Wales Hospital, Sydney), R. Innes (Prince of Wales Hospital, Sydney), E. Kurtop (Prince of Wales Hospital, Sydney).

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Authors and Affiliations

  1. Medical Intensive Care Unit, ACZA Campus Stuivenberg, Lange Beeldekensstraat 267, 2060 , Antwerp, Belgium

    Manu L. N. G. Malbrain, Bart L. De Keulenaer & Ronny Daelemans

  2. Intensive care Unit, Istituto di Anestesia e Rianimazione, Ospedale Maggiore Policlinico, Milan, Italy

    Davide Chiumello & Luciano Gattinoni

  3. Intensive Care unit, Ospedale di Circolo, Varese, Italy

    Paolo Pelosi

  4. Medical Intensive Care Unit, Division of Internal Medicine, University Hospital Gasthuisberg, Leuven, Belgium

    Alexander Wilmer

  5. Intensive Care Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy

    Nicola Brienza & Vincenzo Malcangi

  6. Intensive Care Unit, The Prince of Wales Hospital, Barker Street, Randwick, Australia

    David Bihari, Richard Innes & Elizabeth Kurtop

  7. General Intensive Care Unit, Rabin Medical Centre, Petah Tikva, Israel

    Jonathan Cohen & Pierre Singer

  8. Intensive Care Unit, Hospital Universitario Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil

    Andre Japiassu

  9. Department of Surgery, Anesthesia and Intensive Care Section, University of Pisa, S. Chiara Hospital, Pisa, Italy

    Monica Del Turco, P. Cosimini & Marco Ranieri

  10. Intensive Care Unit, University Hospital St-Luc, Brussels, Belgium

    Luc Jacquet & Pierre-François Laterre

Authors
  1. Manu L. N. G. Malbrain
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  2. Davide Chiumello
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  3. Paolo Pelosi
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  4. Alexander Wilmer
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  6. Vincenzo Malcangi
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  7. David Bihari
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  8. Richard Innes
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  9. Jonathan Cohen
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  10. Pierre Singer
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  11. Andre Japiassu
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  12. Elizabeth Kurtop
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  13. Bart L. De Keulenaer
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  14. Ronny Daelemans
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  15. Monica Del Turco
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  16. P. Cosimini
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  17. Marco Ranieri
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  18. Luc Jacquet
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  19. Pierre-François Laterre
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  20. Luciano Gattinoni
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Corresponding author

Correspondence to Manu L. N. G. Malbrain.

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Malbrain, M.L.N.G., Chiumello, D., Pelosi, P. et al. Prevalence of intra-abdominal hypertension in critically ill patients: a multicentre epidemiological study. Intensive Care Med 30, 822–829 (2004). https://doi.org/10.1007/s00134-004-2169-9

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  • DOI: https://doi.org/10.1007/s00134-004-2169-9

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