Advertisement

Abdominal compartment syndrome and intra-abdominal hypertension in critically ill patients: diagnostic value of computed tomography

  • S. Bouveresse
  • G. Piton
  • N. Badet
  • G. Besch
  • S. Pili-Floury
  • E. DelabrousseEmail author
Emergency Radiology
  • 24 Downloads

Abstract

Aims

The aims of the present work were to reevaluate, prospectively, the diagnostic value of already-described computed tomography (CT) landmarks of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) and to study the diagnostic value of some undescribed CT signs for the diagnosis of IAH and ACS.

Materials and methods

Consecutive patients admitted to the intensive care unit (ICU) in shock for whom an abdominal CT was clinically indicated were included. CT examinations were reviewed and scored by two reviewers for the 12 proposed CT features of IAH and ACS. Intravesical pressure (IVP) was measured for each patient. Imaging features and clinical data of patients with IAH (IVP ≥ 12 mmHg) were compared to those of patients with normal intra-abdominal pressure (IVP < 12 mmHg).

Results

Forty-one patients were included. Twenty-one patients (51%) presented IAH with an IVP value ≥ 12 mmHg. Four patients (10%) were considered to have ACS (10%). Only an increased peritoneal-to-abdominal height ratio (PAR) was associated with the presence of IAH (PAR = 0.45 [0.40–0.49] in patients with IVP < 12 mmHg and PAR = 0.52 [0.48–0.53] in patients with IVP ≥ 12 mmHg; p < 0.001). Increased PAR ≥ 0.52 had a specificity of 85% for IAH diagnosis.

Conclusion

The present study suggests that a PAR ≥ 0.52 could help radiologists to identify IAH on abdominal CT scan and could lead to adequate identification and/or treatment, even at early stages of IAH.

Key Points

CT is an efficient first-intention procedure to evaluate and follow up underlying conditions in critically ill patients at risk of IAH and ACS overcome.

Raising the possibility of an IAH on a CT examination is relevant information for the clinician.

The only factors associated with intra-abdominal hypertension were the peritoneal-to-abdominal height ratio (PAR) and the ratio of maximal anteroposterior to transverse abdominal diameter (which define the round belly sign when > 0.8).

Keywords

Intra-abdominal hypertension Sagittal abdominal diameter Intensive care units X-ray computed tomography Prospective studies 

Abbreviations

ACS

Abdominal compartment syndrome

CT

Computed tomography

IAH

Intra-abdominal hypertension

ICU

Intensive care unit

IVP

Intravesical pressure

PAR

Peritoneal-to-abdominal height ratio

RBS

Round belly sign

WSACS

World Society of the Abdominal Compartment Syndrome

Notes

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Prof. Eric Delabrousse.

Conflict of interest

The authors declare that they have no competing interests.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was obtained from some subjects in this study.

Written informed consent was not required for all the patients of this study because the subjects were critically patients.

Ethical approval

Institutional review board approval was obtained.

Methodology

• prospective

• observational

• performed at one institution

Supplementary material

330_2018_5994_MOESM1_ESM.docx (1.6 mb)
ESM 1 (DOCX 1671 kb)

References

  1. 1.
    Kirkpatrick AW, Roberts DJ, De Waele J et al (2013) 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 39:1190–1206CrossRefGoogle Scholar
  2. 2.
    Luckianow GM, Ellis M, Governale D, Kaplan LJ (2012) Abdominal compartment syndrome: risk factors, diagnosis, and current therapy. Crit Care Res Pract 2012:1–8CrossRefGoogle Scholar
  3. 3.
    Malbrain ML, Chiumello D, Pelosi P et al (2004) Prevalence of intra-abdominal hypertension in critically ill patients: a multicentre epidemiological study. Intensive Care Med 30:822–829CrossRefGoogle Scholar
  4. 4.
    Zhang HY, Liu D, Tang H et al (2015) Prevalence and diagnosis rate of intra-abdominal hypertension in critically ill adult patients: a single-center cross-sectional study. Chin J Traumatol 18:352–356CrossRefGoogle Scholar
  5. 5.
    Kim IB, Prowle J, Baldwin I, Bellomo R (2012) Incidence, risk factors and outcome associations of intra-abdominal hypertension in critically ill patients. Anaesth Intensive Care 40(79)Google Scholar
  6. 6.
    Strang SG, Van Lieshout EM, Verhoeven RA, Van Waes OJ, Verhofstad MH (2016) Recognition and management of intra-abdominal hypertension and abdominal compartment syndrome; a survey among Dutch surgeons. Eur J Trauma Emerg Surg 43:85–98Google Scholar
  7. 7.
    Iyer D, Rastogi P, Åneman A, D’Amours S (2014) Early screening to identify patients at risk of developing intra-abdominal hypertension and abdominal compartment syndrome. Acta Anaesthesiol Scand 58:1267–1275CrossRefGoogle Scholar
  8. 8.
    De Waele JJ, Hoste EA, Malbrain ML (2006) Decompressive laparotomy for abdominal compartment syndrome—a critical analysis. Crit Care 10:R51CrossRefGoogle Scholar
  9. 9.
    Arabadzhiev GM, Tzaneva VG, Peeva KG (2015) Intra-abdominal hypertension in the ICU—a prospective epidemiological study. Clujul Med 1957 88:188–195Google Scholar
  10. 10.
    Dalfino L, Tullo L, Donadio I, Malcangi V, Brienza N (2008) Intra-abdominal hypertension and acute renal failure in critically ill patients. Intensive Care Med 34:707–713.  https://doi.org/10.1007/s00134-007-0969-4
  11. 11.
    Kyoung KH, Hong SK (2015) The duration of intra-abdominal hypertension strongly predicts outcomes for the critically ill surgical patients: a prospective observational study. World J Emerg Surg 10Google Scholar
  12. 12.
    Malbrain MLNG, Chiumello D, Cesana BM et al (2014) 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 80:293–306PubMedGoogle Scholar
  13. 13.
    Kron IL, Harman PK, Nolan SP (1984) The measurement of intra-abdominal pressure as a criterion for abdominal re-exploration. Ann Surg 199:28–30CrossRefGoogle Scholar
  14. 14.
    Iberti TJ, Lieber CE, Benjamin E (1989) Determination of intra-abdominal pressure using a transurethral bladder catheter: clinical validation of the technique. Anesthesiology 70:47–50CrossRefGoogle Scholar
  15. 15.
    De Waele JJ, Kimball E, Malbrain M et al (2016) Decompressive laparotomy for abdominal compartment syndrome: decompressive laparotomy for abdominal compartment syndrome. Br J Surg 103:709–715CrossRefGoogle Scholar
  16. 16.
    Desie N, Willems A, De Laet I et al (2012) Intra-abdominal pressure measurement using the FoleyManometer does not increase the risk for urinary tract infection in critically ill patients. Ann Intensive Care 2(1)Google Scholar
  17. 17.
    Le Gall JR, Lemeshow S, Saulnier F (1993) A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA 270:2957–2963CrossRefGoogle Scholar
  18. 18.
    Kirkpatrick AW, Brenneman FD, McLean RF, Rapanos T, Boulanger BR (2000) Is clinical examination an accurate indicator of raised intra-abdominal pressure in critically injured patients? Can J Surg 43:207Google Scholar
  19. 19.
    Wachsberg RH, Sebastiano LL, Levine CD (1998) Narrowing of the upper abdominal inferior vena cava in patients with elevated intraabdominal pressure. Abdom Imaging 23:99–102CrossRefGoogle Scholar
  20. 20.
    Patel A, Lall CG, Jennings SG, Sandrasegaran K (2007) Abdominal compartment syndrome. AJR Am J Roentgenol 189:1037–1043CrossRefGoogle Scholar
  21. 21.
    Epelman M, Soudack M, Engel A, Halberthal M, Beck R (2002) Abdominal compartment syndrome in children: CT findings. Pediatr Radiol 32:319–322Google Scholar
  22. 22.
    Al-Bahrani AZ, Abid GH, Sahgal E, O'shea S, Lee S, Ammori BJ (2007) A prospective evaluation of CT features predictive of intra-abdominal hypertension and abdominal compartment syndrome in critically ill surgical patients. Clin Radiol 62:676–682Google Scholar
  23. 23.
    Wu J, Zhu Q, Zhu W, Chen W, Wang S (2014) Computed tomographic features of abdominal compartment syndrome complicated by severe acute pancreatitis. Zhonghua Yi Xue Za Zhi 94:3378–3381Google Scholar
  24. 24.
    Laffargue G, Taourel P, Saguintaah M, Lesnik A (2012) CT diagnosis of abdominal compartment syndrome. AJR Am J Roentgenol 178:771–772Google Scholar
  25. 25.
    Zissin R (2000) The significance of a positive round belly sign on CT. AJR Am J Roentgenol 175:267–267CrossRefGoogle Scholar
  26. 26.
    Moreno FL, Hagan AD, Holmen JR, Pryor TA, Strickland RD, Castle CH (1984) Evaluation of size and dynamics of the inferior vena cava as an index of right-sided cardiac function. Am J Cardiol 53:579–585Google Scholar
  27. 27.
    Pickhardt PJ, Shimony JS, Heiken JP, Buchman TG, Fisher AJ (1999) The abdominal compartment syndrome: CT findings. AJR Am J Roentgenol 173:575–579Google Scholar
  28. 28.
    Tarrant AM, Ryan MF, Hamilton PA, Benjaminov O (2008) A pictorial review of hypovolaemic shock in adults. Br J Radiol 81:252–257CrossRefGoogle Scholar
  29. 29.
    Ames JT, Federle MP (2009) CT hypotension complex (shock bowel) is not always due to traumatic hypovolemic shock. AJR Am J Roentgenol 192:W230–W235CrossRefGoogle Scholar
  30. 30.
    De Waele JJ, Malbrain ML, Kirkpatrick AW (2015) The abdominal compartment syndrome: evolving concepts and future directions. Crit Care 19.  https://doi.org/10.1186/s13054-015-0879-8
  31. 31.
    Smit M, Werner MJM, Lansink-Hartgring AO, Dieperink W, Zijlstra JG, van Meurs M (2016) How central obesity influences intra-abdominal pressure: a prospective, observational study in cardiothoracic surgical patients. Ann Intensive Care 6:99Google Scholar
  32. 32.
    Maddison L, Starkopf J, Reintam Blaser A (2016) Mild to moderate intra-abdominal hypertension: does it matter? World J Crit Care Med 5:96–102Google Scholar

Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  • S. Bouveresse
    • 1
  • G. Piton
    • 2
  • N. Badet
    • 1
  • G. Besch
    • 3
  • S. Pili-Floury
    • 3
  • E. Delabrousse
    • 1
    • 4
    • 5
    Email author
  1. 1.Department of RadiologyUniversity HospitalBesançonFrance
  2. 2.Department of Medical Intensive CareUniversity HospitalBesançonFrance
  3. 3.Department of Surgical Intensive CareUniversity HospitalBesançonFrance
  4. 4.EA 4662 Nanomedicine Lab, Imagery and TherapeuticsUniversity of Franche-ComtéBesançonFrance
  5. 5.Service de Radiologie Viscérale, CHRU BesançonHôpital Jean MinjozBesançonFrance

Personalised recommendations