Skip to main content
Log in

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

  • Original
  • Published:
Intensive Care Medicine Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Malbrain MLNG (2001) Intra-abdominal pressure in the intensive care unit: clinical tool or toy? In: Vincent JL (ed) Yearbook of intensive care and emergency medicine. Springer, Berlin Heidelberg New York, pp 547–585

  2. Pelosi P, Aspesi M, Gamberoni C, Chiumello D, Severgnini P, Oggioni R, Tulli G, Malacrida R, Chiaranda M (2002) Measuring intra-abdominal pressure in the intensive care setting. Intensivmed 39:509–519

    Article  Google Scholar 

  3. Ivatury RR, Diebel L, Porter JM, Simon RJ (1997) Intra-abdominal hypertension and the abdominal compartment syndrome. Surg Clin North Am 77:783–800

    CAS  PubMed  Google Scholar 

  4. Iberti TJ, Lieber CE, Benjamin E (1989) Determination of intra-abdominal pressure using a transurethral bladder catheter: clinical validation of the technique. Anesthesiology 70:47–50

    CAS  PubMed  Google Scholar 

  5. Malbrain MLNG (1999) Abdominal pressure in the critically ill: measurement and clinical relevance. Intensive Care Med 25:1453–1458

    Article  CAS  PubMed  Google Scholar 

  6. Sugrue M, Jones F, Lee A, Buist MD, Deane S, Bauman A, Hillman K (1996) Intra-abdominal pressure and gastric intramucosal pH: Is there an association? World J Surg 20:988–991

    CAS  PubMed  Google Scholar 

  7. Collee GG, Lomax DM, Ferguson C, Hanson GC (1993) Bedside measurement of intra-abdominal pressure (IAP) via an indwelling naso-gastric tube: clinical validation of the technique. Intensive Care Med 19:478–480

    CAS  PubMed  Google Scholar 

  8. Ivatury RR, Porter JM, Simon RJ, Islam S, Ranjit J, Stahl WM (1998) Intra-abdominal hypertension after life-threatening penetrating abdominal trauma: prophylaxis, incidence, and clinical relevance to gastric mucosal pH and abdominal compartment syndrome. J Trauma 44:1016–1023

    CAS  PubMed  Google Scholar 

  9. Sugrue M, Buist MD, Hourihan F, Deane S, Bauman A, Hillman K (1995) Prospective study of intra-abdominal hypertension and renal function after laparotomy. Br J Surg 82:235–238

    CAS  PubMed  Google Scholar 

  10. Sugrue M, Jones F, Deane SA, Bishop G, Bauman A, Hillman K (1999) Intra-abdominal hypertension is an independent cause of postoperative renal impairment. Arch Surg 134:1082–1085

    CAS  PubMed  Google Scholar 

  11. Diebel LN, Wilson RF, Dulchavsky SA, Saxe J (1992) Effect of increased intra-abdominal pressure on hepatic arterial, portal venous, and hepatic microcirculatory blood flow. J Trauma 33:279–283

    CAS  PubMed  Google Scholar 

  12. Diebel LN, Dulchavsky SA, Brown WJ (1997) Splanchnic ischemia and bacterial translocation in the abdominal compartment syndrome. J Trauma 43:852–855

    CAS  PubMed  Google Scholar 

  13. Gattinoni L, Pelosi P, Suter PM, Pedoto A, Vercesi P, Lissoni A (1998) Acute respiratory distress syndrome caused by pulmonary and extrapulmonary disease. Different syndromes? Am J Respir Crit Care Med 158:3–11

    CAS  PubMed  Google Scholar 

  14. Bloomfield GL, Ridings PC, Blocher CR, Marmarou A, Sugerman HJ (1996) Effects of increased intra-abdominal pressure upon intracranial and cerebral perfusion pressure before and after volume expansion. J Trauma 40:936–941

    CAS  PubMed  Google Scholar 

  15. Cullen DJ, Coyle JP, Teplick R, Long MC (1989) Cardiovascular, pulmonary, and renal effects of massively increased intra-abdominal pressure in critically ill patients. Crit Care Med 17:118–121

    CAS  PubMed  Google Scholar 

  16. Schein M, Ivatury R (1998) Intra-abdominal hypertension and the compartment syndrome. Br J Surg 85:1027–1028

    CAS  PubMed  Google Scholar 

  17. Ertel W, Oberholzer A, Platz A, Stocker R, Trentz O (2000) Incidence and clinical pattern of the abdominal compartment syndrome after “damage-control” laparotomy in 311 patients with severe abdominal and/or pelvic trauma. Crit Care Med 28:1747–1753

    CAS  PubMed  Google Scholar 

  18. Cheatham ML, Safcsak K (1998) Intra-abdominal pressure: a revised method for measurement. J Am Coll Surg 186:594–595

    CAS  PubMed  Google Scholar 

  19. Raeburn CD, Moore EE, Biffl WL, Johnson JL, Meldrum DR, Offner PJ, Franciose RJ, Burch JM (2001) The abdominal compartment syndrome is a morbid complication of postinjury damage control surgery. Am J Surg 182:542–546

    Article  CAS  PubMed  Google Scholar 

  20. Vincent JL, Moreno R, Takala J, Willatts S, De Mendonca A, Bruining H, Reinhart CK, Suter PM, Thijs LG (1996) The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. Intensive Care Med 22:707–710

    Article  PubMed  Google Scholar 

  21. Bone RC, Sibbald WJ, Sprung CL (1992) The ACCP-SCCM consensus conference on sepsis and organ failure. Chest 101:1481–1483

    CAS  PubMed  Google Scholar 

  22. Malbrain M (2000) Abdominal pressure in the critically ill. Curr Opin Crit Care 6:17–29

    Article  Google Scholar 

  23. Meldrun DR, Moore FA, Moore EE, Franciose RJ, Sauaia A, Burch JM (1997) Prospective characterization and selective management of the abdominal compartment syndrome. Am J Surg 174:667–673

    CAS  PubMed  Google Scholar 

  24. Fahrmeir L, Tutz G (1991) Multivariate statistical modelling based on generalized linear models. Springer, Berlin Heidelberg New York

  25. Sugrue M, Bauman A, Jones F, Bishop G, Flabouris A, Parr M, Stewart A, Hillman K, Deane SA (2002) Clinical examination is an inaccurate predictor of intra-abdominal pressure. World J Surg 26:1428–1431

    Article  PubMed  Google Scholar 

  26. Castillo M, Lis RJ, Ulrich H, Rivera G, Hanf C, Kvetan V (1998) Clinical estimate compared to intra-abdominal pressure measurement. Crit Care Med 26 (Suppl1):78A (Abstract)

    Article  Google Scholar 

  27. Platell CF, Hall J, Clarke G, Lawrence-Brown M (1990) Intra-abdominal pressure and renal function after surgery to the abdominal aorta. Aust N Z J Surg 60 : 213–6.

    Google Scholar 

  28. Kron IL, Harman PK, Nolan SP (1984) The measurement of intra-abdominal pressure as a criterion for abdominal re-exploration. Am Surg 199:28–30

    CAS  Google Scholar 

  29. Sugrue M, Jones F, Janjua KJ, Deane SA, Bristow P, Hillman K (1998) Temporary abdominal closure: a prospective evaluation of its effects on renal and respiratory function. J Trauma 45:914–921

    CAS  PubMed  Google Scholar 

  30. Biancofiore G, Bindi ML, Romanelli AM, Boldrini A, Consani G, Bisà M, Filippini F, Vagelli A, Mosca F (2003) Intra-abdominal pressure monitoring in liver transplant recipients: a prospective study. Intensive Care Med 29:30–36

    PubMed  Google Scholar 

  31. Balogh Z, McKinley BA, Cocanour CS, Kozar RA, Valdivia A, Sailors RM, Moore FA (2003) Supranormal trauma resuscitation causes more cases of abdominal compartment syndrome. Arch Surg 138:637–643

    Article  PubMed  Google Scholar 

  32. Balogh Z, McKinley BA, Holcomb JB, Miller CC, Cocanour CS, Kozr RA, Valdivia A, Ware DN, Moore FA (2003) Both primary and secondary abdominal compartment syndrome can be predicted early and are harbingers of multiple organ failure. J Trauma 54:848–861

    PubMed  Google Scholar 

  33. Fietsam R, Villalba M, Glover JL, Clark K (1989) Intra-abdominal compartment syndrome as a complication of ruptured abdominal aortic aneurysm repair. Am Surg 55:396–402

    PubMed  Google Scholar 

  34. Morris JA, Eddy VA, Blinman TA, Rutherford EJ, Sharp KW (1993) The staged laparotomy for trauma: issues in unpacking and reconstruction. Ann Surg 217:576–586.

    PubMed  Google Scholar 

  35. McNelis J, Marini CP, Jurkiewicz A, Fields S, Caplin D, Stein D, Ritter G, Nathan I, Simms H (2002) Predictive factors associated with the development of abdominal compartment syndrome in the surgical intensive care unit. Arch Surg 137:133–136

    Article  PubMed  Google Scholar 

  36. McNelis J, Marini CP, Simms HH (2003) Abdominal compartment syndrome: clinical manifestations and predictive factors. Curr Opin Crit Care 9:133–136

    Article  PubMed  Google Scholar 

Download references

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).

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Manu L. N. G. Malbrain.

Rights and permissions

Reprints and permissions

About this article

Cite this article

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

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

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

Keywords

Navigation