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

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).

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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

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Correspondence to E. Delabrousse.

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Guarantor

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

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The authors declare that they have no competing interests.

Statistics and biometry

One of the authors has significant statistical expertise.

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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.

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Institutional review board approval was obtained.

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• prospective

• observational

• performed at one institution

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Bouveresse, S., Piton, G., Badet, N. et al. Abdominal compartment syndrome and intra-abdominal hypertension in critically ill patients: diagnostic value of computed tomography. Eur Radiol 29, 3839–3846 (2019). https://doi.org/10.1007/s00330-018-5994-x

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Keywords

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