Incidence, Risk Factors, and Outcomes of Intra-Abdominal Hypertension in Critically Ill Patients-A Prospective Multicenter Study (IROI Study)

Incidence Risk Factors Outcomes

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Objectives: To identify the prevalence, risk factors, and outcomes of intra-abdominal hypertension in a mixed multicenter ICU population.

Design: Prospective observational study.

Setting: Fifteen ICUs worldwide.

Patients: Consecutive adult ICU patients with a bladder catheter.

Interventions: None.

Measurements and Main Results: Four hundred ninety-one patients were included. Intra-abdominal pressure was measured a minimum of every 8 hours. Subjects with a mean intra-abdominal pressure equal to or greater than 12 mm Hg were defined as having intra-abdominal hypertension. Intra-abdominal hypertension was present in 34.0% of the patients on the day of ICU admission (159/467) and in 48.9% of the patients (240/491) during the observation period. The severity of intra-abdominal hypertension was as follows: grade I, 47.5%; grade II, 36.6%; grade III, 11.7%; and grade IV, 4.2%. The severity of intra-abdominal hypertension during the first 2 weeks of the ICU stay was identified as an independent predictor of 28-and 90-day mortality, whereas the presence of intra-abdominal hypertension on the day of ICU admission did not predict mortality. Body mass index, Acute Physiology and Chronic Health Evaluation II score greater than or equal to 18, presence of abdominal distension, absence of bowel sounds, and positive end-expiratory pressure greater than or equal to 7 cm H2O were independently associated with the development of intra-abdominal hypertension at any time during the observation period. In subjects without intra-abdominal hypertension on day 1, body mass index combined with daily positive fluid balance and positive end-expiratory pressure greater than or equal to 7 cm H2O (as documented on the day before intra-abdominal hypertension occurred) were-associated with the development of intraabdominal hypertension during the first week in the ICU.

Conclusions: In our mixed ICU patient cohort, intra-abdominal hypertension occurred in almost half of all subjects and was twice as prevalent in mechanically ventilated patients as in spontaneously breathing patients. Presence and severity of intra-abdominal hypertension during the observation period significantly and independently increased 28-and 90-day mortality. Five admission day variables were independently associated with the presence or development of intra-abdominal hypertension. Positive fluid balance was associated with the development of intra-abdominal hypertension after day 1.

Original languageEnglish
Pages (from-to)535-542
Number of pages8
JournalCritical Care Medicine
Volume47
Issue number4
DOIs
Publication statusPublished - Apr 2019

Cite this

@article{1e5d86c08b6544678bb11df4b3afbea0,
title = "Incidence, Risk Factors, and Outcomes of Intra-Abdominal Hypertension in Critically Ill Patients-A Prospective Multicenter Study (IROI Study)",
abstract = "Objectives: To identify the prevalence, risk factors, and outcomes of intra-abdominal hypertension in a mixed multicenter ICU population.Design: Prospective observational study.Setting: Fifteen ICUs worldwide.Patients: Consecutive adult ICU patients with a bladder catheter.Interventions: None.Measurements and Main Results: Four hundred ninety-one patients were included. Intra-abdominal pressure was measured a minimum of every 8 hours. Subjects with a mean intra-abdominal pressure equal to or greater than 12 mm Hg were defined as having intra-abdominal hypertension. Intra-abdominal hypertension was present in 34.0{\%} of the patients on the day of ICU admission (159/467) and in 48.9{\%} of the patients (240/491) during the observation period. The severity of intra-abdominal hypertension was as follows: grade I, 47.5{\%}; grade II, 36.6{\%}; grade III, 11.7{\%}; and grade IV, 4.2{\%}. The severity of intra-abdominal hypertension during the first 2 weeks of the ICU stay was identified as an independent predictor of 28-and 90-day mortality, whereas the presence of intra-abdominal hypertension on the day of ICU admission did not predict mortality. Body mass index, Acute Physiology and Chronic Health Evaluation II score greater than or equal to 18, presence of abdominal distension, absence of bowel sounds, and positive end-expiratory pressure greater than or equal to 7 cm H2O were independently associated with the development of intra-abdominal hypertension at any time during the observation period. In subjects without intra-abdominal hypertension on day 1, body mass index combined with daily positive fluid balance and positive end-expiratory pressure greater than or equal to 7 cm H2O (as documented on the day before intra-abdominal hypertension occurred) were-associated with the development of intraabdominal hypertension during the first week in the ICU.Conclusions: In our mixed ICU patient cohort, intra-abdominal hypertension occurred in almost half of all subjects and was twice as prevalent in mechanically ventilated patients as in spontaneously breathing patients. Presence and severity of intra-abdominal hypertension during the observation period significantly and independently increased 28-and 90-day mortality. Five admission day variables were independently associated with the presence or development of intra-abdominal hypertension. Positive fluid balance was associated with the development of intra-abdominal hypertension after day 1.",
keywords = "intra-abdominal hypertension, intra-abdominal pressure, prevalence, risk factors, ABDOMINAL COMPARTMENT SYNDROME, INTERNATIONAL-CONFERENCE, PRESSURE, EXPERTS",
author = "{Incidence Risk Factors Outcomes} and Blaser, {Annika Reintam} and Adrian Regli and {De Keulenaer}, Bart and Kimball, {Edward J.} and Liis Starkopf and Davis, {Wendy A.} and Patrick Greiffenstein and Joel Starkopf and Annamaria Palermo and Kadri Tamme and Liivi Maddison and Triin Jakobson and Mikhail Kirov and Alexey Smetkin and Yana Ilyina and Andrey Litvin and Anastasiya Kazlova and Aliaksandr Filatov and Francisco Pracca and Gustavo Sosa and {Dos Santos}, Maicol and Ioana Grigoras and Irina Ristescu and Adina Blejusca and Zsolt Bodnar and Edit Tidrenczel and Gina Oliveira and Ana Albuquerque and Manuela Fernandes and Ulle Kirsimagi and Ordonez, {Carlos A.} and Ramiro Manzano-Nunez and Pereira, {Bruno M.} and Moore, {Margaret M.} and Wojciech Dabrowski",
year = "2019",
month = "4",
doi = "10.1097/CCM.0000000000003623",
language = "English",
volume = "47",
pages = "535--542",
journal = "Critical Care Medicine",
issn = "0090-3493",
publisher = "Lippincott Williams & Wilkins",
number = "4",

}

Incidence, Risk Factors, and Outcomes of Intra-Abdominal Hypertension in Critically Ill Patients-A Prospective Multicenter Study (IROI Study). / Incidence Risk Factors Outcomes.

In: Critical Care Medicine, Vol. 47, No. 4, 04.2019, p. 535-542.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Incidence, Risk Factors, and Outcomes of Intra-Abdominal Hypertension in Critically Ill Patients-A Prospective Multicenter Study (IROI Study)

AU - Incidence Risk Factors Outcomes

AU - Blaser, Annika Reintam

AU - Regli, Adrian

AU - De Keulenaer, Bart

AU - Kimball, Edward J.

AU - Starkopf, Liis

AU - Davis, Wendy A.

AU - Greiffenstein, Patrick

AU - Starkopf, Joel

AU - Palermo, Annamaria

AU - Tamme, Kadri

AU - Maddison, Liivi

AU - Jakobson, Triin

AU - Kirov, Mikhail

AU - Smetkin, Alexey

AU - Ilyina, Yana

AU - Litvin, Andrey

AU - Kazlova, Anastasiya

AU - Filatov, Aliaksandr

AU - Pracca, Francisco

AU - Sosa, Gustavo

AU - Dos Santos, Maicol

AU - Grigoras, Ioana

AU - Ristescu, Irina

AU - Blejusca, Adina

AU - Bodnar, Zsolt

AU - Tidrenczel, Edit

AU - Oliveira, Gina

AU - Albuquerque, Ana

AU - Fernandes, Manuela

AU - Kirsimagi, Ulle

AU - Ordonez, Carlos A.

AU - Manzano-Nunez, Ramiro

AU - Pereira, Bruno M.

AU - Moore, Margaret M.

AU - Dabrowski, Wojciech

PY - 2019/4

Y1 - 2019/4

N2 - Objectives: To identify the prevalence, risk factors, and outcomes of intra-abdominal hypertension in a mixed multicenter ICU population.Design: Prospective observational study.Setting: Fifteen ICUs worldwide.Patients: Consecutive adult ICU patients with a bladder catheter.Interventions: None.Measurements and Main Results: Four hundred ninety-one patients were included. Intra-abdominal pressure was measured a minimum of every 8 hours. Subjects with a mean intra-abdominal pressure equal to or greater than 12 mm Hg were defined as having intra-abdominal hypertension. Intra-abdominal hypertension was present in 34.0% of the patients on the day of ICU admission (159/467) and in 48.9% of the patients (240/491) during the observation period. The severity of intra-abdominal hypertension was as follows: grade I, 47.5%; grade II, 36.6%; grade III, 11.7%; and grade IV, 4.2%. The severity of intra-abdominal hypertension during the first 2 weeks of the ICU stay was identified as an independent predictor of 28-and 90-day mortality, whereas the presence of intra-abdominal hypertension on the day of ICU admission did not predict mortality. Body mass index, Acute Physiology and Chronic Health Evaluation II score greater than or equal to 18, presence of abdominal distension, absence of bowel sounds, and positive end-expiratory pressure greater than or equal to 7 cm H2O were independently associated with the development of intra-abdominal hypertension at any time during the observation period. In subjects without intra-abdominal hypertension on day 1, body mass index combined with daily positive fluid balance and positive end-expiratory pressure greater than or equal to 7 cm H2O (as documented on the day before intra-abdominal hypertension occurred) were-associated with the development of intraabdominal hypertension during the first week in the ICU.Conclusions: In our mixed ICU patient cohort, intra-abdominal hypertension occurred in almost half of all subjects and was twice as prevalent in mechanically ventilated patients as in spontaneously breathing patients. Presence and severity of intra-abdominal hypertension during the observation period significantly and independently increased 28-and 90-day mortality. Five admission day variables were independently associated with the presence or development of intra-abdominal hypertension. Positive fluid balance was associated with the development of intra-abdominal hypertension after day 1.

AB - Objectives: To identify the prevalence, risk factors, and outcomes of intra-abdominal hypertension in a mixed multicenter ICU population.Design: Prospective observational study.Setting: Fifteen ICUs worldwide.Patients: Consecutive adult ICU patients with a bladder catheter.Interventions: None.Measurements and Main Results: Four hundred ninety-one patients were included. Intra-abdominal pressure was measured a minimum of every 8 hours. Subjects with a mean intra-abdominal pressure equal to or greater than 12 mm Hg were defined as having intra-abdominal hypertension. Intra-abdominal hypertension was present in 34.0% of the patients on the day of ICU admission (159/467) and in 48.9% of the patients (240/491) during the observation period. The severity of intra-abdominal hypertension was as follows: grade I, 47.5%; grade II, 36.6%; grade III, 11.7%; and grade IV, 4.2%. The severity of intra-abdominal hypertension during the first 2 weeks of the ICU stay was identified as an independent predictor of 28-and 90-day mortality, whereas the presence of intra-abdominal hypertension on the day of ICU admission did not predict mortality. Body mass index, Acute Physiology and Chronic Health Evaluation II score greater than or equal to 18, presence of abdominal distension, absence of bowel sounds, and positive end-expiratory pressure greater than or equal to 7 cm H2O were independently associated with the development of intra-abdominal hypertension at any time during the observation period. In subjects without intra-abdominal hypertension on day 1, body mass index combined with daily positive fluid balance and positive end-expiratory pressure greater than or equal to 7 cm H2O (as documented on the day before intra-abdominal hypertension occurred) were-associated with the development of intraabdominal hypertension during the first week in the ICU.Conclusions: In our mixed ICU patient cohort, intra-abdominal hypertension occurred in almost half of all subjects and was twice as prevalent in mechanically ventilated patients as in spontaneously breathing patients. Presence and severity of intra-abdominal hypertension during the observation period significantly and independently increased 28-and 90-day mortality. Five admission day variables were independently associated with the presence or development of intra-abdominal hypertension. Positive fluid balance was associated with the development of intra-abdominal hypertension after day 1.

KW - intra-abdominal hypertension

KW - intra-abdominal pressure

KW - prevalence

KW - risk factors

KW - ABDOMINAL COMPARTMENT SYNDROME

KW - INTERNATIONAL-CONFERENCE

KW - PRESSURE

KW - EXPERTS

U2 - 10.1097/CCM.0000000000003623

DO - 10.1097/CCM.0000000000003623

M3 - Article

VL - 47

SP - 535

EP - 542

JO - Critical Care Medicine

JF - Critical Care Medicine

SN - 0090-3493

IS - 4

ER -