Predictive factors associated with the development of abdominal compartment syndrome in the surgical intensive care
John McNelis1, Corrado P Marini, Antoni Jurkiewicz
1Department of Surgery, Northshore-Long Island Jewish Health System, Albert Einstein College of Medicine, New Hyde Park, NY, USA. jmcnelis@lij.edu
Hypothesis:
Intraoperative and postoperative variables contribute to the development of abdominal compartment syndrome (ACS) in general surgical patients.
Design:
Case-control cohort study of 44 patients admitted to the surgical intensive care unit from March 1, 1995, to January 1, 2001. Groups were matched with respect to age, sex, diagnosis, and procedure. Prospectively collected data included demographics, ventilatory parameters, fluid requirements, hemodynamic and oxygen-derived variables, length of stay, and mortality rates. Statistical analysis was done with the Fisher exact test and/or chi(2) analysis. Continuous variables were analyzed with multivariate and univariate analysis. Data are presented as mean +/- SD. Statistical significance is defined as P<.05.
Setting:
Long Island Jewish Medical Center (New Hyde Park, NY) is a large tertiary teaching hospital.
Patients:
Twenty-two patients admitted to the surgical intensive care unit who developed ACS, and 22 case-control patients without ACS.
Main Outcome Measures:
Identification of variables that predict the development of ACS.
Results:
Twenty-two patients with episodes of ACS (group 1) were examined and contrasted with 22 matched patients without ACS (group 2). Using univariate analysis, the groups differed with respect to 24-hour fluid administration and balance, number of emergency procedures, peak airway pressure, central venous pressure, pulmonary artery occlusion pressure, lengths of stay in the hospital and intensive care unit, and mortality rates. With multivariate analysis, only 24-hour fluid balance and peak airway pressure (group 1 vs group 2: mean +/- SD, 15.9 +/- 10.3 L vs 7.0 +/- 3.5 L, and 57.9 +/- 11.9 mm Hg vs 32.2 +/- 7.1 mm Hg, respectively; P<.05) remained significantly different. The groups did not differ with regard to age, cardiac index, operative blood loss, duration of surgery, intraoperative fluid input, or balance. A predictive equation for ACS development was created: P = 1/(1 +e(-z)), where z= -18.6763 + 0.1671 (peak airway pressure) + 0.0009 (fluid balance).
Conclusion:
The results of this study indicate that 24-hour fluid balance and peak airway pressure are 2 independent variables predictive of the development of ACS in nontrauma surgical patients.