Intra-abdominal pressure and intra-abdominal hypertension in critically ill obstetric patients: a prospective cohort
1Department of Anaesthesiology & Critical Care, University College of Medical Sciences & GTB Hospital, Delhi 110095, India.
Insights
Intra-abdominal hypertension is less common in critically ill pregnant patients than in general ICU populations. Normalizing intra-abdominal pressure after delivery improves survival, though it doesn't correlate with organ function.
Area of Science:
- Critical Care Medicine
- Obstetrics
- Abdominal Physiology
Background:
- Critically ill obstetric patients may present with risk factors for intra-abdominal hypertension (IAH).
- IAH is a condition characterized by elevated intra-abdominal pressure (IAP).
- Understanding IAH epidemiology in this population is crucial for patient management.
Purpose of the Study:
- To evaluate intra-abdominal pressure (IAP) in critically ill obstetric patients.
- To assess the effect of IAP on organ function.
- To determine the epidemiology of intra-abdominal hypertension (IAH) in this cohort.
Main Methods:
- Included obstetric patients admitted to the Intensive Care Unit (ICU) with expected stays >24 hours.
- Measured intra-abdominal pressure daily using a Foley catheter and intravesical pressure.
- Analyzed data for correlation with organ dysfunction and mortality.
Main Results:
- 101 patients enrolled; 6% had IAH (IAP ≥12mmHg).
- All patients with IAH were pregnant; normalization post-delivery improved outcomes in 4/6 cases.
- Weak correlation (r=0.211) between IAP and organ dysfunction; no significant difference in IAP between survivors and non-survivors.
Conclusions:
- IAH incidence in critically ill obstetric patients is lower than in mixed ICU populations, linked to pregnancy.
- Post-delivery IAP normalization correlates with improved survival.
- No significant correlation found between IAP, organ function, or mortality.
Background:
Critically ill obstetric patients may have risk factors for intra-abdominal hypertension. This study evaluated the intra-abdominal pressure and its effect on organ function and the epidemiology of intra-abdominal hypertension.
Methods:
Obstetric patients admitted to an Intensive Care Unit, with an anticipated stay greater than 24hours, were included. Intra-abdominal pressure was measured daily via a Foley catheter, based on intravesical pressure.
Results:
One-hundred-and-one patients were enrolled. The intra-abdominal pressure was 5-7mmHg in 34%; 7-12mmHg in 60%; and ≥12mmHg (intra-abdominal hypertension) in 6%. All six patients with intra-abdominal hypertension were pregnant at the time of admission. The intra-abdominal pressure in four patients normalized to <12mmHg following delivery, but in the remaining two it persisted ≥12mmHg and both these patients died. Correlation between intra-abdominal pressure and organ dysfunction was weak (r=0.211). Statistical comparison between patients with and without intra-abdominal hypertension for risk factors, daily intra-abdominal pressures, and Sequential Organ Failure Assessment score could not be done due to the disproportionately small number of patients with intra-abdominal hypertension as opposed to those without (6 versus 95). Intra-abdominal pressure did not significantly differ between survivors and non-survivors (8.5±1.1 vs 7.9±1.7mmHg, P=0.079).
Conclusions:
The incidence of intra-abdominal hypertension in critically ill obstetric patients was lower than previously defined for mixed Intensive Care Unit populations, with an association with the pregnant state. Normalization of intra-abdominal pressure after delivery was associated with better survival. There was no correlation between intra-abdominal pressure and organ function or mortality.
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