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Intra-abdominal pressure during and after cardiac surgery: a single-centre prospective cohort study
Émilie Richer-Séguin1, Christian Ayoub1, Jean-Sébastien Lebon1
1Department of Anesthesia, Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montreal, QC, Canada.
Insights
Intra-abdominal hypertension (IAH) is common in cardiac surgery patients, affecting over half during the procedure. However, this study found no association between intraoperative IAH and adverse outcomes like acute kidney injury.
Area of Science:
- Cardiology
- Critical Care Medicine
- Surgical Outcomes
Background:
- Intra-abdominal hypertension (IAH) is linked to poor outcomes in various clinical settings.
- The prevalence and impact of IAH specifically in cardiac surgery patients remain largely uncharacterized.
Purpose of the Study:
- To determine the incidence of IAH in patients undergoing cardiac surgery.
- To investigate the association between IAH and patient characteristics.
- To assess the relationship between IAH and postoperative outcomes such as mortality, acute kidney injury (AKI), and length of stay.
Main Methods:
- A prospective cohort study was conducted at a single center.
- Intra-abdominal pressure (IAP) was measured at three time points: after anesthesia, after surgery, and 2 hours post-ICU admission.
- IAH was defined as IAP ≥ 12 mm Hg. Postoperative outcomes included death, AKI, and ICU/hospital length of stay.
Main Results:
- IAH was highly prevalent, observed in 55% of patients post-anesthesia and 60% post-surgery.
- IAP showed independent associations with body mass index, central venous pressure, and mean pulmonary artery pressure.
- Intraoperative IAH was not significantly associated with adverse outcomes, including AKI.
Conclusions:
- Intra-abdominal hypertension is a frequent finding in patients during cardiac surgery.
- Despite its high prevalence, the clinical significance of intraoperative IAH in this population requires further investigation as it was not linked to adverse outcomes in this study.
Purpose:
While intra-abdominal hypertension (IAH) has been associated with adverse outcomes in multiple settings, the epidemiology and clinical implications of IAH in the context of cardiac surgery are less known. In this study, we aimed to describe the prevalence of IAH in patients undergoing cardiac surgery and determine its association with patient characteristics and postoperative outcomes.
Methods:
We conducted a single-centre prospective cohort study in which intra-abdominal pressure was measured in the operating room after general anesthesia (T1), after the surgical procedure (T2), and two hours after intensive care unit (ICU) admission (T3) in a subset of patients. Intra-abdominal hypertension was defined as intra-abdominal pressure (IAP) ≥ 12 mm Hg. Postoperative outcomes included death, acute kidney injury (AKI), and length of stay in the ICU and hospital.
Results:
A total of 513 IAP measurements were obtained from 191 participants in the operating room and 131 participants in the ICU. Intra-abdominal hypertension was present in 105/191 (55%) at T1, 115/191 (60%) at T2, and 31/131 (24%) at T3. Intra-abdominal pressure was independently associated with body mass index, central venous pressure, and mean pulmonary artery pressure but was not associated with cumulative fluid balance. Intraoperative IAH was not associated with adverse outcomes including AKI.
Conclusions:
Intra-abdominal hypertension is very common during cardiac surgery but its clinical implications are uncertain.
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