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首页> 外文期刊>Critical care medicine >Expanded measurements of intra-abdominal pressure do not increase the detection rate of intra-abdominal hypertension: A single-center observational study
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Expanded measurements of intra-abdominal pressure do not increase the detection rate of intra-abdominal hypertension: A single-center observational study

机译：腹腔内压力的扩展测量不会增加腹腔内高血压的检出率：单中心观察性研究

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OBJECTIVE:: Intra-abdominal hypertension may contribute to a poor outcome. Whether limiting intra-abdominal pressure measurements to preselected at-risk patients allows for sufficient detection of intra-abdominal hypertension is unclear. We aimed to clarify whether expanded intra-abdominal pressure monitoring results in an increased detection rate of intra-abdominal hypertension. DESIGN:: Retrospective observational study. SETTING:: General ICU of University Hospital. PATIENTS:: Consecutive adult ICU patients from 2004 to 2011. INTERVENTIONS:: Intra-abdominal pressure measurements in predefined at-risk patients. MEASUREMENTS AND MAIN RESULTS:: Prospectively collected data of 2,696 admissions were divided into three subgroups according to the intra-abdominal pressure measurement policy in different years: 1) 2004-2005, mechanically ventilated patients with at least one additional risk factor for intra-abdominal hypertension (multiple trauma, abdominal surgery, pancreatitis, post-cardiopulmonary resuscitation, fluid resuscitation > 5 L/24 hr, vasoactive or inotropic support, and renal replacement therapy); 2) 2006-2009, all mechanically ventilated patients expected to stay for more than or equal to 24 hours; and 3) 2010-2011, mechanically ventilated patients with a body mass index greater than 30 kg/m, positive end-expiratory pressure more than 10 cm H2O, PaO2/FIO2 less than 300, use of vasopressors/inotropes, pancreatitis, hepatic failure/cirrhosis with ascites, gastrointestinal bleeding, or postlaparotomy. In all, 2,696 patients were studied, and 1,241 patients (46.0%) underwent intra-abdominal pressure monitoring. The intra-abdominal pressure was measured in 31.7%, 55.6%, and 41.1% of patients during the first, second, and third time periods (p < 0.001), and intra-abdominal hypertension (intra-abdominal pressure ≥ 12 mm Hg) occurred in 19.9%, 20.3%, and 20.1% of patients, respectively (p = 0.972). The mean intra-abdominal pressure at admission day was an independent predictor of mortality in patients with intra-abdominal pressure measurements started within the first 24 hours (odds ratio, 1.046 [95% CI, 1.019-1.072]). The mortality of patients with intra-abdominal hypertension was 29.8% versus 18.6% in those without intra-abdominal hypertension (p < 0.001). CONCLUSIONS:: Expanding the measurement of intra-abdominal pressure to more than 50% of intensive care admissions does not increase the detection rate of intra-abdominal hypertension. In patients with intra-abdominal pressure monitoring, the mean intra-abdominal pressure on the admission day is an independent predictor of mortality.
机译：目的：腹内高压可能导致不良预后。目前尚不清楚将腹腔内压力测量值限制为预选的有风险的患者是否可以充分检测腹腔内高压。我们旨在阐明扩大腹腔内压力监测是否会导致腹腔内高血压的检出率增加。设计：：回顾性观察研究。地点：大学医院综合ICU。患者：2004年至2011年连续成人ICU患者。干预措施：预定义的高危患者的腹腔内压力测量。测量和主要结果：根据不同年份的腹腔内压力测量政策，分别收集了2696例入院患者的数据分为三个亚组：1）2004-2005年，机械通气患者至少有一个腹腔内其他危险因素高血压（多次创伤，腹部手术，胰腺炎，心肺复苏术后，液体复苏> 5 L / 24小时，血管活性或正性肌力支持和肾脏替代疗法）; 2）2006-2009年，所有机械通气患者均应停留超过或等于24小时;和3）2010-2011年，体重指数大于30 kg / m，呼气末正压大于10 cm H2O，PaO2 / FIO2小于300的机械通气患者，使用升压药/正性肌力药，胰腺炎，肝功能衰竭/肝硬化伴腹水，胃肠道出血或开腹手术。总共研究了2696例患者，并进行了1241例患者（46.0％）的腹腔内压力监测。在第一时间段，第二时间段和第三时间段（p <0.001）和腹腔内高血压（腹腔内压力≥12 mm Hg）的患者中，分别测量了31.7％，55.6％和41.1％的患者腹腔内压力分别发生在19.9％，20.3％和20.1％的患者中（p = 0.972）。入院当天的平均腹腔内压力是死亡率的独立预测指标，在开始的24小时内开始进行腹腔内压力测量（优势比为1.046 [95％CI，1.019-1.072]）。腹内高压患者的死亡率为29.8％，而无腹内高压的患者为18.6％（p <0.001）。结论：将腹腔内压的测量范围扩大到重症监护病房的50％以上并不会增加腹腔内高压的检出率。在有腹腔内压力监测的患者中，入院当天的平均腹腔内压力是死亡率的独立预测因子。

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