PREVALENCE AND OUTCOMES OF INTRA-ABDOMINAL HYPERTENSION IN CRITICALLY ILL PATIENTS IN A MIXED INTENSIVE CARE POPULATION

Abstract

Intra-abdominal hypertension (IAH) is a condition with significant morbidity and mortality risks in ICU patients, particularly when it escalates to Abdominal Compartment Syndrome (ACS). IAH and ACS can have detrimental effects like, reduced cardiac output, decreased splanchnic blood flow, and renal impairment. Notably, the prevalence of IAH can be as high as 50.5% among ICU patients. Nevertheless, this condition still demands attention in numerous healthcare facilities, including Ghana. The main objective of this study was to investigate the prevalence and prognostic implications of IAH in a mixed surgical and medical ICU environment

MATERIALS AND METHODS The study participants were adult patients admitted to the Main ICU of Komfo Anokye Teaching Hospital. Intra-abdominal pressure was measured on admission and every six hours during the initial 48 hours of admission or until the patient's discharge or demise. The modified Krohn's method was employed to carry out these measurements. The Sequential Organ Failure Assessment (SOFA) scores of the participants were calculated daily to evaluate the extent of organ dysfunction. The baseline SOFA score on admission served as the reference point for comparisons. This allowed for a comparison between the group with IAH and the group with normal intra-abdominal pressure, aiming to ascertain whether IAH significantly impacted SOFA scores as a metric for organ dysfunction. The impact of intra-abdominal pressure on critical outcome measures such as ventilator-free days and length of stay in ICU were also measured.

RESULTS AND ANALYSIS Ninety participants were enrolled in the study consecutively. The results of the same were analysed. The mean age of participants was 44.3(S. D 17.9, CI=40.4-48.03). Males represented the majority of participants with 53.3% while females formed 46.6%. Intra-abdominal hypertension was defined as “IAP ≥ 12mmHg” according to the WSACS consensus guidelines while abdominal compartment syndrome was defined as “IAP ≥ 20mmHg with new onset organ failure”. The prevalence of IAH was 47% (95% CI 0.36-0.57) and that of ACS was 1.1% of the general population and 2.38% of the cohort that developed intra-abdominal hypertension. Identified risk factors for IAH included Mechanical Ventilation (p-value 0.004), positive fluid balance (p-value 0.028), obesity (p-value 0.073) and massive fluid resuscitation (p-value 0.012). Other identified risk factors included abdominal surgery, major trauma, Acidosis and sepsis but these were not statistically significant. The mean SOFA score on day one for all participants was 7.3±3.9 which was lower than that of the group that developed IAH and higher than the normal IAP group. Mean SOFA scores worsened significantly in the IAH group over the first 48 hours but reduced in the normal IAP group. IAH did not significantly prolong the ICU length of stay. However, the IAH group had significantly less ventilator-free days than the normal IAP group.

CONCLUSION The prevalence of IAH was 47% in the KATH ICU. IAH increased mean SOFA scores and increased ventilator dependence. It is crucial to have protocols for identifying and managing intra-abdominal hypertension to improve ICU outcomes.