[Intraabdominal hypertension and decompressive surgery. Clinical experience].
BACKGROUND
Increased intraabdominal pressure (IAP) is associated with higher complication and mortality rates. Decompressive surgery is the most effective treatment for abdominal hypertension in trauma and septic patients with IAP.


OBJECTIVE
To establish the association between IAP, complications, and mortality and to evaluate morbidity and mortality after decompressive surgery.


METHODS
We performed a prospective, analytical, longitudinal study designed in 2 phases. In the first phase, 17 patients (mean age = 66 years, range: 39-78) admitted to the intensive care unit who underwent abdominal surgery were studied. In the second phase, 47 patients (mean age = 65 years, range: 48-78) underwent decompressive surgery, 6 for abdominal trauma and 41 for postoperative peritonitis. In both phases, all patients were fitted with urinary, arterial, and pulmonary artery catheters. The following variables were recorded: hemodynamic, respiratory and renal parameters; IAP, APACHE II, complications, and mortality.


RESULTS
Patients with complications had significantly higher mean IAP (12.3 mm Hg; 95% CI, 10.7-13.9) than those without complications (7.9 mm Hg; 95% CI, 4.7-11.1) (p = 0.004). Patients that survived had a significantly lower mean IAP (8.7 mm Hg; 95% CI, 5.9-11.5) than those that died (12.4 mm Hg; 95% CI, 10.2-14.7) (p = 0.03). In patients who underwent decompressive surgery, a significant difference was found between APACHE II predicted mortality (40.4%) and observed mortality (25.5%) (p = 0.02). One patient with decompressive surgery developed an intestinal fistula.


CONCLUSIONS
Controlling IAP, prophylaxis against abdominal hypertension, recognizing abdominal hypertension and decompressive surgery are new parameters and new concepts to be considered in the treatment of critical surgical patients.
Navarro
Salvador
S
Servicio de Cirugía General y Digestiva, Consorci Sanitari Parc Taulí, Institut Universitari Parc Taulí, Universitat Autònoma de Barcelona, Parc Taulí s/n, 08208 Sabadell, Barcelona, Spain.
Rebasa
Pere
P
Vázquez
Antonia
A
Hernández
Raquel
R
Hidalgo
José Manuel
JM
Canovas
Gabriel
G
D000007:Abdominal Injuries / Q000601:surgery*; D000328:Adult; D000368:Aged; D019299:Decompression, Surgical; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics; D006801:Humans; D006973:Hypertension / Q000503:physiopathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000601:surgery*; D011446:Prospective Studies