title: Intra-abdominal hypertension in patients with sellar region tumors.
abstract: BACKGROUND
  Data on intra-abdominal hypertension [IAH] and secondary abdominal compartment syndrome [ACS] due to neurological insults are limited.
  
  
  METHODS
  This was a prospective observational study conducted between January 2010 and January 2011 in the neurological ICU [NICU]. Forty-one consecutive patients with sellar region tumors [SRT] were enrolled into the study. If conservative therapy was ineffective in patients with ACS, thoracic epidural anesthesia [EA] was performed. Primary endpoint was defined as the efficacy of conservative treatment and EA in patients with IAH and ACS; secondary endpoint, the influence of IAH and ACS on outcomes.
  
  
  RESULTS
  Of the 41 patients, 13 (31.7%) had normal intra-abdominal pressure and 28 (68.3%) developed IAH, of whom 9 (22%) had ACS (group II). On average, IAH developed on the second postoperative day, while ACS, between the third and the fifth day. Multiple organ dysfunction developed in 3 (23.1%) patients of group I and in 23 (82%) patients of group II (p = 0.0003). Ileus due to gastrointestinal dysmotility was present in 6 (46.2%) patients of group I and in all patients of group II (p = 0.0001). Significant risk factors for ileus were diencephalon dysfunction (whole group - in 33 patients (80.5%); group I - in 6 patients (46.2%); group II - in 27 patients (96.4%), p = 0.0002) and sepsis (whole group - in 8 patients (19.5%); group I - no cases; group II - in 8 patients (28.6%), p = 0.03). Conservative treatment was effective in the majority of patients (78.9%) with IAH and only in 3 (33%) patients with ACS. Thoracic EA was performed in four patients with ACS with success. Length of stay in the NICU was 6.5 ± 4.6 days in group I and 24.1 ± 25.7 (p = 0.02) days in group II. Five out of nine (55.6%) patients with ACS died. None of these patients received EA. All patients with EA had favorable outcomes.
  
  
  CONCLUSIONS
  The development of IAH is common after SRT surgery. If conservative treatment is ineffective, EA can be considered in patients with secondary ACS. Further studies are warranted.
authors.affiliation: Department of Neurological Intensive Care Unit (NICU), Burdenko Neurosurgical Research Institute, 16 4th Tverskaya-Yamskaya, Moscow, 125047, Russia. Stan.Popugaev@yahoo.com.
authors.forename: Konstantin A
authors.initials: KA
authors.lastname: Popugaev
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authors.forename: Valeriy I
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authors.lastname: Lukianov