title: Expanded measurements of intra-abdominal pressure do not increase the detection rate of intra-abdominal hypertension: a single-center observational study.
abstract: 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.
  
  
  METHODS
  Retrospective observational study.
  
  
  METHODS
  General ICU of University Hospital.
  
  
  METHODS
  Consecutive adult ICU patients from 2004 to 2011.
  
  
  METHODS
  Intra-abdominal pressure measurements in predefined at-risk patients.
  
  
  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.
authors.affiliation: 1Department of Anesthesiology and Intensive Care, University of Tartu, Tartu, Estonia. 2General ICU, Department of Anesthesiology and Intensive Care, Tartu University Hospital, Tartu, Estonia.
authors.forename: Annika Reintam
authors.initials: AR
authors.lastname: Blaser
authors.forename: Silver
authors.initials: S
authors.lastname: Sarapuu
authors.forename: Kadri
authors.initials: K
authors.lastname: Tamme
authors.forename: Joel
authors.initials: J
authors.lastname: Starkopf
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003935:Diagnostic Techniques, Cardiovascular; D005260:Female; D006801:Humans; D059325:Intra-Abdominal Hypertension / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult