title: Early screening to identify patients at risk of developing intra-abdominal hypertension and abdominal compartment syndrome.
abstract: BACKGROUND
  To develop a screening tool to identify patients at risk of developing intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) within 24 h of a patient's admission to intensive care unit (ICU).
  
  
  METHODS
  Prospective, observational study of 403 consecutively enrolled patients with an indwelling catheter, admitted to a mixed medical-surgical ICU in a tertiary referral, university hospital. Intra-abdominal pressure was measured at least twice daily and IAH and ACS defined as per consensus definitions.
  
  
  RESULTS
  Thirty-nine per cent of patients developed IAH and 2% developed ACS. Abdominal distension, hemoperitoneum/pneumoperitoneum/intra-peritoneal fluid collection, obesity, intravenous fluid received > 2.3 l, abbreviated Sequential Organ Failure Assessment score > 4 points and lactate > 1.4 mmol/l were identified as independent predictors of IAH upon admission to ICU. The presence of three or more of these risk factors at admission identified patients that would develop IAH with a sensitivity of 75% and a specificity of 76%, the development of grades II, III and IV IAH with a sensitivity of 91% and a specificity of 62%. Patients that developed IAH required a significantly longer duration of mechanical ventilation and ICU care. Patients that developed grades II-IV IAH had a significantly higher rate of ICU mortality.
  
  
  CONCLUSIONS
  IAH is a common clinical entity in the intensive care setting that is associated with morbidity and mortality. A screening tool, based on data readily available within a patient's first 24 h in ICU, was developed and effectively identified patients that required intra-abdominal pressure monitoring.
authors.affiliation: Intensive Care Unit, Liverpool Hospital, Sydney, NSW, Australia; Trauma Department, Liverpool Hospital, Sydney, NSW, Australia; South Western Sydney Clinical School, The University of New South Wales, Sydney, NSW, Australia.
authors.forename: D
authors.initials: D
authors.lastname: Iyer
authors.forename: P
authors.initials: P
authors.lastname: Rastogi
authors.forename: A
authors.initials: A
authors.lastname: Åneman
authors.forename: S
authors.initials: S
authors.lastname: D'Amours
mesh_terms: D018806:APACHE; D000368:Aged; D005260:Female; D006801:Humans; D059325:Intra-Abdominal Hypertension / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome