Incidence, Risk Factors, and Prognosis of Intra-Abdominal Hypertension in Critically Ill Children: A Prospective Epidemiological Study.
OBJECTIVE
To assess the incidence, risk factors, and outcomes of intra-abdominal hypertension (IAH) in a pediatric intensive care unit (PICU).


METHODS
Prospective cohort study from January 2011 to January 2013. All children consecutively admitted to the PICU, staying more than 24 hours and requiring bladder catheterization, were included in the study. On admission, demographic data and risk factors for IAH were studied. The intra-abdominal pressure was measured every 6 hours through a bladder catheter until discharge, death, or removal of the catheter.


RESULTS
Of the 175 patients, 22 (12.6%) had IAH and 7 (4%) had abdominal compartment syndrome during the intensive care unit (ICU) stay. The independent risk factors associated with IAH were the presence of abdominal distension (odds ratio [OR] 7.1; 95% confidence interval [CI], 2.6-19.9; P < .0001) and a plateau pressure of more than 30 cm H2O (OR 6.42; 95% CI, 2.13-19.36; P = .01). The presence of IAH was associated with higher mortality (40.9% vs 15.6%; P = .01) and prolonged ICU stay (19.5 [3-97] vs 8 [1-104] days, OR 1.02; 95% CI, 1.00-1.04; P = .02). Thirty-three (18.8%) patients died in the ICU, and IAH was an independent risk factor for mortality (OR 6.98; 95% CI, 1.75-27.86; P = .006).


CONCLUSIONS
Intra-abdominal hypertension does occur in about 13% of the critically ill children, albeit less frequently than adult patients, probably related to a better compliance of the abdominal wall. The presence of abdominal distension and a plateau pressure of more than 30 cm H2O was found to be independent predictors of IAH. Children with IAH had higher mortality rate and more prolonged ICU stay.
Division of Pediatric Intensive Care, Department of Pediatrics, Prince Sultan Military Medical City, Riyadh, Saudi Arabia thabetfarah@yahoo.fr.
Farah Chedly
FC
Thabet
Department of Family and Community Medicine, Faculty of Medicine of Sousse, Sousse, Tunisia.
Iheb Mohamed
IM
Bougmiza
Division of Pediatric Intensive Care, Department of Pediatrics, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
May Said
MS
Chehab
Division of Pediatric Intensive Care, Department of Pediatrics, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
Hind Ali
HA
Bafaqih
Division of Pediatric Intensive Care, Department of Pediatrics, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
Sulaiman Abdulkareem
SA
AlMohaimeed
Intensive Care Unit and High Care Burn Unit, Ziekenhuis Netwerk Antwerpen, ZNA Stuivenberg, Antwerpen, Belgium.
Manu L N G
ML
Malbrain
D002648:Child; D002675:Child, Preschool; D003422:Critical Care; D016638:Critical Illness / Q000401:mortality* / Q000628:therapy; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D059325:Intra-Abdominal Hypertension / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy; D007902:Length of Stay; D008297:Male; D009102:Multiple Organ Failure / Q000401:mortality / Q000503:physiopathology / Q000517:prevention & control; D017410:Practice Guidelines as Topic; D011312:Pressure; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D012529:Saudi Arabia / Q000453:epidemiology; D016896:Treatment Outcome
abdominal compartment syndrome; abdominal hypertension; abdominal pressure; children; outcome; risk factors