title: Intra abdominal hypertension; incidence, prevalence and outcomes in a mixed intensive care unit: Prospective cohort study.
abstract: BACKGROUND
  This study was conducted primarily to determine the prevalence and incidence of intra-abdominal hypertension (IAH) in a mixed ICU (medical & surgical) population and, secondarily, to compare outcomes between patients with and without IAH.
  
  
  METHODS
  The prospective cohort study was conducted from April to July 2011 on adult patients admitted in ICU, on mechanical ventilation and with an indwelling urinary catheter. Intra-vesicular pressure was measured. Primary endpoint was IAH and it was defined as Intra-abdominal pressure>12 mm Hg on two consecutive readings 6 h apart.
  
  
  RESULTS
  Total 83 patients were enrolled in the study; 61% from medical services and 39% from surgical services. Mean age in years±SD was 47 ± 17.5 with male preponderance (66%). IAH was detected in 23/83 (28%) at the time of admission, while six out of remaining 60 patients (10%) developed the condition during their ICU stay; the incidence and prevalence was 10% and 35%, respectively. Secondary end points of the study comparing outcomes between patients with and without IAH, though different in the two groups, did not achieve statistical significance. In-hospital mortality 65.5% vs. 44.4% p-value 0.054. New onset renal failure 34.5% vs. 16.7% p-value 0.054%. Difficulty in weaning from mechanical ventilation 37.9% vs. 25.9% p-value 0.008.
  
  
  CONCLUSIONS
  IAH is a poorly recognized clinical entity with potentially devastating impact on patient outcomes. Since majority of patients had IAH at the time of admission, all ICU patients especially on ventilator should have baseline intra-abdominal pressures measured at the time of admission and subjected to appropriate management to prevent them from developing abdominal compartment syndrome.
authors.affiliation: Patel Hospital, Gulshan-Iqbal, Karachi, Pakistan. Electronic address: gms786@gmail.com.
authors.forename: Ghulam
authors.initials: G
authors.lastname: Murtaza
authors.affiliation: The Aga Khan University Hospital, Karachi, Pakistan. Electronic address: inam.pal@aku.edu.
authors.forename: K M Inam
authors.initials: KM
authors.lastname: Pal
authors.affiliation: Department of Surgery, Emory University, Atlanta, GA 30322, United States. Electronic address: raheeljajja@gmail.com.
authors.forename: Mohammad Raheel Nawaz
authors.initials: MR
authors.lastname: Jajja
authors.affiliation: The Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Zunaira
authors.initials: Z
authors.lastname: Nawaz
authors.affiliation: The Aga Khan University Hospital, Karachi, Pakistan. Electronic address: reham.koondhar@aku.edu.
authors.forename: Reham
authors.initials: R
authors.lastname: Koondhar
authors.affiliation: The Aga Khan University Hospital, Karachi, Pakistan. Electronic address: sana.nasim@aku.edu.
authors.forename: Sana
authors.initials: S
authors.lastname: Nasim
mesh_terms: D034841:Abdominal Cavity / Q000503:physiopathology*; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D059325:Intra-Abdominal Hypertension / Q000453:epidemiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010154:Pakistan / Q000453:epidemiology; D011312:Pressure; D015995:Prevalence; D011446:Prospective Studies
keywords: Abdominal compartment syndrome; Acute renal failure; Intra-abdominal hypertension; Mortality