title: Intra-abdominal hypertension; prevalence, incidence and outcomes in a low resource setting; a prospective observational study.
abstract: BACKGROUND
  Intra-abdominal hypertension (IAH) is defined as a sustained elevation in intra-abdominal pressure (IAP) greater than or equal to 12 mmHg. IAH has been shown to cause organ derangements and dysfunction in the body. Objective screening of IAH is neither done early enough nor at all thus leading to significant morbidity and mortality among surgical patients. The epidemiology and outcome of IAH among surgical patients has not been documented in Uganda. The aim of this study was to determine the prevalence, incidence and outcome of intra-abdominal hypertension among patients undergoing emergency laparotomy.
  
  
  METHODS
  Prospective observational study, conducted from January to April 2015 among patients undergoing emergency laparotomy. Inclusion criteria was; age >7 yrs, scheduled for emergency laparotomy, able to lie supine.
  
  
  METHODS
  pregnant, failed urethral catheterization, known cardiac, renal and respiratory disorders. Consecutive sampling was used. IAP, blood pressure, heart rate, respiratory rate, Sp02, Serum creatinine, Serum urea, and Urine output were measured preoperatively and postoperatively at 0, 6, 24 and 48 h. IAH was defined as IAP > 12 mmHg on three consecutive readings 3 min apart.
  
  
  RESULTS
  In total 192 patients were enrolled. Mean age ± SD was 14.25 (±3.16) yrs in the paediatrics and 34.4(±13.72) yrs in the adults with male preponderance 65 and 80.7 % respectively. The prevalence of IAH was 25 % paediatrics and 17.4 % adults and the cumulative incidence after surgery was 20 % paediatrics and 21 % adults. In paediatrics, IAH was associated with mortality at 0 h postoperatively, RRR = 1:24, 95 % CI (1.371-560.178), p-value 0.048. In adults, the statistically significant outcomes associated with IAH were respiratory system dysfunction RRR1:2.783, p-value 0.023, 95 % CI (1.148-6.744) preoperatively and mortality RRR 1:2.933, p-value 0.034, 95 % CI (1.017-8.464) at 6 h, RRR 1:3.769, p-value 0.033, 95 % CI (1.113-12.760) at 24 h postoperatively.
  
  
  CONCLUSIONS
  The prevalence and incidence of IAH in the paediatrics and adults group in our study population were high. IAH was associated with mortality in both adult and paediatrics groups and respiratory system dysfunction in adult group. This calls for objective monitoring of intraabdominal pressure in patients undergoing emergency laparotomy with the aim of reducing associated mortality.
authors.affiliation: Department of Surgery, College of Health Sciences, Makerere University, Mulago Hill road, P.O Box 7072, Kampala, Uganda East Africa ; Department of Surgery, School of Medicine, College of Health Sciences, Makerere University, P.O Box 7072 Kampala, Uganda.
authors.forename: Job
authors.initials: J
authors.lastname: Kuteesa
authors.affiliation: Department of Surgery, College of Health Sciences, Makerere University, Mulago Hill road, P.O Box 7072, Kampala, Uganda East Africa.
authors.forename: Olivia
authors.initials: O
authors.lastname: Kituuka
authors.affiliation: Department of Surgery, College of Health Sciences, Makerere University, Mulago Hill road, P.O Box 7072, Kampala, Uganda East Africa.
authors.forename: Dan
authors.initials: D
authors.lastname: Namuguzi
authors.affiliation: Department of Nursing, College of Health Sciences, Makerere University, Kampala, Uganda.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Ndikuno
authors.affiliation: Department of Surgery, College of Health Sciences, Makerere University, Mulago Hill road, P.O Box 7072, Kampala, Uganda East Africa.
authors.forename: Samuel
authors.initials: S
authors.lastname: Kirunda
authors.affiliation: Department of Paediatrics, College of Health Sciences, Makerere University, Kampala, Uganda.
authors.forename: David
authors.initials: D
authors.lastname: Mukunya
authors.affiliation: Department of Surgery, College of Health Sciences, Makerere University, Mulago Hill road, P.O Box 7072, Kampala, Uganda East Africa.
authors.forename: Moses
authors.initials: M
authors.lastname: Galukande
keywords: Emergency laparotomy; Intra-abdominal hypertension; Intra-abdominal pressure; Mortality