Prevalence and Predictors of Intra-abdominal Hypertension and Compartmentsyndrome in Surgical Patients in Critical Care Units at Kenyatta National Hospital
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Date
2016Author
Mwihaki, Dr.Alex, M
Type
ThesisLanguage
enMetadata
Show full item recordAbstract
The harmful effects of intra-abdominal hypertension (IAH) have been documented on almost
every organ system. It may be under-diagnosed since it mainly affects patients who are
critically ill and whose organ dysfunction may be incorrectly attributed to progression of the
primary disease. The prevalence of IAH and abdominal compartment syndrome (ACS) at
Kenyatta National Hospital (KNH) is not known. In addition, no much attention is paid to the
problem and routine monitoring is not practiced in our critical care units (CCU).The purpose
of this study was to determine the prevalence and factors associated with development of
IAH/ACS among critically ill surgical patients.
Objective
The aim of this study was to determine the prevalence and possible predictors of IAH and
ACS among surgical patients in critical care units at Kenyatta National Hospital.
Materials and Methods
Design and setting
This was a cross sectional descriptive study involving surgical patients in critical care units
at Kenyatta National Hospital carried out over a duration of seven months from March 2015
to October 2015.
Patients
One hundred and thirteen critically ill and ventilated patients aged 13 years and above
admitted to various critical care units and with no contraindication to transvesicalintraabdominal
pressure measurements were recruited into the study.
Measurements
World society of abdominal compartment syndrome (WSACS) consensus guidelines 2013
criteria and Krohn’sintravesical method were used to measure and describe prevalence of
IAH and ACS. IAP was measured at first contact, then at 12 and at 24 hours. Additional
parameters recorded included: Base excess, serum bilirubin, total blood count, serum urea
xiv
and creatinine, urine output, vital signs, peak airway pressure and amount of resuscitation
fluid administered and fluid balance in 24 hr. as recorded in the patient’s input-output chart.
Results
A total of 113 consecutive surgical patients admitted to the critical care units were studied.
Demographic, clinical data, laboratory data and maximal (max) and mean intra-abdominal
pressure (IAP) were recorded. Frequency, means and standard deviation were used to
describe the data. With level of significance set at <0.005,categorical variables i.e. age,
gender and diagnosis categories were analyzed using Chi square test.Continous variables
were analyzed using student ‘t’ test and Mann Whitney test as appropriate. Of our study
population 71.7% (by IAP max) and 67.3 %( by IAP mean) had IAH. Abdominal
compartment syndrome (ACS) developed in 4.4% of the group. The following factors were
significant determinants of risk of IAH : amount of IV fluids over 24 hours(3949.6 vs.
2931.1,p=0.003 ,adjusted OR 1.0[1.0-1.002]),hemoglobin values at admission(9.9 vs. 12.0
,p=<0.012,adjusted OR 0.6[0.4-0.9])peak airway pressure(28.4 vs. 17.3 ;p=0.018,adjusted
OR 1.6[1.1-2.4])and synchronized intermittent mandatory ventilation(SIMV)(60 vs.
32;p=0.041,adjusted OR 1.4[ 0.78-2.04]).
Of those who had IAH, age, amount of IV fluids in 24 hours, fluid balance and ventilator
mode were significant determinants of risk of progression to ACS .
Conclusion
In Kenyatta National Hospital among critically ill surgical patients, the prevalence of
intraabdominal hypertension and abdominal compartment syndrome is high. Clinical
parameters pertaining to fluids administration and ventilator mode are significant
determinants.
Publisher
University of Nairobi
Rights
Attribution-NonCommercial-NoDerivs 3.0 United StatesUsage Rights
http://creativecommons.org/licenses/by-nc-nd/3.0/us/Collections
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