Prevalence And Predictors Of Intra-Abdominal Hypertension And Compartment syndrome In Surgical Patients In Critical Care Units At Kenyatta National Hospital

Abstract

Background 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.