Analyzing intra-abdominal pressures and outcomes in patients undergoing laparotomy

Sharad Daga; Srinivas Yerrapragada; Amirineni Krishna Chowdary; G. Satyanarayana

doi:10.18203/2349-2902.isj20164043

Authors

Sharad Daga Department of Surgery, MBS Hospital and Medical College, Kota, Rajasthan, India
Srinivas Yerrapragada Department of General Surgery, Kamineni Academy of Medical Sciences and Research Centre, L. B. Nagar, Hyderabad, Telangana, India
Amirineni Krishna Chowdary Department of General Surgery, Kamineni Academy of Medical Sciences and Research Centre, L. B. Nagar, Hyderabad, Telangana, India
G. Satyanarayana Department of General Surgery, Kamineni Academy of Medical Sciences and Research Centre, L. B. Nagar, Hyderabad, Telangana, India

DOI:

https://doi.org/10.18203/2349-2902.isj20164043

Keywords:

Intra-abdominal pressure, Laparotomy, Abdominal compartment syndrome

Abstract

Background:Despite the abundance of knowledge, IAH still remains strangely under-diagnosed. A national postal questionnaire in United Kingdom reported that despite widespread awareness of IAH and the ACS, many intensive care units never measure the IAP. The aim was to evaluate the effects of intra-abdominal hypertension and to assess whether intra-abdominal pressure is a predictor of morbidity and mortality in patients undergoing laparotomy.

Methods: This was a prospective observational study conducted in Department of General Surgery, Kamineni Hospitals, L. B. Nagar, Hyderabad, India on patients undergoing emergency and elective laparotomy, over a period of 2 years from October 2012 to October 2014. The study included 51 patients who underwent laparotomy. IAP was measured preoperatively and then post-operatively at 0, 6, 24, 48 and 72 hours. If IAP remained below 12 mmHg, measurement was discontinued after 24 hours. Duration of ICU and hospital stay, occurrence of burst abdomen, new organ function damage, need for ventilatory support and mortality in patients undergoing laparotomy were noted as outcomes.

Results:At admission, an overall 65% incidence of intra-abdominal hypertension (IAH) was observed. In this group of 33 patients, CVS dysfunction was seen in 11 patients (33.3%), Respiratory dysfunction was seen in 9 patients (27.2%) and renal dysfunction was seen in 11 patients (33.3%). At 24 hours improvement was seen in all organ dysfunctions. Number of patients with CVS, respiratory and renal dysfunction in this group of 33 patients at 24 hours was 5 (15%), 4 (12%) and 6 (18%) respectively. This signifies that along with decrease in incidence of IAH, there is concomitant decrease in incidence of organ dysfunctions and morbidity.

Conclusions:Raised intra-abdominal pressure (IAP) is associated with higher morbidity and mortality in patients undergoing laparotomy. Intra-abdominal hypertension (IAH) has detrimental effect on various organ systems and decompression leads to improvement in all the parameters.

Metrics

Metrics Loading ...

References

Saggi BH, Sugerman HJ, Ivatury RR, Bloomfield GL. Abdominal compartment syndrome. J Trauma. 1998;45:597-609.

Mohapatra B. Abdominal compartment syndrome. Indian J Crit Care Med. 2004;8:26-32.

Malbrain ML, Cheatham ML, Kirkpatrick A, Sugrue M, Parr M, Waele DJ, et al. Results from the international conference of experts on intra-abdominal hypertension and abdominal compartment syndrome. Intensive Care Med. 2006;32:1722-32.

Shafik A, Sharkawy EA, Sharaf WM. Direct measurement of intra-abdominal pressure in various conditions. Eur J Surg. 1997;163:883-7.

Cleva R, Silva FP, Zilberstein B, Machado DJ. Acute renal failure due to abdominal compartment syndrome: report on four cases and literature review. Rev Hosp Clin Fac Med Sao Paulo. 2001;56:123-30.

Sugrue M, Bukhari Y. Intra-abdominal pressure and abdominal compartment syndrome in acute general surgery. World J Surg. 2009;33:1123-7.

Sugrue M, Buist MD, Hourihan F, Deane S, Bauman A, Hillman K. Prospective study of intra-abdominal hypertension and renal function after laparotomy. Br J Surg. 1995;82:235-8.

Esquis P, Consolo D, Magnin G, Pointaire P, Moretto P, Ynsa MD, et al. High intra-abdominal pressure enhances the penetration and antitumor effect of intraperitoneal cisplatin on experimental peritoneal carcinomatosis. Ann Surg. 2006;244:106-12.

Waele JJ, Hoste EA, Malbrain ML. Decompressive laparotomy for abdominal compartment syndrome--a critical analysis. Crit Care. 2006;10(2):51.

Esquis P, Consolo D, Magnin G, Pointaire P, Moretto P, Ynsa MD, et al. High intra-abdominal pressure enhances the penetration and antitumor effect of intraperitoneal cisplatin on experimental peritoneal carcinomatosis. Ann Surg. 2006;244:106-12.

Ravishankar N, Hunter J. Measurement of intra-abdominal pressure in intensive care units in the United Kingdom: a national postal questionnaire study. Br J Anaesth. 2005;94:763-6.

Hong JJ, Cohn SM, Perez JM. Prospective study of the incidence and outcome of intra-abdominal hypertension and the abdominal compartment syndrome. Br J Surg. 2002;89(5):591-6.

Meldrum DR, Moore FA, Moore EE. Prospective characterization and selective management of the abdominal compartment syndrome. Am J Surg. 1997;174:667-73.

Khan S, Verma AK, Ahmad SM. Analyzing intra-abdominal pressures and outcomes in patients undergoing emergency laparotomy. J Emerg Trauma Shock. 2010;3(4):318-25.

Cheatham ML, White MW, Sagraves SG, Johnson JL, Block EF. Abdominal perfusion pressure: a superior parameter in the assessment of intra-abdominal hypertension. J Trauma. 2000;49:621-7.

Cheatham ML, Malbrain ML, Kirkpatrick A, Sugrue M, Parr M, Waele J, et al. Results from the international conference of experts on intra-abdominal hypertension and abdominal compartment syndrome. Intensive Care Med. 2007;33:951-62.

Britt RC, Gannon T, Collins JN. Secondary abdominal compartment syndrome: risk factors and outcomes. Am Surg. 2005;7(11):982-5.